COVID-19 Age-Mortality Curves for 2020 are Flatter in Developing Countries Using Both Official Death Counts and Excess Deaths

Background: Previous studies have found a pattern of flatter COVID-19 age-mortality curves among low- and middle-income countries using only official COVID-19 death counts. This study examines this question by comparing the age gradient of COVID-19 mortality in a broad set of countries using both official COVID-19 death counts and excess mortality estimates for 2020.Methods: The analysis uses official COVID-19 death counts for 64 countries and excess death estimates for 41 countries. A standardized population analysis was conducted to assess the extent to which variation across countries in the age distribution of COVID-19 deaths was driven by variation in the population age distribution.Findings: A higher share of pandemic-related deaths in 2020 were at younger ages in middle-income countries compared to high-income countries. People under age 65 constituted on average (1) 11 percent of both official deaths and excess deaths in high-income countries, (2) 40 percent of official deaths and 37 percent of excess deaths in upper-middle-income countries, and (3) 54 percent of official deaths in lower-middle-income countries. These contrasting profiles are due only in part to differences in population age structure.Interpretation: These findings are driven by some combination of variation in age patterns of infection rates and infection fatality rates. They indicate that COVID-19 is not just a danger to older people in developing countries, where a large share of victims are people of working age, who are caregivers and breadwinners for their families.Funding Information: None.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Ethics approval was not sought as the study presents results of an analysis of secondary data and does not involve human participants