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Covid-19 was the third leading cause of death in Australia last year

BMJ 2023; 381 doi: (Published 13 April 2023) Cite this as: BMJ 2023;381:p842


Covid-19 in Australia: How did a country that fought so hard for extra time end up so ill prepared?

  1. Alison Barrett
  1. Adelaide

Covid-19 became Australia’s third leading cause of death in 2022, after ischaemic heart disease and dementia, according to an analysis.1

There were 20 200 more deaths in 2022 than would have been expected if the pandemic had not happened, with a total excess mortality of 12% for the year, found a review of excess deaths by Australia’s Actuaries Institute’s covid-19 mortality working group.

“This analysis shows the distressing grip covid-19 had on Australia during 2022. In the space of just one year, the number of deaths significantly increased in our country,” said Elayne Grace, chief executive of the Actuaries Institute.

Australia minimised mortality and morbidity from covid-19 compared with other countries in 2020 and 2021 with non-pharmaceutical interventions, research has found, with 281 deaths per million population compared with 2567 in the UK and 2985 in the US.2

Karen Cutter, spokesperson for the mortality working group, said, “The order of the top five leading causes of death had remained the same since 2018, but that changed in 2022 when covid-19 became widely prevalent in Australia.”

Most excess deaths occurred in people older than 65 years. However, excess mortality was at least 5% in all age groups in 2022, according to the analysis.

Of the 20 200 excess deaths, half were from covid-19, and included 172 deaths reported as being from long covid. Some 15% were related to covid-19 in that covid-19 contributed to the death but was not the main cause.

Non-covid-19 excess deaths

The remaining third of excess deaths (34%) had no mention of covid-19 on the death certificate and represented excess mortality of 4%, “which is extraordinarily high in itself,” according to the institute.

Of the non-covid-19 excess deaths, ischaemic heart disease, cerebrovascular disease, diabetes, dementia, and cancer were all higher than predicted by between 2% and 17%.

The institute noted that while influenza circulated in Australia in 2022, deaths from respiratory diseases were lower than expected, but not as low as earlier in the pandemic.

Some causes for non-covid-19 excess deaths may include delays in emergency and routine care during the pandemic, and association of covid-19 with mortality risk from other diseases including heart disease.

“We note that multiple factors are likely in play and different factors may be more or less pronounced at various times,” said the authors.

Other countries including the UK3 and US4 have hypothesised similar causes for non-covid-19 excess mortality.

Future mortality

Frequency and prevalence of future waves, as well as potential changes in severity from new covid-19 strains, are likely to continue influencing mortality levels, but it is not clear for how long, the group has suggested.5

“It is unclear how close we are to reaching an endemic state, when the impact of covid-19 on mortality will become more predictable,” it said.

Vaccines remain an important tool in minimising deaths from covid-19, as well as reducing severe illness and long covid.

Michael Toole and Brendan Crabb from Australia’s Burnet Institute called on politicians to acknowledge that the pandemic was not over, while also recognising those who have died.6 “Suppressing the virus is still important,” they said. This can be done by encouraging people to be up-to-date with booster vaccines, wear high quality masks, and improve indoor air quality.” Being ready to adopt new knowledge and technology such as nasal spray vaccines and antiviral drugs was also important.


  • Alison Barrett is managing editor of Croakey Health Media

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