AUTHOR=Durán Doris , Carabali Mabel , Bilal Usama , Nicolau Belinda , Kaufman Jay S. 
  
TITLE=Multiple cause of death during the COVID-19 pandemic: a population study In Colombia and Brazil
  
JOURNAL=International Journal of Public Health
  
VOLUME=Volume 71 - 2026
  
YEAR=2026
  
URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2026.1609429
  
DOI=10.3389/ijph.2026.1609429
  
ISSN=1661-8564
  
ABSTRACT=ObjectivesTo assess differences in age-standardized disease-specific mortality rates derived from the underlying cause of death (UCOD) versus multiple cause of death (MCOD) data in two Latin American countries during the COVID-19 pandemic.MethodsUsing all death certificates for residents of Brazil (n = 6,207,785) and Colombia (n = 1,180,880) from 2019 through 2022, we extracted UCOD and all contributing causes, assigned weights (50% to UCOD, remainder equally among contributing causes), and calculated annual age- and sex-standardized mortality rates for neoplasms, circulatory diseases, diabetes mellitus (DM), and non-COVID communicable diseases. We then computed rate differences and rate ratios contrasting MCOD with UCOD estimates.ResultsMCOD-DM mortality exceeded UCOD by up to 70%. In Colombia, MCOD–CVD surpassed UCOD during 2020–2021, corresponding to approximately 1,950 extra male and 1,560 extra female CVD deaths in 2021. Discrepancies for neoplasms and other communicable diseases were smaller and stable.ConclusionThese findings demonstrate that MCOD methods reveal substantial underestimation of diabetes- and cardiovascular-related mortality, underscoring the value of MCOD surveillance for public health planning.