Introduction: COVID-19 has raised world concern since it emerged in Wuhan, China in December 2019. The direct and indirect death rates in the world and in Iran have increased significantly after the occurrence of this pandemic in the world.
Objective: In this study EMR estimated by Multilevel Poison Regression then this estimation compared to the historical trends, to obtain total death related to the COVID-19 in addtion the geographic distribution of EMR has been presented for Iran country.
Materials and Methods: All-cause mortality count of each province of Iran from March 21, 2013 to June 20, 2020 downloaded from National Organizationfor Civil Registration (NOCR). The data from spring of 2020 (March 20, 2020 to June 20, 2020) remove from data and then the multilevel poison model has been used to estimate all-cause mortality in spring 2020 then excess mortality attributable to COVID-19 (the difference between the numberof registered and expected deaths) has been calculated.
Results: The results of this study showed that Iran’s EMR in spring 2020 was 23% (Male=25%, Female=21%). More result also showed that four category low (EMR≤5%, n=3), moderate (5 %< EMR<20%, n=10), high (20 %< EMR<40%, n=16) and very high (40≤EMR, n=2) EMR.
Conclusion: Due to the diverse EMR in different provinces of Iran, the type of management of provinces with low and moderate EMR can be used as a suitable model to control EMR in provinces with high and very high EMR.
- WHO characterizes COVID-19 as a pandemic WHO.Available at: URL:https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen; 2020.
- WHO. Coronavirus disease (COVID-19) pandemic Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAiA8Jf-BRB-EiwAWDtEGnT5aEuG4ks8f8z7dtHGUcjaM39WLnJ7x3mIhCI7qpdwCot2ITMuOxoCrgkQAvD_BwE; 2020.
- Tadbiri H, Moradi-Lakeh M, Naghavi M. All-cause excess mortality and COVID-19-related deaths in Iran. MJIRI. 2020;34(1):561-6. doi: 10.47176/mjiri.34.80.
- Goldstein ND, Burstyn I. On the importance of early testing even when imperfect in a pandemic such as COVID-19. Glob Epidemiol. 2020;2:100031-. doi: 10.1016/j.gloepi.2020.100031. PMID: 32995744.
- Kandel N, Chungong S, Omaar A, Xing J. Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries. Lancet. 2020;395(10229):1047-53. doi: 10.1016/S0140-6736(20)30553-5 . PMID: 32199075.
- Zainol Rashid Z, Othman SN, Abdul Samat MN, Ali UK, Wong KK. Diagnostic performance of COVID-19 serology assays. Malays J Pathol. 2020;42(1):13-21. PMID: 32342927.
- National Organization for Civil Registration (NOCR). Registered Deaths by Province by Sex. Tehran, Iran: 2020 Available from: https://www.sabteahval.ir/avej/Page.aspx?mId=49826&ID=2182&Page=Magazines/SquareshowMagazine; 2020.
- Leon DA, Shkolnikov VM, Smeeth L, Magnus P, Pechholdová M, Jarvis CI, et al. COVID-19: a need for real-time monitoring of weekly excess deaths. Lancet. 2020;395(10234):e81-e. doi: 10.1016/S0140-6736(20)30933-8 . PMID: 32333839.
- Fesharaki MG, Kazemnejad A, Zayeri F, Sanati J, Akbari H. Historical cohort study on the factors affecting blood pressure in workers of polyacryl iran corporation using bayesian multilevel modeling with skew T distribution. Iranian Red Crescent Medical Journal. 2013;15(5):418. doi: 10.5812/ircmj.10930.
- Snijders TA, Bosker RJ. Multilevel analysis: An introduction to basic and advanced multilevel modeling: Sage. 2011.
- Goldstein H. Handbook of Multilevel Analysis. New York: Springer. 2008.
- Polyakova M, Kocks G, Udalova V, Finkelstein A. Initial economic damage from the COVID-19 pandemic in the United States is more widespread across ages and geographies than initial mortality impacts. Proc Natl Acad Sci U S A. 2020;117(45):27934-9. doi: 10.1073/pnas.2014279117.
- Blangiardo M, Cameletti M, Pirani M, Corsetti G, Battaglini M, Baio G. Estimating weekly excess mortality at sub-national level in Italy during the COVID-19 pandemic. PloS one. 2020;15(10). doi: :10.1371/journal.pone.0240286.
- Freitas ARR, Medeiros NMd, Frutuoso LCV, Beckedorff OA, Martin LMAd, Coelho MMdM, et al. Tracking excess deaths associated with the COVID-19 epidemic as an epidemiological surveillance strategy-preliminary results of the evaluation of six Brazilian capitals. Rev Soc Bras Med Trop. 2020;53:e20200558-e. doi: 10.1590/0037-8682-0558-2020.
- Strang P, Fürst P, Schultz T. Excess deaths from COVID-19 correlate with age and socio-economic status. A database study in the Stockholm region. Ups J Med Sci. 2020;125(4):297-304. doi: 10.1080/03009734.2020.1828513 . PMID: 33100083.
- Michelozzi P, de'Donato F, Scortichini M, Pezzotti P, Stafoggia M, De Sario M, et al. Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities. BMC Public Health. 2020;20(1):1238-.
- Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess Deaths From COVID-19 and Other Causes, March-April 2020. Jama. 2020;324(5):510-3. doi: 10.1001/jama.2020.11787.
- Weinberger DM, Chen J, Cohen T, Crawford FW, Mostashari F, Olson D, et al. Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020. JAMA Intern Med. 2020;180(10):1336-44. doi: 10.1001/jamainternmed.2020.3391.
- Vieira A, Peixoto VR, Aguiar P, Abrantes A. Rapid Estimation of Excess Mortality during the COVID-19 Pandemic in Portugal -Beyond Reported Deaths. J Epidemiol Glob Health. 2020;10(3):209-13.
- Chinazzi M, Davis JT, Ajelli M, Gioannini C, Litvinova M, Merler S, et al. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science. 2020;368(6489):395-400. doi: 10.1126/science.aba9757.
- Gostic K, Gomez AC, Mummah RO, Kucharski AJ, Lloyd-Smith JO. Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19. Elife. 2020;24(9):55570. doi: 10.7554/eLife.55570 . PMID: 32091395.
- Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. Int J Surg. 2020;78:185-93. doi: 10.1016/j.ijsu.2020.04.018. PMID: 32305533
- Bashir MF, Ma B, Bilal, Komal B, Bashir MA, Tan D, et al. Correlation between climate indicators and COVID-19 pandemic in New York, USA. Sci Total Environ. 2020;728(138835):20. doi: 10.1016/j.scitotenv.2020.138835 . PMID: 32334162.
- Li H, Xu XL, Dai DW, Huang ZY, Ma Z, Guan YJ, et al. Air pollution and temperature are associated with increased COVID-19 incidence: A time series study. Int J Infect Dis. 2020;97:278-82. doi: 10.1016/j.ijid.2020.05.076. PMID: 32502664.
- Zhang X, Tang M, Guo F, Wei F, Yu Z, Gao K, et al. Associations between air pollution and COVID-19 epidemic during quarantine period in China. Environ Pollut. 2020;268(Pt A):115897. doi: 10.1016/j.envpol.2020.115897. PMID: 33126032.