Document Type : Research articles


1 Biostatistics MSC Student, Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran

2 Assistant Professor of Biostatistics, Biostatistics Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran


Background: COVID-19 has raised a worldwide trajectory since it emerged in Wuhan, China in December 2019. The direct and indirect mortalities in the world and as well as in Iran have increased significantly after the occurrence of this pandemic.
Objectives: In this study, Excess Mortality Rate (EMR) was estimated by multilevel poison regression method and then this estimation was compared to the historical trends to obtain total deaths related to COVID-19. Additionally, the geographic distribution of EMR has also been presented for Iran.
Methods: All-cause mortality rates of each province of Iran from March 21, 2013 to September 22, 2021 was downloaded from National Organization for Civil Registration (NOCR). The data of COVID-19 pandemic period (spring 1399 SH (Mar 20, 2020) to summer 1400 SH (Sep 22, 2021)) was removed from the data and then the multilevel poison model was applied to estimate all-cause mortality in this period. Then, EMR= (real deaths-expected death)/(real deaths) ratio was calculated.
Results: The results of this study showed that Irans EMR in COVID-19 pandemic was 36% (Male=35%, Female=36%, P-value=0.798). Our findings also revealed four category of EMR including low (EMR?30%, n=9), moderate (30 %< EMR?35%, n=8), high (35 %< EMR?40%, n=10) and very high (40 %< EMR, n=4) in different provinces.
Conclusion: Due to the diverse EMR in different provinces of Iran, the type of disease management of provinces with low and moderate EMR can be used as an appropriate model to control EMR in provinces with high and very high EMR.


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