The number of excess deaths due to COVID-19 was largest in the regions of south Asia, north Africa and the Middle East, and eastern Europe. The global all-age rate of excess mortality due to the COVID-19 pandemic was 120♳ deaths (113♱–129♳) per 100 000 of the population, and excess mortality rate exceeded 300 deaths per 100 000 of the population in 21 countries. FindingsĪlthough reported COVID-19 deaths between Jan 1, 2020, and Dec 31, 2021, totalled 5♹4 million worldwide, we estimate that 18♲ million (95% uncertainty interval 17♱–19♶) people died worldwide because of the COVID-19 pandemic (as measured by excess mortality) over that period. Out-of-sample predictive validity testing was done on the basis of our final model specification. Mean values and 95% uncertainty intervals were then generated at national, regional, and global levels. With the selected best model, we ran a prediction process using 100 draws for each covariate and 100 draws of estimated coefficients and residuals, estimated from the regressions run at the draw level using draw-level input data on both excess mortality and covariates. We used least absolute shrinkage and selection operator (LASSO) regression as a variable selection mechanism and selected 15 covariates, including both covariates pertaining to the COVID-19 pandemic, such as seroprevalence, and to background population health metrics, such as the Healthcare Access and Quality Index, with direction of effects on excess mortality concordant with a meta-analysis by the US Centers for Disease Control and Prevention. As mortality records are incomplete worldwide, we built a statistical model that predicted the excess mortality rate for locations and periods where all-cause mortality data were not available.

Ensemble weights were based on root mean squared errors derived from an out-of-sample predictive validity test.

Six models were used to estimate expected mortality final estimates of expected mortality were based on an ensemble of these models. Excess mortality over time was calculated as observed mortality, after excluding data from periods affected by late registration and anomalies such as heat waves, minus expected mortality. In addition, we obtained excess mortality data for 12 states in India. The Lancet Regional Health – Western PacificĪll-cause mortality reports were collected for 74 countries and territories and 266 subnational locations (including 31 locations in low-income and middle-income countries) that had reported either weekly or monthly deaths from all causes during the pandemic in 20, and for up to 11 year previously.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.

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