Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jul 27, 2021
Date Accepted: Jan 6, 2022
Date Submitted to PubMed: Jan 17, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Robust and Timely Estimation of Excess Mortality: Statistical Analysis of Cremation Data During the COVID-19 Pandemic
ABSTRACT
Background:
Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating timely mortality data that encompasses the majority of deaths within the province.
Objective:
Our objectives were to (1) validate the ability of cremation data in permitting real-time estimation of excess all-cause mortality, interim of vital statistics data, and (2) describe the patterns of excess mortality.
Methods:
Cremation records from January 2020 until April 2021 were compared to the historical records from 2017-2019, grouped according to week, age, sex, and COVID-19 status. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years to determine whether there was excess mortality and if so, which age groups had the greatest number of excess deaths during the COVID Pandemic, and whether deaths attributed to COVID-19 account for the entirety of the excess mortality.
Results:
Between 2017-2019, cremations were performed for 67.4% (95% CI: 67.3–67.5%) of deaths; the proportion of cremated deaths remained stable throughout 2020, establishing that the COVID-19 pandemic did not significantly alter cremation practices, even within age and sex categories. During the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI: 14.6–19.3%) in mortality. The accuracy of this excess mortality estimation was later confirmed by vital statistics data.
Conclusions:
The stability in the percent of Ontarians cremated and the completion of cremation data several months before vital statistics data, enables accurate estimation of all-causes mortality in near real-time with cremation data. These findings demonstrate the utility of cremation data to provide timely mortality information during public health emergencies.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.