Reduced mortality during the COVID-19 outbreak in Japan, 2020: A two-stage interrupted time-series design

Daisuke Onozuka, Yuta Tanoue, Shuhei Nomura, Takayuki Kawashima, Daisuke Yoneoka, Akifumi Eguchi, Chris Fook Sheng Ng, Kentaro Matsuura, Shoi Shi, Koji Makiyama, Shinya Uryu, Yumi Kawamura, Shinichi Takayanagi, Stuart Gilmour, Takehiko I. Hayashi, Hiroaki Miyata, Francesco Sera, Tomimasa Sunagawa, Takuri Takahashi, Yuuki TsuchihashiYusuke Kobayashi, Yuzo Arima, Kazuhiko Kanou, Motoi Suzuki, Masahiro Hashizume

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Coronavirus disease 2019 (COVID-19) continues to be a major global health burden. This study aims to estimate the all-cause excess mortality occurring in the COVID-19 outbreak in Japan, 2020, by sex and age group. Methods: Daily time series of mortality for the period January 2015-December 2020 in all 47 prefectures of Japan were obtained from the Ministry of Health, Labour and Welfare, Japan. A two-stage interrupted time-series design was used to calculate excess mortality. In the first stage, we estimated excess mortality by prefecture using quasi-Poisson regression models in combination with distributed lag non-linear models, adjusting for seasonal and long-term variations, weather conditions and influenza activity. In the second stage, we used a random-effects multivariate meta-analysis to synthesize prefecture-specific estimates at the nationwide level. Results: In 2020, we estimated an all-cause excess mortality of -20 982 deaths [95% empirical confidence intervals (eCI): -38 367 to -5472] in Japan, which corresponded to a percentage excess of -1.7% (95% eCI: -3.1 to -0.5) relative to the expected value. Reduced deaths were observed for both sexes and in all age groups except those aged <60 and 70-79 years. Conclusions: All-cause mortality during the COVID-19 outbreak in Japan in 2020 was decreased compared with a historical baseline. Further evaluation of cause-specific excess mortality is warranted.

Original languageEnglish
Pages (from-to)75-84
Number of pages10
JournalInternational Journal of Epidemiology
Issue number1
Publication statusPublished - 2022 Feb 1


  • All-cause death
  • COVID-19
  • Japan
  • excess mortality
  • two-stage interrupted time-series design

ASJC Scopus subject areas

  • Epidemiology


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