Today we are living in a situation of extreme confusion regarding the information on mortality in Chile. Statistics on deaths in the time of the pandemic have become arid and leads people to doubt the figures that have been delivered in the months through the relevant public bodies.
Knowing the mortality levels of a country or region is part of demographics, the discipline that studies human populations including their size, composition, distribution, density, growth and other related, social and economic characteristics. Demographic dynamics are composed of birth rate, mortality and migrations, changes that affect the size, composition and spatial distribution of the population. One of the relevant fields of demographics is population projections. With this data, different countries can adapt public policies based on the transformations expected to occur in the years ahead.
So far a very short definition of demographics, which partly requires knowledge of statistical techniques, as well as sociological and economic aspects to gain a better understanding of the variations that occur in the population of a given territory.
What happens in Chile: based on the INE, 2018 – population estimates and projections 1992-2050 – today we are 19.5 million inhabitants, including 8% of immigrants. Life expectancy at birth is 80 years. Women live 5.3 years longer than men. The overall fertility rate (children per woman of reproductive age) is below the replacement level and is now 1.7. The population growth rate stands at a lean 1%. Adults over the age of 65 are 12% of the population and it is projected that by 2050 it will be 25%, that is, 1 in 4 Chileans by mid-century will be over 65 years old. However, it’s not just that. The over-80s, an important group in which the highest rates of functional dependence and needing care, whether family or by the state, appear, will grow from almost 3% today to 10% by 2050.
Today, everyone’s attention is placed on one of the branches of demographics, which is mortality. Demographic data has always needed the rest necessary for proper analysis, so a review of pandemic numbers perhaps allows us to avoid hasty reflections on the impact of the pandemic on overall mortality, death count and ways of making comparisons, uncertain and changing due to contingency.
First it should be made clear that the comparison of the number of deaths from one year to another, based on some previous year or an average of previous years, may serve as a reference but it is not a good point of comparison, since there is distortion by the size and composition of the population, in particular the age structure. The mortality rate varies for that reason.
In the Chilean case, deaths in 2015 were 106,076 people with a mortality rate of 5.9 per thousand. In 2019, there were 114,655 deaths with a mortality rate of 6.0 per thousand. The average number of deaths between 2015 – 2019 was 110,197 people (INE, 2018).
However, the deaths projected by 2020 by the INE show a total of 117,050 people (an average of 320 deaths each day) with a mortality rate of 6 per thousand. Why is it important to consider this rate and that estimate of deaths? For a very simple reason: the aforementioned demographic aspects are incorporated that make it possible to compare the reality of deaths up to this point. This is how you can review the excess mortality caused by the current pandemic.
Between January and mid-June, according to data from the Civil Registry 2000-2012, there are 43.6% of deaths in our country. By the same way, until 15 June, the estimate would show a total of 51,034 deaths proportionally.
According to information on the Website of the Civil Registry, between January 1 and June 15, 2020 the number of deaths registered is 53,476. A difference of 2,442 people; 4.8% more than estimated. That is from a demographic point of view the difference between projected deaths and deaths inscribed in this year’s. This can be considered excess mortality during the time that goes this year, probably a result of the impact of COVID-19.
We have also revised the figures for March (start of COVID-19) until 15 June. In those three and a half months, 28.6% of the year’s deaths occur, yielding an estimate of 33,476. In the Civil Registry, during the same period, 36,626 deaths were recorded. That is, the difference in death above the projection would be 3,150 people; I mean, 9.4% more. This figure does not differ substantially from the number of COVID-19 deaths indicated by the health authority: to this date 3,383 people.
These statistics show us overall the demographic effect on pandemic mortality until mid-June. If we assume that the total excess deaths are due to COVID-19 – probable matter, but not yet determined – there is no evidence of an underestimation of total deaths. We will have to wait a longer time to know the changes in the distribution of causes of deaths for reasons of alterations in daily life (e.g. dilation in consultations or treatments for other diseases) and possibly also the shortening of life time in older adults with chronic or other diseases of high complexity.
However, in population age group deaths, 62% of deaths in Chile under normal conditions occur in people over 70 years of age. Pandemic mortality figures (data from 9 April to 31 May) show that 65% of deaths have been in people over 70, a difference of only 3 percentage points.
The figures delivered respond to a review of the official sources available to the Chilean State. In fact, this analysis does not make it into dissensures regarding the nomination of causes of death on death certificates. Responsibility for this complex purification process lies with the Department of Statistics and Information (DEIS) of the Ministry of Health and may take even a year. The new guidelines in this regard point to the reduction of these deadlines for reasons of need to know as much detail as possible the causes of death in the midst of the pandemic.
These certificates must record the immediate cause of death, the intermediate and the basic. A change in consideration in any of them is sufficient for the proportions of death to change for a particular cause. The last document we have for review of causes of deaths dates back to Minsal 2019 and presents figures from 2016. The three main causes are tumors (neoplasms), 26.1%; diseases of the circulatory system, 27.1%, and diseases of the respiratory system, 9.5%.
In the specific case of death associated with COVID-19, as it is currently a high sensitivity information, it should be analyzed and annotated with special care. In fact, Minsal believes that up to 25% of causes of death could have changes in the code of the basic cause of death by the annual quality review process, which includes the improvement and specification of these causes by crossing with other sources of information.
Undoubtedly, the clarification of the data associated with coronavirus deaths can give us more tools to better deal with this pandemic and other possible in the future. It is also clear that contagions in our country are linked to sociodemographic determinants such as multidimensional poverty, which reaches 2 in 10 Chileans, and in particular the overcrowding factor that lives in some communes and neighborhoods of our capital and other areas of the country.
We have confronted the pandemic with the human, material and social organization resources we have built throughout our history. Goodness and lack should serve us to enhance what we have seen as positive – in my view, the extraordinary response of the health system and all health officials – and the negative – a state which clearly suffers from a lack of appropriate public health policies to deal with a pandemic of this magnitude. This deficit aspect, we must admit, has been common in countries that have been much more developed than ours.
The role of citizenship has been erratic. We have been able to witness significant degrees of disconnection of sectors of the population from the scale of the problem. It is inescapable task for authorities, media and professionals in general to strengthen communication capacity in crisis. This has had a level of improvisation that has not helped to improve the situation, as the messages have been confusing, adorned with too many technicalities and in many cases alarmist with no sense of social responsibility.
The demographic impact on pandemic mortality will need to be seen by the end of the year with all the information in sight and properly purged by the relevant public bodies.
So far our performance is mediocre. Our mortality rate per million inhabitants is 174. In South America it is only surpassed by Ecuador, 222; Brazil and Peru with 205. Far from U.S. mortality rates, 355; Canada, 214, and European countries, where they have already begun the process of deconfunding and safe return to economic and social activities, such as the United Kingdom, 620; Spain, 575; Italy, 569; and France, 453, to name a few (these data have been provided by the Commercial Ening Carlos Aparicio).
Finally, the call is to caution with the management of demographic data associated with mortality, as it is a very complex area of knowledge and requires extensive knowledge and experience. Short-term data analysis is not a good advisor. This view can confuse and generate hasty opinions that do not contribute to an effective sizing of the health crisis and generate unnecessary alarm. It is also necessary to rely – with critical attention indeed – on the technical bodies of the Chilean State. These are, for this very case, the Civil Registry, the DEIS, the Ministry of Health and the National Institute of Statistics.
We are in the midst of a serious global public health event, in particular because of the high number of contagions, its rapid spread, its high lethality in older adults and the high hospitalization requirements it has brought with it. Likewise, its effects on work and income, mental health due to confinement and hopelessness, as well as the interruption of the much-needed daily community activities. Therefore, to dispose and deliver to the correct and thoughtful public information is an essential matter that entails high responsibility on the part of all actors, in particular public authorities, politicians and media professionals, among others.
The content poured into this opinion column is the sole responsibility of its author, and does not necessarily reflect the editorial line or position of El Mostrador.