{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:49:47Z","timestamp":1792144187674,"version":"4.4.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"S2","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Popul Health Metrics"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the comprehensive death reporting system in South Africa, significant gaps persist in our understanding of the pandemic\u2019s impact in rural areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We computed monthly death counts stratified by demographic factors from a population-based demographic surveillance cohort in rural KwaZulu-Natal. We fit seasonally adjusted negative binomial regression models to estimate excess mortality during the COVID-19 pandemic period (5 March 2020 to 31 December 2021) compared to the pre-pandemic period (1 January 2015 to 4 March 2020). We then assessed the relative risk of death by health and sociodemographic factors and considering apotential interaction with the COVID-19 pandemic. Finally, we calculated changes in life expectancy at the age of 15 and conducted a decomposition analysis to identify life expectancy changes by age group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We observed two major periods of excess mortality during the beta and delta waves of the COVID-19 pandemic, respectively. During the pre-pandemic period, people with HIV (PWH) had slightly higher mortality rates (RR\u2009=\u20091.8; 95%CI 1.3 - 2.4) than their HIV-negative counterparts. This excess risk reduced during the COVID-19 period (HIV RR\u2009=\u20091.5; 95%CI 1.2 - 2.0). Similar patterns were noted for individuals with diabetes (pre-pandemic RR\u2009=\u20091.6; 95%CI 1.2 - 2.2 vs during COVID-19 RR\u2009=\u20091.4; 95%CI 1.1 - 1.9). In contrast, individuals with hypertension experienced a 15% relative increase death rate during the pandemic compared to pre-COVID period (p-interaction\u2009=\u20090.003). Similarly, hypertensive PWH had significantly elevated mortality risks during COVID-19 (RR\u2009=\u20092.18; 95% CI: 1.45\u20133.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Throughout the study, women consistently had higher life expectancy at age 15 than men. However, women contributed more to pandemic-related life expectancy reductions, along with specific age and health groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found contrasting impacts of co-morbidities on mortality during the COVID-19 pandemic in rural South Africa, and that reductions in life expectancy at age 15 were greater in women than men. These findings emphasize the critical need to consider specific needs of rural populations, and tailor public health strategies that prioritize vulnerable populations and address health inequities to mitigate the effects of pandemics in low-resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12963-026-00520-2","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:34:06Z","timestamp":1792143246000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of COVID-19 on all-cause mortality and life expectancy: findings from a population-based cohort in uMkhanyakude district, northern KwaZulu-natal"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5273-1743","authenticated-orcid":false,"given":"Lusanda","family":"Mazibuko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kobus","family":"Herbst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Baisley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chodziwadziwa Whiteson","family":"Kabudula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Bashingwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth Tippett","family":"Bar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Olivier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Busang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyabonga","family":"Nxumalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dickman","family":"Gareta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thobeka","family":"Mngomezulu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Siedner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"520_CR1","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1038\/s41586-022-05522-2","volume":"613","author":"W Msemburi","year":"2023","unstructured":"Msemburi W, Karlinsky A, Knutson V, et al. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613:130\u201337.","journal-title":"Nature"},{"key":"520_CR2","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1016\/S0140-6736(21)02796-3","volume":"399","author":"H Wang","year":"2022","unstructured":"Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022;399:1513\u201336.","journal-title":"Lancet"},{"key":"520_CR3","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1016\/S0140-6736(22)00845-5","volume":"399","author":"P Jha","year":"2022","unstructured":"Jha P, Brown PE, Ansumana R. Counting the global COVID-19 dead. Lancet. 2022;399:1937\u201338. https:\/\/doi.org\/10.1016\/S0140-6736(22)00845-5.","journal-title":"Lancet"},{"key":"520_CR4","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1111\/rssa.12826","volume":"185","author":"DL Millimet","year":"2022","unstructured":"Millimet DL, Parmeter CF. COVID-19 severity: a new approach to quantifying global cases and deaths. J R Stat Soc Ser Stat Soc. 2022;185:1178\u2013215.","journal-title":"J R Stat Soc Ser Stat Soc"},{"issue":"7","key":"520_CR5","doi-asserted-by":"publisher","first-page":"110257","DOI":"10.1016\/j.isci.2024.110257","volume":"27","author":"KR Prentice","year":"2024","unstructured":"Prentice KR, Williams BA, True JM, Jones CH. Advancing health equity in the aftermath of COVID-19: confronting intensifying racial disparities. iScience. 2024;27(7):110257. https:\/\/doi.org\/10.1016\/j.isci.2024.110257.","journal-title":"iScience"},{"issue":"3","key":"520_CR6","doi-asserted-by":"publisher","first-page":"433","DOI":"10.9745\/GHSP-D-21-00172","volume":"9","author":"J Adams","year":"2021","unstructured":"Adams J, MacKenzie MJ, Amegah AK, Ezeh A, Gadanya MA, Omigbodun A, et al. The conundrum of low COVID-19 mortality burden in sub-saharan Africa: myth or reality? Glob Health Sci Pract. 2021;9(3):433\u201343. https:\/\/doi.org\/10.9745\/GHSP-D-21-00172.","journal-title":"Glob Health Sci Pract"},{"key":"520_CR7","doi-asserted-by":"publisher","unstructured":"Cabore JW, Karamagi HC, Kipruto HK, Mungatu JK, Asamani JA, Droti B, et al. COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns. Lancet Glob Health. 2022;10(8):e1099\u2013e 1114. https:\/\/doi.org\/10.1016\/S2214-109X(22)00233-9.","DOI":"10.1016\/S2214-109X(22)00233-9"},{"key":"520_CR8","doi-asserted-by":"crossref","unstructured":"Gouda HN, Charlson F, Sorsdahl K, et al. Burden of non-communicable diseases in sub-saharan Africa, 1990-2017. results from the global burden of disease study 2017. Lancet Glob Health. 2019;7:e1375\u201387.","DOI":"10.1016\/S2214-109X(19)30374-2"},{"key":"520_CR9","unstructured":"National Institute for Communicable Diseases. Latest confirmed cases of COVID-19 IN SOUTH AFRICA (31 December 2021). 2021. https:\/\/www.nicd.ac.za\/latest-confirmed-cases-of-covid-19-in-south-africa-31-december-2021\/."},{"key":"520_CR10","unstructured":"National Institute for Communicable Diseases. COVID-19 Weekly Epidemiology Brief: Week ending 1 January 2022 (Week 52 of 2021). 2021. https:\/\/www.nicd.ac.za\/wp-content\/uploads\/2022\/01\/COVID-19-Weekly-Epi-Brief_Week-52.pdf."},{"key":"520_CR11","unstructured":"Bradshaw D. Report on weekly deaths in South Africa, 26 Dec 2021 \u2013 1 Jan 2022 (Week 52). 2022. https:\/\/www.samrc.ac.za\/sites\/default\/files\/bod\/weeklyreports\/weekly1Jan2022.pdf."},{"issue":"1","key":"520_CR12","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s41118-021-00134-6","volume":"77","author":"RE Dorrington","year":"2021","unstructured":"Dorrington RE, Moultrie TA, Laubscher R, Groenewald PJ, Bradshaw D. Rapid mortality surveillance using a national population register to monitor excess deaths during SARS-CoV-2 pandemic in South Africa. Genus. 2021;77(1):19. https:\/\/doi.org\/10.1186\/s41118-021-00134-6.","journal-title":"Genus"},{"key":"520_CR13","unstructured":"SAMRC Excess Mortality Report. Report on weekly deaths in South Africa. January, 21. https:\/\/www.samrc.ac.za\/reports\/report-weekly-deaths-south-africa."},{"key":"520_CR14","doi-asserted-by":"crossref","unstructured":"Sankoh O, Dickson KE, Faniran S, et al. Births and deaths must be registered in Africa. Lancet Glob Health. 2020;8:e33\u201334.","DOI":"10.1016\/S2214-109X(19)30442-5"},{"key":"520_CR15","unstructured":"Western Cape Department of Health in collaboration with the National Institute for Communicable Diseases, South Africa, Boulle, A, Davies, M-A, et al. Risk factors for coronavirus disease 2019 (COVID-19) death in a population cohort study from the Western Cape Province, South Africa. Clin Infect Dis. 2021;73:e2005\u201315."},{"key":"520_CR16","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1093\/ije\/dym211","volume":"37","author":"F Tanser","year":"2008","unstructured":"Tanser F, Hosegood V, Barnighausen T, et al. Cohort profile: Africa Centre demographic information system (ACDIS) and population-based HIV survey. Int J Epidemiol. 2008;37:956\u201362.","journal-title":"Int J Epidemiol"},{"key":"520_CR17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/ije\/dyaa264","volume":"50","author":"D Gareta","year":"2021","unstructured":"Gareta D, Baisley K, Mngomezulu T, et al. Cohort profile update: Africa Centre demographic information system (ACDIS) and population-based HIV survey. Int J Epidemiol. 2021;50:33\u201334.","journal-title":"Int J Epidemiol"},{"key":"520_CR18","unstructured":"Wong EB, Olivier S, Gunda R, et al. Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health. 2021;9:e967\u201376."},{"key":"520_CR19","doi-asserted-by":"crossref","unstructured":"Tlou B. Underlying determinants of maternal mortality in a rural South African population with high HIV prevalence (2000-2014): a population-based cohort analysis. PLoS One. 2018;13:e0203830.","DOI":"10.1371\/journal.pone.0203830"},{"key":"520_CR20","unstructured":"Births and Deaths Registration Act: Regulations."},{"key":"520_CR21","doi-asserted-by":"crossref","unstructured":"Gunda R, Koole O, Gareta D, et al. Cohort profile: the vukuzazi (\u2018wake up and know yourself\u2019 in isiZulu) population science programme. Int J Epidemiol. 2022;51:e131\u201342.","DOI":"10.1093\/ije\/dyab229"},{"key":"520_CR22","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1136\/jech.2003.009654","volume":"58","author":"D Eayres","year":"2004","unstructured":"Eayres D. Evaluation of methodologies for small area life expectancy estimation. J Epidemiol Community Health. 2004;58:243\u201349.","journal-title":"J Epidemiol Community Health"},{"key":"520_CR23","unstructured":"Vaupel JW, Romo VC. Decomposing change in life expectancy: a bouquet of formulas in honor of Nathan Keyfitz\u2019s 90th Birthday."},{"key":"520_CR24","doi-asserted-by":"publisher","unstructured":"Jassat W, Cohen C, Tempia S, et al. A national cohort study of COVID-19 in-hospital mortality in South Africa: the intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting. Preprint, Infectious Diseases (Except HIV\/AIDS). 22 December 2020. https:\/\/doi.org\/10.1101\/2020.12.21.20248409.","DOI":"10.1101\/2020.12.21.20248409"},{"issue":"1","key":"520_CR25","doi-asserted-by":"publisher","first-page":"6283","DOI":"10.1038\/s41598-021-85359-3","volume":"11","author":"P Ssentongo","year":"2021","unstructured":"Ssentongo P, Heilbrunn ES, Ssentongo AE, Advani S, Chinchilli VM, Nunez JJ, et al. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis. Sci Rep. 2021;11(1):6283. https:\/\/doi.org\/10.1038\/s41598-021-85359-3.","journal-title":"Sci Rep"},{"key":"520_CR26","doi-asserted-by":"crossref","unstructured":"Mehtar S, Preiser W, Lakhe NA, et al. Limiting the spread of COVID-19 in Africa: one size mitigation strategies do not fit all countries. Lancet Glob Health. 2020;8:e881\u201383.","DOI":"10.1016\/S2214-109X(20)30212-6"},{"key":"520_CR27","unstructured":"Bank L, Sharpley N. Covid and custom in Rural South Africa."},{"key":"520_CR28","unstructured":"Bapela MP, Mabona M, Mhlongo B, et al. KwaZulu-Natal department of health COVID-19. Situational report: 29. 2022, November."},{"key":"520_CR29","doi-asserted-by":"publisher","first-page":"1098066","DOI":"10.3389\/fpubh.2023.1098066","volume":"11","author":"Q Zhang","year":"2023","unstructured":"Zhang Q, Yu Y, He J, Yao X, He Y, Wu J, et al. Did the COVID-19 pandemic impact urticaria information-seeking behavior in China? A retrospective longitudinal study. Front Public Health. 2023;11:1098066. https:\/\/doi.org\/10.3389\/fpubh.2023.1098066.","journal-title":"Front Public Health"},{"key":"520_CR30","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1016\/j.dsx.2020.07.005","volume":"14","author":"N Zaki","year":"2020","unstructured":"Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: a systematic review. Diabetes Metab Syndr Clin Res Rev. 2020;14:1133\u201342.","journal-title":"Diabetes Metab Syndr Clin Res Rev"},{"key":"520_CR31","unstructured":"Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study. 2021."},{"key":"520_CR32","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.genm.2012.10.001","volume":"9","author":"JE Seifarth","year":"2012","unstructured":"Seifarth JE, McGowan CL, Milne KJ. Sex and life expectancy. Gend Med. 2012;9:390\u2013401.","journal-title":"Gend Med"},{"issue":"2","key":"520_CR33","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1159\/000355310","volume":"60","author":"M Luy","year":"2014","unstructured":"Luy M, Gast K. Do women live longer or do men die earlier? Reflections on the causes of sex differences in life expectancy. Gerontology. 2014;60(2):143\u201353. https:\/\/doi.org\/10.1159\/000355310.","journal-title":"Gerontology"},{"key":"520_CR34","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1080\/03768350802640123","volume":"26","author":"C Ogunmefun","year":"2009","unstructured":"Ogunmefun C, Schatz E. Caregivers\u2019 sacrifices: the opportunity costs of adult morbidity and mortality for female pensioners in rural South Africa. Dev South Afr. 2009;26:95\u2013109.","journal-title":"Dev South Afr"},{"key":"520_CR35","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1111\/gwao.12565","volume":"28","author":"BR Parry","year":"2021","unstructured":"Parry BR, Gordon E. The shadow pandemic: inequitable gendered impacts of COVID-19 in South Africa. Gend Work Organ. 2021;28:795\u2013806.","journal-title":"Gend Work Organ"},{"key":"520_CR36","doi-asserted-by":"publisher","first-page":"113364","DOI":"10.1016\/j.socscimed.2020.113364","volume":"266","author":"J Connor","year":"2020","unstructured":"Connor J, Madhavan S, Mokashi M, et al. Health risks and outcomes that disproportionately affect women during the covid-19 pandemic: a review. Soc Sci Med. 2020;266:113364.","journal-title":"Soc Sci Med"},{"key":"520_CR37","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ijregi.2022.08.014","volume":"5","author":"N Tlotleng","year":"2022","unstructured":"Tlotleng N, Cohen C, Made F, et al. COVID-19 hospital admissions and mortality among healthcare workers in South Africa, 2020-2021. IJID Reg. 2022;5:54\u201361.","journal-title":"IJID Reg"},{"key":"520_CR38","doi-asserted-by":"publisher","first-page":"877800","DOI":"10.3389\/fpubh.2022.877800","volume":"10","author":"CA M\u00e9ndez-Liz\u00e1rraga","year":"2022","unstructured":"M\u00e9ndez-Liz\u00e1rraga CA, Casta\u00f1eda-Cediel M, Delgado-S\u00e1nchez G, et al. Evaluating the impact of mobility in COVID-19 incidence and mortality: a case study from four states of Mexico. Front Public Health. 2022;10:877800.","journal-title":"Front Public Health"},{"key":"520_CR39","doi-asserted-by":"publisher","unstructured":"Chen Y-H, Glymour M, Riley A, Balmes J, Duchowny K, Harrison R, et al. Excess mortality associated with the COVID-19 pandemic among californians 18\u201365 years of age, by occupational sector and occupation: March through November 2020. PLoS One. 2021;16(6):e0252454. https:\/\/doi.org\/10.1371\/journal.pone.0252454.","DOI":"10.1371\/journal.pone.0252454"},{"key":"520_CR40","doi-asserted-by":"publisher","unstructured":"Singh U, Olivier S, Cuadros D, Castle A, Moosa Y, Zulu T, et al. The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey. Lancet Glob Health. 2023;11(9):e1372\u201382. https:\/\/doi.org\/10.1016\/S2214-109X(23)00239-5.","DOI":"10.1016\/S2214-109X(23)00239-5"},{"issue":"1","key":"520_CR41","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.1186\/s12889-020-09988-5","volume":"20","author":"N Akseer","year":"2020","unstructured":"Akseer N, Mehta S, Wigle J, Chera R, Brickman ZJ, Al-Gashm S, et al. Non-communicable diseases among adolescents: current status, determinants, interventions and policies. BMC Public Health. 2020;20(1):1908. https:\/\/doi.org\/10.1186\/s12889-020-09988-5.","journal-title":"BMC Public Health"},{"issue":"1","key":"520_CR42","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1186\/s12889-016-3779-1","volume":"16","author":"D Jourdan","year":"2016","unstructured":"Jourdan D, Christensen JH, Darlington E, Bonde AH, Bloch P, Jensen BB, et al. The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes. BMC Public Health. 2016;16(1):1123. https:\/\/doi.org\/10.1186\/s12889-016-3779-1.","journal-title":"BMC Public Health"},{"key":"520_CR43","doi-asserted-by":"publisher","first-page":"484","DOI":"10.2471\/BLT.16.179382","volume":"94","author":"R Baker","year":"2016","unstructured":"Baker R, Taylor E, Essafi S, et al. Engaging young people in the prevention of noncommunicable diseases. Bull World Health Organ. 2016;94:484\u2013484.","journal-title":"Bull World Health Organ"},{"key":"520_CR44","doi-asserted-by":"publisher","unstructured":"Seang K, Javanbakht M, Lee S-J, Brookmeyer R, Pheng P, Chea P, et al. Differences in prevalence and risk factors of non-communicable diseases between young people living with HIV (YLWH) and young general population in Cambodia. PLoS One. 2022;17(6):e0269989. https:\/\/doi.org\/10.1371\/journal.pone.0269989.","DOI":"10.1371\/journal.pone.0269989"},{"key":"520_CR45","doi-asserted-by":"publisher","unstructured":"Achwoka D, Oyugi JO, Mutave R, Munywoki P, Achia T, Akolo M, et al. High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya. PLoS One. 2020;15(7):e0235606. https:\/\/doi.org\/10.1371\/journal.pone.0235606.","DOI":"10.1371\/journal.pone.0235606"},{"key":"520_CR46","doi-asserted-by":"publisher","unstructured":"Chimbindi N, Mthiyane N, Birdthistle I, Floyd S, McGrath N, Pillay D, et al. Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS. PLoS One. 2018;13(10):e0203193. https:\/\/doi.org\/10.1371\/journal.pone.0203193.","DOI":"10.1371\/journal.pone.0203193"},{"key":"520_CR47","doi-asserted-by":"publisher","unstructured":"Strongman H, Carreira H, De Stavola BL, Bhaskaran K, Leon DA. Factors associated with excess all-cause mortality in the first wave of the COVID-19 pandemic in the UK: a time series analysis using the clinical practice research datalink. PLoS Med. 2022;19(1):e1003870. https:\/\/doi.org\/10.1371\/journal.pmed.1003870.","DOI":"10.1371\/journal.pmed.1003870"},{"key":"520_CR48","doi-asserted-by":"publisher","unstructured":"Bradshaw D, Dorrington R, Laubscher R, et al. COVID-19 and all-cause mortality in South Africa - the hidden deaths in the first four waves. South Afr J Sci. 118. 31 May 2022. https:\/\/doi.org\/10.17159\/sajs.2022\/13300.","DOI":"10.17159\/sajs.2022\/13300"}],"container-title":["Population Health Metrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12963-026-00520-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12963-026-00520-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12963-026-00520-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:34:10Z","timestamp":1792143250000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12963-026-00520-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":48,"journal-issue":{"issue":"S2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["520"],"URL":"https:\/\/doi.org\/10.1186\/s12963-026-00520-2","relation":{},"ISSN":["1478-7954"],"issn-type":[{"value":"1478-7954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"21 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The AHRI health and demographic surveillance system (HDSS) was reviewed and approved by the Biomedical Ethics Review Committee of the University of KwaZulu-Natal (BE290\/16). Ethical approval for the Vukuzazi study was obtained from the Ethics Committees of the University of KwaZulu-Natal (BE560\/17), the London School of Hygiene & Tropical Medicine (#14722), the Partners Institutional Review Board (2018P001802), and the University of Alabama at Birmingham (#300007237). All study participants, or parents\/guardians in the case of minors, provided written informed consent to participate.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors of this paper declare no conflict of interest.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"82"}}