RT Journal Article SR Electronic T1 Excess deaths reveal unequal impact of COVID-19 in Ecuador JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e006446 DO 10.1136/bmjgh-2021-006446 VO 6 IS 9 A1 Leticia Cuéllar A1 Irene Torres A1 Ethan Romero-Severson A1 Riya Mahesh A1 Nathaniel Ortega A1 Sarah Pungitore A1 Ruian Ke A1 Nicolas Hengartner YR 2021 UL http://gh.bmj.com/content/6/9/e006446.abstract AB Latin America has struggled to control the transmission of COVID-19. Comparison of excess death (ED) rates during the pandemic reveals that Ecuador is among the highest impacted countries. In this analysis, we update our previous findings with the most complete all-cause mortality records available for 2020, disaggregated by sex, age, ethnicity and geography. Our study shows that in 2020, Ecuador had a 64% ED rate (95% CI 63% to 65%) or 64% more deaths than expected. Men had a higher ED rate, 75% (95% CI 73% to 76%), than women’s 51% (95% CI 49% to 52%), and this pattern of higher EDs for men than women held for most age groups. The only exception was the 20–29 age group, where women had 19% more deaths, compared to 10% more deaths for men, but that difference is not statistically significant. The analysis provides striking evidence of the lack of COVID-19 diagnostic testing in Ecuador: the confirmed COVID-19 deaths in 2020 accounted for only 21% of total EDs. Our significant finding is that indigenous populations, who typically account for about 5% of the deaths, show almost four times the ED rate of the majority mestizo group. Indigenous women in each age group have higher ED rates than the general population and, in ages between 20 and 49 years, they have higher ED rates than indigenous men. Indigenous women in the age group 20–29 years had an ED rate of 141%, which is commensurate to the ED rate of indigenous women older than 40 years.Data may be obtained from a third party and are not publicly available.