Abstract
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 underreporting of coronavirus disease 2019 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 2017-2022, 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 [CI] = -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 9 December 2022 to 30 January 2023. CONCLUSIONS: As in many jurisdictions, we estimate that the coronavirus disease 2019 pandemic had a much wider impact on mortality than what was officially documented in Mainland China.