Covid-19 Excess Mortality in China: A Regional Comparison

Estimates of Covid-19 excess mortality are often considered to reflect the true death toll of the pandemic. As such, information on excess mortality is urgently needed to better understand the impact of the pandemic and prepare for future crises. This study estimated Covid-19 excess mortality at the provincial, regional, and national levels in China and investigated its associated regional disparities. The analyses were based on population and death rates data published by the national and provincial bureaus of statistics in China. The results suggest that excess deaths in China were over 1 million during each year of the pandemic, totaling to over 4 million by the end of 2022, at an excess death rate of 15.4%. This rate was likely comparable to that of the Organization for Economic Cooperation and Development (OECD), but higher than the US rate. Striking disparities were discovered among the 31 provinces with excess death rates ranging from negative rates in two eastern provinces to over 30% in three inland provinces. Rates in western China were over twice as high as those in eastern China. Variations with each individual regions were the largest in the central region and the smallest in the Northeast, which was the hardest hit with excess death rate of over 23%. The regional disparities in excess mortality rates seem to reflect pre-existing regional inequalities in socio-economic development in China. Such findings suggest that China has far to go to mitigate regional inequalities, achieve sustainability, and prepare for the next major crises.