Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach

Lada Trajceska; Aleksandra Canevska; Nikola Gjorgjievski; Mimoza Milenkova; Adrijana Spasovska-Vasilevska; Galina Severova-Andreevska; Daniela Mladenovska; Vladimir Pusevski; Maja Kuzmanovska; Elizabeta Janceska; Golubinka Bosevska; Irena Rambabova-Busljetik; Gjulsen Selim; Goce Spasovski

doi:10.3889/oamjms.2020.5508

Authors

Lada Trajceska University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Aleksandra Canevska University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Nikola Gjorgjievski University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Mimoza Milenkova University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Adrijana Spasovska-Vasilevska University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Galina Severova-Andreevska University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Daniela Mladenovska University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Vladimir Pusevski University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Maja Kuzmanovska Laboratory for Virology, Institute of Public Health, Skopje, Republic of Macedonia, Balkans
Elizabeta Janceska Laboratory for Virology, Institute of Public Health, Skopje, Republic of Macedonia, Balkans
Golubinka Bosevska Laboratory for Virology, Institute of Public Health, Skopje, Republic of Macedonia, Balkans
Irena Rambabova-Busljetik University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Gjulsen Selim University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans
Goce Spasovski University Clinic for Nephrology, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia, Balkans

DOI:

https://doi.org/10.3889/oamjms.2020.5508

Keywords:

Coronavirus Disease-19, Excess mortality, Pandemic, Nephrology, P- score

Abstract

BACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest.

AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years.

METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%.

RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (p_score0.72).

CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1^stmonths of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths.

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