Association between democratic governance and excess mortality during the COVID-19 pandemic: an observational study

Vageesh Jain*, Jonathan Clarke, Thomas Beaney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Background: Excess mortality has been used to assess the overall health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision making, which may be useful in a pandemic. But during the pandemic, they have been criticised as being hesitant to enforce restrictive public health measures. Methods: Through linking open-access datasets we constructed univariable and multivariable linear regression models investigating the association between country V-Dem Liberal Democracy Indices (LDI), representing strength of democratic governance and excess mortality rates, from January 2020 to September 2021. We adjusted for several important confounders and conducted a range of sensitivity analyses to assess the robustness of our findings. Results: Across 78 countries, 4.19 million deaths million excess deaths were recorded. On multivariable regression, a one-point increase in V-Dem LDI was associated with a decrease in excess mortality of 2.18 per 100 000 (p=0.004), after accounting for age, gender, wealth and universal health coverage. This association was only partially attenuated by COVID-19 vaccination rates and remained robust in all sensitivity analyses. Conclusions: Democratic governance may have played an important role in mitigating the overall health impact of COVID-19 across countries. This study strengthens the case to broaden the scope of traditional pandemic risk assessment and discussions on preparedness.

Original languageEnglish
Article numbere218920
JournalJournal of Epidemiology and Community Health
Early online date29 Jun 2022
DOIs
Publication statusE-pub ahead of print - 29 Jun 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2022 Author(s) (or their employer(s)).

Keywords

  • COVID-19
  • EPIDEMICS
  • HEALTH POLICY
  • MORTALITY

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