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Multiple cause of death during the COVID-19 pandemic: a population study In Colombia and Brazil

Doris Durán1,2,3, Mabel Carabali1, Usama Bilal4

  • 1Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.

International Journal of Public Health
|June 3, 2026
PubMed

Insights

Multiple cause of death (MCOD) data reveal significantly higher mortality rates for diabetes mellitus (DM) and cardiovascular diseases (CVD) compared to underlying cause of death (UCOD) data. This highlights MCOD

Area of Science:

  • Epidemiology
  • Public Health Surveillance
  • Mortality Statistics

Background:

  • Accurate mortality statistics are crucial for public health.
  • Underlying Cause of Death (UCOD) coding may underestimate disease burden.
  • Multiple Cause of Death (MCOD) data offer a broader perspective on contributing factors.

Purpose of the Study:

  • To compare age-standardized mortality rates using UCOD versus MCOD data.
  • To assess discrepancies in disease-specific mortality during the COVID-19 pandemic in Latin America.
  • To evaluate the impact of MCOD methodology on public health surveillance.

Main Methods:

  • Analysis of death certificates from Brazil and Colombia (2019-2022).
  • Extraction of UCOD and all contributing causes.
  • Calculation of age- and sex-standardized mortality rates for key disease groups using UCOD and MCOD approaches.
  • Comparison of mortality rates derived from UCOD and MCOD data.

Main Results:

  • MCOD-derived diabetes mellitus mortality was up to 70% higher than UCOD.
  • In Colombia, MCOD cardiovascular disease mortality exceeded UCOD during 2020-2021.
  • Discrepancies for neoplasms and other communicable diseases were smaller.

Conclusions:

  • MCOD methods reveal substantial underestimation of diabetes and cardiovascular mortality.
  • MCOD surveillance provides a more comprehensive understanding of disease burden.
  • Findings underscore the value of MCOD data for effective public health planning and resource allocation.
Abstract

Keywords:
COVID-19Latin Americachronic diseasesdeath certificatesepidemiologymortality

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