Australians are still dying at higher rates than before the pandemic, reflecting how COVID-19’s lingering effects may be driving a sustained increase in death and disease around the globe.

Excess mortality — the increase above the expected toll had the pandemic not occurred — was 5% for Australia in 2023, the Sydney-based Actuaries Institute said in a report Monday, significantly higher than the 1% to 2% excess seen in years of crushing seasonal influenza epidemics.

The elevated toll in a country with high COVID-19 vaccination rates reveals the long tail of a pandemic that not only caused the most deaths in a century, but left many survivors with lingering ailments, and disrupted medical care for patients with other conditions. More than four years on, hospitals are still grappling with an unexpected increase in coronary artery disease.