Monitoring Excess Mortality During the COVID-19 Pandemic — The Case of Brazil

The Ministry of Health of Brazil, in collaboration with Zenysis Technologies and the Vital Strategies office in Brazil, have developed the Excess Mortality Monitoring Dashboard to visualize deaths by natural causes at the national, regional, state and state capital levels in Brazil.

Excess mortality analyses are a useful tool for estimating the number of deaths that have occurred in a given period over and above what would be expected under “normal” (or historical) conditions. Presently, excess mortality analyses are widely used around the world to estimate the full impact of COVID-19 on mortality at the population level.

The dashboard is a major milestone in the Ministry of Health’s efforts to improve the availability and transparency of public health data in Brazil. A brief background on the Ministry of Health’s Excess Mortality Monitoring Dashboard is set out below.

Data Integration

Development of the Excess Mortality Monitoring Dashboard required integration, harmonization and analysis of data from multiple data sources. In Brazil, deaths are separately recorded in two parallel information systems:

• The Transparency Portal of the Brazilian National Civil Registry, which is responsible for issuing legal death certificates in Brazil; and
• The Ministry of Health’s Mortality Information System (SIM), which records causes of death as reported by doctors. This system is the official source for vital statistics and epidemiological studies on mortality in Brazil.

The integrated mortality data from these two sources includes all COVID-19 confirmed deaths as well as reported deaths by all other natural causes (i.e. excluding deaths by external causes such as injuries, accidents or poisonings).

Preliminary population estimates for all 5,570 municipalities in Brazil for the period 2000–2019 were also integrated to produce national and regional mortality rate comparisons for each state.

Analytical Methodology

The analyses shown in the Excess Mortality Monitoring Dashboard compare reported deaths by all natural causes with expected deaths by all natural causes for 2020. Expected deaths by natural causes were estimated using 2015–2019 mortality data from the Mortality Information System and 95% confidence intervals. The resulting excess mortality analysis for the Southeast Region of Brazil is shown in Figure 1 below:

Figure 1: On the left, deaths by all natural causes reported via the Transparency Portal and Mortality Information System are shown in blue and red, respectively. Expected deaths by natural causes are shown in grey. On the right, the mortality rate (deaths by natural causes per 1 million inhabitants) is shown. Data shown are for Brazil’s Southeast Region and for epidemiological weeks 1–40, 2020.

The excess mortality analysis for Brazil throughout 2020 is shown below:

Figure 2: Deaths by all natural causes reported via the Transparency Portal and Mortality Information System are shown in blue and red, respectively. Expected deaths by all natural causes are shown in grey. Data shown are for epidemiological weeks 1–40, 2020.

The Excess Mortality Monitoring Dashboard is updated weekly on Wednesdays, with data from a new epidemiological week. Data published on the dashboard is delayed by four weeks, in order to allow time for validation before being used in the dashboard’s visualizations. More information on this and other specifications may be found in this Technical Note embedded in the Excess Mortality Monitoring Dashboard.

The Excess Mortality Monitoring Dashboard is the first product to come out of the collaboration between the Ministry of Health of Brazil, Zenysis Technologies and Vital Strategies. Marina Miranda, Ministry of Health’s Technical Consultant on Analyses for Health, stated:

“The unique value of the Excess Mortality Monitoring Dashboard is the integration of different official mortality data systems for the first time … [the Dashboard] enables all Brazilians to access this important data in a rapid and user-friendly way”.

What’s next

In the next phase of our collaboration, we envision continuing to advance the development of the Ministry of Health’s “Painel IVIS Análitico” (Integrated Health Surveillance Analytics Platform), host of the new Excess Mortality Monitoring Dashboard. We are committed to our shared vision of leveraging technological innovation to improve data transparency and data-driven decision making at all levels of the Brazilian health system.

Learn more about Zenysis’ open-source data integration and advanced analytics platform, Harmony: https://github.com/Zenysis/Harmony.