tetano
Editor, Senior Moderator
Public Health Rep
. 2021 Feb 17;33354921991521.
doi: 10.1177/0033354921991521. Online ahead of print.
Estimating and Characterizing COVID-19 Deaths, Puerto Rico, March-July 2020
Alejandro Azofeifa[SUP] 1 [/SUP], Diana Valencia[SUP] 1 [/SUP], Carmen J Rodriguez[SUP] 2 [/SUP], Maritza Cruz[SUP] 2 [/SUP], Devin Hayes[SUP] 1 [/SUP], Ed?n Monta?ez-B?ez[SUP] 2 [/SUP], Betzaida Tejada-Vera[SUP] 1 [/SUP], Joshua E Villafa?e-Delgado[SUP] 2 [/SUP], Jessica J Cabrera[SUP] 2 [/SUP], Miguel Valencia-Prado[SUP] 2 [/SUP]
Affiliations
Abstract
Objectives: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.
Methods: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.
Results: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported.
Conclusions: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.
Keywords: COVID-19; Puerto Rico; excess deaths; mortality; surveillance.
. 2021 Feb 17;33354921991521.
doi: 10.1177/0033354921991521. Online ahead of print.
Estimating and Characterizing COVID-19 Deaths, Puerto Rico, March-July 2020
Alejandro Azofeifa[SUP] 1 [/SUP], Diana Valencia[SUP] 1 [/SUP], Carmen J Rodriguez[SUP] 2 [/SUP], Maritza Cruz[SUP] 2 [/SUP], Devin Hayes[SUP] 1 [/SUP], Ed?n Monta?ez-B?ez[SUP] 2 [/SUP], Betzaida Tejada-Vera[SUP] 1 [/SUP], Joshua E Villafa?e-Delgado[SUP] 2 [/SUP], Jessica J Cabrera[SUP] 2 [/SUP], Miguel Valencia-Prado[SUP] 2 [/SUP]
Affiliations
- PMID: 33596136
- DOI: 10.1177/0033354921991521
Abstract
Objectives: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.
Methods: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.
Results: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported.
Conclusions: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.
Keywords: COVID-19; Puerto Rico; excess deaths; mortality; surveillance.