{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:39:18Z","timestamp":1789468758919,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"U.S. Centers for Disease Control and Prevention - The Center for Global Health","award":["NU2HGH000044"],"award-info":[{"award-number":["NU2HGH000044"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,22]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Studies on excess deaths (ED) show that reported deaths from COVID-19 underestimate death. To understand mortality for improved pandemic preparedness, we estimated ED directly and indirectly attributable to COVID-19 and ED by age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study using routinely reported individual deaths data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>The 21 health facilities in Bishkek that register all city deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Residents of Bishkek who died in the city from 2015 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measure<\/jats:title>\n                    <jats:p>We report weekly and cumulative ED by age, sex and causes of death for 2020. EDs are the difference between observed and expected deaths. Expected deaths were calculated using the historical average and the upper bound of the 95% CI from 2015 to 2019. We calculated the percentage of deaths above expected using the upper bound of the 95% CI of expected deaths. COVID-19 deaths were laboratory confirmed (U07.1) or probable (U07.2 or unspecified pneumonia).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 4660 deaths in 2020, we estimated 840\u20131042 ED (79\u201398 ED per 100\u2009000 people). Deaths were 22% greater than expected. EDs were greater for men (28%) than for women (20%). EDs were observed in all age groups, with the highest ED (43%) among people 65\u201374 years of age. Hospital deaths were 45% higher than expected. During peak mortality (1 July \u201321 July), weekly ED was 267% above expected, and ED by disease-specific cause of death were above expected: 193% for ischaemic heart diseases, 52% for cerebrovascular diseases and 421% for lower respiratory diseases. COVID-19 was directly attributable to 69% of ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Deaths directly and indirectly associated with the COVID-19 pandemic were markedly higher than reported, especially for older populations, in hospital settings, and during peak weeks of SARS-CoV-2 transmission. These ED estimates can support efforts to prioritise support for persons at greatest risk of dying during surges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-069521","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T21:56:53Z","timestamp":1689112613000},"page":"e069521","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Excess deaths directly and indirectly attributable to COVID-19 using routinely reported mortality data, Bishkek, Kyrgyzstan, 2020: a cross-sectional study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0514-5108","authenticated-orcid":false,"given":"Yekaterina","family":"Bumburidi","sequence":"first","affiliation":[{"name":"Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Altynai","family":"Dzhalimbekova","sequence":"additional","affiliation":[{"name":"Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Malisheva","sequence":"additional","affiliation":[{"name":"Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan"},{"name":"Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald L","family":"Moolenaar","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Horth","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan"},{"name":"Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Singer","sequence":"additional","affiliation":[{"name":"Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinagul","family":"Otorbaeva","sequence":"additional","affiliation":[{"name":"Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"2025120520113688000_13.7.e069521.1","unstructured":"The Centre for Evidence-Based Medicine . 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