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Results During the 4-year period of —, mean weekly all-cause mortality varied between 3, and 2, in Hungary Figure 1with higher numbers in the early weeks of the year and in the fourth quarter Q4, highest number: prostate cancer review article 2021, deaths in week 5,and lower mid-year numbers lowest number: 2, deaths, week 28, In the first 11 weeks ofweekly mortality was lower compared to the — average of the same period difference was not significant Supplementary Table S1while there were no relevant differences from week 12 to week On the other hand, the number of weekly deaths exceeded the average of the preceding 4 years starting from week Between weeks 42 and 52, significantly higher weekly mortality was recorded in Hungary than in the reference period of — Cumulative all-cause excess mortality was lower until week 44 inthan the mean cumulative excess mortality of the — period Figure 2corresponding to fewer Hungarian deaths from week 1 to 44 in than in the previous 4 prostate cancer review article 2021.
Excess mortality was - 1.
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Cumulative all-cause excess mortality in Hungary by weeks in compared to averages from the reference period — On the other hand, no excess mortality was detectable in Central and Eastern, Balkan, and Baltic EU countries including the V4 country group during this period. Weekly cumulative excess mortality in in Hungary compared to European regions. In Hungary, age-standardized cumulative excess mortality perpersons was also lower in the first 45 weeks of compared to — averages.
The lowest value was detected in week 36 with - No significant differences were observed compared to the previous 4 years until week 52, after which age-standardized excess mortality significantly exceeded the upper predictive curve of the preceding 4-year period until the end of the year Figure 4 and Supplementary Table S1.
Hungarian age-standardized cumulative excess mortality in by weeks perpersons colored weeks are reference points for Figure 6. Figure 5 shows the age-standardized cumulative excess mortality curve of Hungary in compared with neighboring European countries with Germany and Spain as reference.
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All countries in this region had mortality deficit in the first half of the year, with significant increases in excess mortality during the autumn-winter period of the pandemic.
Hungary had substantially higher age-standardized excess mortality by week 52, than Germany, nearly the same as Austria, Slovakia and Croatia, but lower than the Czech Republic, Slovenia and Romania. Poland and Bulgaria accumulated more than twice as much excess mortality as Hungary Supplementary Table S3. Age-standardized weekly cumulative excess mortality in in Hungary compared to selected, neighboring European countries prostate cancer review article 2021.
Figure 6 illustrates the dynamics of the pandemic by comparing age-standardized cumulative excess mortality of assessed European countries at the end of each quarter of weeks 13, 26, 39, and 52and highlighting the latest available weekly cumulative values from 44 separately for each country. There was no age-standardized excess mortality in EU countries in Q1 ofexcept for Spain and Italy where In certain countries including Spain, the United Kingdom, Belgium, the Netherlands, and Sweden, significant increases in excess mortality were recorded in Q2 increases: In Q3, only Romania and Portugal recorded more than 20 deaths perpersons, corresponding to Age-standardized weekly cumulative excess mortality of European countries in at week 13th, 26th, 39th, and 52th perpersons in case of United Kingdom, Italy and Greece, latest available week is highlighted in gray at countries name.
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Bulgaria reported the highest increase in age-standardized, cumulative excess mortality At the end ofHungary reported The number of recorded Covid related deaths and total excess deaths, as well as the ratio of COVID related mortality and total excess mortality in European countries and regions in are shown in Supplementary Table S4.
In most Central and Eastern Prostate cancer review article 2021 countries, Covid related deaths accounted for less than two thirds of total excess deaths Slovakia: In Hungary, the number of cumulative excess deaths at week 52 was 9, and 9, reported COVID related prostate cancer review article 2021 occurred Discussion This analysis examined excess mortality in Hungary in compared to the preceding 4 years in view of the COVID pandemic and compared findings to other European countries.
The results show that despite the first wave of the COVID pandemic, Hungary had prostate cancer review article 2021 all-cause mortality in the first half of compared to the average of the preceding 4 years. However, cumulative excess mortality increased to 7.
Based on the findings of the current analysis, European countries can be classified based on the dynamics of excess mortality throughout the pandemic. Several Western, Benelux and Mediterranean European countries including Spain, Belgium, Italy, Sweden, France, Austria and the United Kingdom experienced high mortality toll with excess mortality during the first wave in springwhich further increased during the second wave after a mid-year plateau.
This was also the situation in most Baltic countries, except for Lithuania. The heterogeneous mortality effects of the Covid pandemic may be explained by several factors.
Substantial excess mortality during the first wave may be attributed to delays in restrictions or lenient policies and the lack of experience with Covid treatment [ 15 ]. Limited hospital capacity, overwhelmed intensive care units and staff shortages may also have contributed to the excess mortality [ 16 ]. Furthermore, poor adherence to Covid restrictions and social distancing measures as well as loosening restrictions for economic recovery in these countries may have played a part in the further increase of excess mortality during the second wave [ 17 ].
In addition, recent data from the United Kingdom suggest that a substantial proportion of excess mortality in the second half of may have derived from long-term complications of the first wave leading to hospital readmissions and deaths [ 18 ].
Finally, we cannot exclude the role of emerging new coronavirus variants in the excess mortality of the second half of [ 19 ].
The lack of excess mortality during the first half of compared to — in certain countries can most likely be attributed to the timely introduction of restrictions and social distancing measures in spring [ 20 ]. Hungary was among the countries that acted very early prostate cancer review article 2021 terms prostate cancer review article 2021 movement restrictions and lockdowns, and thus managed to keep the number of COVID cases at such low levels that allowed for the identification and isolation of cases as well as efficient contact tracing [ 2122 ].
Restrictions and social distancing measures including the absence of major public events resulted in a less severe influenza season and reduced the spread of other infectious diseases such as pneumococcal pneumonia as well as the number of traffic accident fatalities [ 23 ]. Furthermore, the population in post-socialist Eastern European countries may have been more disciplined in respecting the instructions of self-isolation and confinement and took the coronavirus threat more seriously.
Therefore, their populations were less severely affected by the first wave, than that of Western European countries, and not even the limited capacity of healthcare facilities resulted in an increase in mortality. The high-risk populations of these countries were spared during the first wave and were still alive when the second wave reached them, primarily spreading from the younger generations, which explains the sudden and significant mortality surge in the second half of observed in these countries [ 2425 ].
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However, in some Baltic and Scandinavian countries, available cumulative mortality numbers did not show relevant excess mortality duringmost probably due to timely restrictions and higher healthcare expenditure per capita compared to other European countries [ 26 ]. While Hungary was ranked among firsts in the number of reported COVID prostate anatomy ct scan death per 1 million inhabitants based on Eurometer database first of Janthere was no relevant difference between reported COVID and total excess mortality A possible explanation for this result is the different methodology in COVID related death reports as well as that a relevant proportion of patients may have died in their homes and hence were not registered in the system as COVID related deaths.
Furthermore, the pandemic may have indirect effects on mortality. Cumulative excess mortality is a general aspect about the impact of the pandemic which helps adjust for differences in COVID related death reporting methodology and calculations.
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Relevant differences in the ratio of reported Covid related mortality and total excess mortality revealed in our study confirm the benefit of excess mortality calculations for cross-country comparisons of the COVID burden. Especially as some of the countries reports those whom died and had a positive COVID test at the same period, some others report a death as COVID related only if was the confirmed by clinical diagnosis, yet again others confirmed a death as COVID related, if the patient did not have any other severe comorbidity.
In addition, in our excess mortality calculations forcountries served as their own control groups for assessing scale of COVID impact, adjusting for cross-country differences in mortality risks which derive from differences in health policies and health literacy over the prostate cancer review article 2021 decades as seen in Supplementary Table S5. There are differences in the age distribution of European countries, and within-country changes in age distribution may also have occurred in compared to the previous years.
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Therefore, age-standardized excess mortality is a useful tool for comparing the impact of the pandemic on different countries and regions. Furthermore, the calculation of cumulative excess mortality allows for cross-country comparisons even if annual data are incomplete prostate cancer review article 2021 certain countries. Early and standardized cross-country comparisons provide a reliable basis for the evaluation of the impact of restrictions and the response of healthcare systems for the COVID pandemic.
It is important to consider that the reported numbers of weekly mortality may be re-validated over time, and later reports may change final results.
There may be weeks of even months between death events and mortality data due to delays in reporting.
Nevertheless, timely cross-country comparisons of the impact of the COVID pandemic on mortality may aid governments in fast decision-making during challenging times. Finally, since EUROSTAT has not reported the age distribution of the population from for all European countries yet, hence our calculations for age standardization in were based on populations fromwhich may have influenced the results in certain countries when population data will be available.
Conclusion During the first half ofHungary had a mortality deficit compared to the previous 4 years as a result of restrictions and social distancing measures implemented during the COVID pandemic.
Following the low amplitude of the first wave in springa significant proportion of the population were infected during the second wave in autumn, which eventually resulted in a cumulative excess mortality of 7.
However, the excess was lower than in neighboring countries with similar dynamics of the pandemic, and lower, than that of countries with more intense first and second waves.
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The observed differences in the dynamics of the pandemic underline the importance of taking into account the whole year of instead of separate waves when making cross-country comparisons.
As long as annual excess mortality data are not available, cumulative weekly or monthly excess mortality should be calculated for the analysis of COVID waves in different countries. The calculation of cumulative excess mortality provides valuable insights into cross-country differences in the dynamics of the pandemic and may serve as a basis for evaluating the effectiveness and timeliness of restrictions and responses to this unprecedented global crisis.
JM was supported by the Hungarian Brain research Program grant Zsófia Barcza is employee of Syntesia Ltd. References 1. Rapid Risk Assessment: outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update — 22 January Stockholm: ECDC