Estimated excess deaths due to COVID-19 among the urban population of Mainland China, December 2022 to January 2023.

BACKGROUND: Mainland China experienced a major surge in SARS-CoV-2 infections in December 2022-January 2023, but its impact on mortality was unclear given the under-reporting of COVID-19 deaths.

METHODS: Using obituary data from the Chinese Academy of Engineering (CAE), we estimated the excess death rate among senior CAE members by taking the difference between the observed rate of all-cause death in December 2022-January 2023 and the expected rate for the same months in 2017 to 2022 by age groups. We used this to extrapolate an estimate of the number of excess deaths in December 2022-January 2023 among urban dwellers in Mainland China.

RESULTS: In December 2022-January 2023, we estimated excess death rates of 0.94 per 100 persons (95% confidence interval: -0.54, 3.16) in CAE members aged 80-84 years, 3.95 (95% CI: 0.50, 7.84) in 85-89 years, 10.35 (95% CI: 3.59, 17.71) in 90-94 years and 16.88 (95% CI: 0.00, 34.62) in 95 years and older. Using our baseline assumptions, this extrapolated to 917,000 (95% CI: 425,000-1.45 million) excess deaths among urban-dwellers in Mainland China, much higher than the 81,000 in-hospital deaths officially reported from December 9, 2022 to January 30, 2023.

CONCLUSIONS: As in many jurisdictions, we estimate that the COVID-19 pandemic had a much wider impact on mortality than what was officially documented in Mainland China.