# Impact of the COVID‐19 Pandemic on Mortality Patterns in Bushehr Port of Iran: A Comparative Analysis of the Prepandemic Period (2014–2019) and the Pandemic Era (2020–2023)

## TL;DR

This study examines how the COVID-19 pandemic affected mortality in Bushehr, Iran, finding higher death rates among males and fishermen.

## Contribution

The study provides new insights into pandemic-related mortality patterns in an industrial and coastal region of the Middle East.

## Key findings

- Excess mortality during the pandemic reached 15.1%, with a peak of 75% during the Delta wave.
- Males had 2.2 times higher mortality than females, and fishermen had the highest occupational mortality (SMR = 1.89).
- Acute myocardial infarction deaths increased by 27.3% despite high vaccination coverage.

## Abstract

Industrial and coastal regions may experience unique pandemic‐related mortality patterns, yet data from Middle Eastern occupational cohorts are extremely limited.

In this retrospective cohort study, we analyzed 58,976 deaths in Bushehr Province, Iran (2014–2023). Autoregressive integrated moving average (ARIMA) models were used to estimate excess mortality, and Poisson regression calculated standardized mortality ratios (SMRs) by occupation and sex.

During the pandemic period (2020–2022), excess mortality reached 15.1%, peaking at 75% during the Delta wave. Males had 2.2 times higher mortality than females. The highest occupational mortality was among fishermen (SMR = 1.89, 95% CI: 1.75–2.04). Despite 78% vaccination coverage, acute myocardial infarction deaths increased by 27.3% (p < 0.001), comprising 41% of deaths during the BA.5 wave.

Significant disparities in COVID‐19 mortality were observed by sex and occupation. Industrial workers, particularly males, require targeted public health strategies, including workplace‐based vaccination and cardiovascular screening.