Summary Abstract

April 2024
​In this project, we provide an estimate of the degree of over-reporting of COVID-19 as the underlying cause of death in the US. We calculate the over-reporting adjustment factor by comparing the ratios of reporting of COVID-19 as multiple cause of death to underlying cause of death, with the equivalent ratio for Influenza and Pneumonia (ICD-10 codes J09-J18). ​
Our results show that there is a systematic over-reporting of COVID-19 when reported as underlying cause of death, when compared to Influenza and Pneumonia during the same period.

​The average over-reporting factor is about 2.5 to 3 for all ages. We also observe that for ages 15 to 54 the over-reporting factor ranged from 2 to 3.5 between 2020 and 2022, which is higher than for younger and older individuals. For older individuals, the over-reporting factor ranged from 1.9 to 3, while for younger individuals the over-reporting factor ranged from 1.1 to 2.8.
​
The over-reporting factors we compute only account for the relative over-reporting of COVID-19 as the underlying cause of disease as opposed to as a contributing cause, when compared with influenza and pneumonia. This work therefore contributes to the ongoing discussion of death “with” COVID-19 versus “from” COVID-19.

Conclusions

  • In our study we estimate the degree to which COVID-19 is over-reported as the underlying cause of death in the US. We calculate the over-reporting adjustment factor by comparing the ratios of reporting of COVID-19 as a multiple cause of death with underlying cause of death, with the equivalent ratio for Influenza & Pneumonia (ICD-10 codes J09-J18). We operate under the assumption that Influenza & Pneumonia diseases are comparable (of similar nature) to COVID-19.

  • We conclude that there appears to be a systematic over-reporting of COVID-19 when reported as the underlying cause of death compared to Influenza & Pneumonia. The over-reporting factor is higher for age groups 15-24 and older ranging from 1.89 to 3.4 between 2020 and 2022, and lower for younger individuals. The highest over-reporting factors were observed in 2021 while over-reporting factors in 2020 and 2022 were similar to each other. The detailed estimates for the over-reporting factor for all age groups in 2020, 2021 and 2022 can be found in Table 1 in the full paper.

  • When comparing underlying cause death rates for different age groups for COVID-19 with death rates from Influenza & Pneumonia, we observe that UC COVID-19 death rates were higher than those for Influenza and Pneumonia from age group 15-24 and older. After performing the adjustment for the estimated over-reporting factor, we observe that UC COVID-19* death rates are still higher than for Influenza and Pneumonia for ages 25-34 and older and the equivalent for age group 15-24. We also observe that the death rate from UC COVID-19 was higher in 2021.

  • We believe that the estimates computed above represent a first order approximation towards understanding the mortality patterns associated with COVID-19 and other diseases during the post 2020 period (pandemic and post pandemic).It should be noted that the over-reporting factors we compute only account for the relative over-reporting of COVID-19 as the underlying cause of death as opposed to as a contributing cause, when compared with Influenza and Pneumonia, therefore they contribute to the ongoing discussion of death “with” COVID-19 versus “from” COVID-19.

Suggestions for Further Research

  • The overall over(under)-reporting of COVID-19 deaths (either as UC or MC) relative to Influenza and Pneumonia are not estimated in this work. As noted by (Ioannidis, 2021), due to the incentives for recording positive SARS-CoV-2 tests, developed countries are likely to also have an over-reporting bias in the number of deaths attributed to COVID-19, when compared to other diseases. Further work is needed to understand the extent to which this occurred (or not). 

  • Finally, during our research, we also observed several effects that are beyond the scope of this paper that we believe healthcare professionals would find of interest to investigate further. In particular, a detailed analysis for each age group, with particular focus on individuals aged 14 and lower would be of interest. 

  • For a more detailed analysis, please read our full paper, "US Death Trends for Neoplasms ICD codes: C00-D48, Ages 15-44" at Research Gate. 
Phinance Technologies © 2024
Privacy Policy