{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:55:12Z","timestamp":1789685712524,"version":"4.0.1"},"reference-count":25,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T00:00:00Z","timestamp":1717804800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,1,25]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background and aim<\/jats:title>\n                  <jats:p>Increased mortality during the COVID-19 pandemic is not explained exclusively by COVID-19 infection and its complications. We analysed non-COVID-19 causes of mortality in a population analysis based on data from the Spanish National Institute of Statistics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using monthly mortality data in Spain (January 2010\u2013December 2020), we analysed deaths associated with cancer, blood, endocrine, mental, nervous, cardiovascular, respiratory and digestive diseases and explored the COVID-19 impact using a difference-in-difference strategy. We calculated monthly interannual variations in mortality and computed percentage change in terms of the log of deaths in month <jats:italic>h<\/jats:italic> of year <jats:italic>t<\/jats:italic> minus the log of deaths in month <jats:italic>h<\/jats:italic> in the previous year <jats:italic>t\u22121<\/jats:italic>.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2020 in Spain, mortality increased 17.9% compared with 2019. COVID-19 was the leading cause of death (n=60\u2009358), followed by ischaemic heart disease (n=29\u2009654). Throughout 2020, monthly interannual variations in cardiovascular mortality showed an average upward trend of 1.7%, while digestive, cancer and blood diseases showed a downward trend.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>During the COVID-19 pandemic in Spain in 2020, excess mortality was primarily related to cardiovascular mortality while mortality associated with digestive, cancer and blood diseases was reduced.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002568","type":"journal-article","created":{"date-parts":[[2024,6,8]],"date-time":"2024-06-08T06:30:13Z","timestamp":1717828213000},"page":"e002568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Population-based disease-group analysis of Spanish excess mortality in the early COVID-19 pandemic period"],"prefix":"10.1136","volume":"11","author":[{"given":"Francisco","family":"Reyes-Santias","sequence":"first","affiliation":[{"name":"University of Vigo, Vigo, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares, Madrid, Spain"},{"name":"IDIS, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Reboredo-Nogueira","sequence":"additional","affiliation":[{"name":"University of Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Maria","family":"Garcia-Alvarez","sequence":"additional","affiliation":[{"name":"Preventive Medicine Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4486-2820","authenticated-orcid":false,"given":"Sergio","family":"Cinza-Sanjurjo","sequence":"additional","affiliation":[{"name":"IDIS, Santiago de Compostela, Spain"},{"name":"Primary Care, CS Milladoiro, SERGAS, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Ramon","family":"Gonzalez Juanatey","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares, Madrid, Spain"},{"name":"IDIS, Santiago de Compostela, Spain"},{"name":"Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,8]]},"reference":[{"key":"2025081709533504000_11.1.e002568.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"2025081709533504000_11.1.e002568.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"2025081709533504000_11.1.e002568.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-06536-3","article-title":"Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients","volume":"21","author":"Dessie","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2025081709533504000_11.1.e002568.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m1554","article-title":"Covid-19: the precarious position of Spain\u2019s nursing homes","volume":"369","author":"Rada","year":"2020","journal-title":"BMJ"},{"key":"2025081709533504000_11.1.e002568.5","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)02796-3"},{"key":"2025081709533504000_11.1.e002568.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0252441","article-title":"The impact of COVID-19 on hospital admissions and emergency department visits: a population-based study","volume":"16","author":"Rennert-May","year":"2021","journal-title":"PLoS One"},{"key":"2025081709533504000_11.1.e002568.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-020-01780-0"},{"key":"2025081709533504000_11.1.e002568.8","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.recesp.2020.09.022","article-title":"Infartos en tiempos de la COVID-19","volume":"73","author":"Ib\u00e1\u00f1ez","year":"2020","journal-title":"Revista Espa\u00f1ola de Cardiolog\u00eda"},{"key":"2025081709533504000_11.1.e002568.9","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.recesp.2021.10.017","article-title":"An\u00e1lisis de la Atenci\u00f3n al Infarto con Elevaci\u00f3n del Segmento ST en Espa\u00f1a. Resultados del Registro de C\u00f3digo Infarto de la ACI-SEC","volume":"75","author":"Rodr\u00edguez-Leor","year":"2022","journal-title":"Revista Espa\u00f1ola de Cardiolog\u00eda"},{"key":"2025081709533504000_11.1.e002568.10","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.jamda.2020.09.019","article-title":"The effectiveness of transitional care interventions on health care utilization in patients discharged from the hospital with heart failure: a systematic review and meta-analysis","volume":"22","author":"Li","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"2025081709533504000_11.1.e002568.11","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.amjmed.2021.03.007","article-title":"Optimizing the potential for telehealth in cardiovascular care (in the era of COVID-19): time will tell","volume":"134","author":"Patel","year":"2021","journal-title":"Am J Med"},{"key":"2025081709533504000_11.1.e002568.12","doi-asserted-by":"crossref","DOI":"10.1007\/s11886-021-01566-4","article-title":"COVID-19 and cardiovascular disease: a global perspective","volume":"23","author":"Pina","year":"2021","journal-title":"Curr Cardiol Rep"},{"key":"2025081709533504000_11.1.e002568.13","first-page":"565","article-title":"Alternative approaches to evaluation in empirical microeconomics","volume":"44","author":"Blundell","year":"2009","journal-title":"J Hum Resour"},{"key":"2025081709533504000_11.1.e002568.14","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-020-01601-4"},{"key":"2025081709533504000_11.1.e002568.15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.31083\/j.rcm.2021.01.241","article-title":"Exploring the impact of the COVID-19 pandemic on provision of cardiology services: a scoping review","volume":"22","author":"Yasmin","year":"2021","journal-title":"Rev Cardiovasc Med"},{"key":"2025081709533504000_11.1.e002568.16","doi-asserted-by":"crossref","DOI":"10.3389\/ijph.2021.635508","article-title":"Impact of the COVID-19 pandemic on the intensity of health services use in general practice: a retrospective cohort study","volume":"66","author":"Rachamin","year":"2021","journal-title":"Int J Public Health"},{"key":"2025081709533504000_11.1.e002568.17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.ajem.2020.10.022","article-title":"Cardiovascular diseases burden in COVID-19: systematic review and meta-analysis","volume":"46","author":"Hessami","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2025081709533504000_11.1.e002568.18","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.jval.2017.11.011","article-title":"Cost-effectiveness analysis in telehealth: a comparison between home telemonitoring, nurse telephone support, and usual care in chronic heart failure management","volume":"21","author":"Grustam","year":"2018","journal-title":"Value Health"},{"key":"2025081709533504000_11.1.e002568.19","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1002\/ejhf.2358","article-title":"Effects of an outpatient intervention comprising nurse\u2010led non\u2010invasive assessments, telemedicine support and remote cardiologists\u2019 decisions in patients with heart failure (AMULET study): a randomised controlled trial","volume":"24","author":"Krzesi\u0144ski","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2025081709533504000_11.1.e002568.20","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/j.jchf.2021.07.003","article-title":"Outpatient management of heart failure during the COVID-19 pandemic after adoption of a telehealth model","volume":"9","author":"Sammour","year":"2021","journal-title":"JACC Heart Fail"},{"key":"2025081709533504000_11.1.e002568.21","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1089\/tmj.2020.0155","article-title":"Technology literacy as a barrier to Telehealth during COVID-19","volume":"26","author":"Triana","year":"2020","journal-title":"Telemed J E Health"},{"key":"2025081709533504000_11.1.e002568.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr1503323"},{"key":"2025081709533504000_11.1.e002568.23","doi-asserted-by":"crossref","first-page":"4150","DOI":"10.1002\/ehf2.14134","article-title":"An electronic consultation program impacts on heart failure patients\u2019 prognosis: implications for heart failure care","volume":"9","author":"Maz\u00f3n-Ramos","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2025081709533504000_11.1.e002568.24","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.rce.2023.03.005","article-title":"Impact of the COVID-19 pandemic upon a universal electronic consultation program (E-consultation) between general practitioners and cardiologists","volume":"223","author":"Maz\u00f3n-Ramos","year":"2023","journal-title":"Rev Clin Esp (Barc)"},{"key":"2025081709533504000_11.1.e002568.25","unstructured":"Eurostat . Excess mortality - statistics. 2023. Available: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Excess_mortality_-_statistics#:~:text=For%20reference%2C%20the%20excess%20mortality,mortality%20indicator%20was%20%2D4.2%20%25 [Accessed 24 Apr 2023]."}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2023-002568","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:53:47Z","timestamp":1755449627000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2023-002568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,6,8]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/openhrt-2023-002568"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2023-002568","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}