Estimation of Excess Mortality in Germany During 2020-2022

Abstract

Background This study estimates the burden of COVID-19 on mortality in Germany. It is expected that many people have died because of the new COVID-19 virus who otherwise would not have died. Estimating the burden of the COVID-19 pandemic on mortality by the number of officially reported COVID-19-related deaths has been proven to be difficult due to several reasons. Because of this, a better approach, which has been used in many studies, is to estimate the burden of the COVID-19 pandemic by calculating the excess mortality for the pandemic years. An advantage of such an approach is that additional negative impacts of a pandemic on mortality are covered as well, such as a possible pandemic-induced strain on the healthcare system. Methods To calculate the excess mortality in Germany for the pandemic years 2020 to 2022, we compare the reported number of all-cause deaths (i.e., the number of deaths independently of underlying causes) with the number of statistically expected all-cause deaths. For this, the state-of-the-art method of actuarial science, based on population tables, life tables, and longevity trends, is used to estimate the expected number of all-cause deaths from 2020 to 2022 if there had been no pandemic. Results The results show that the observed number of deaths in 2020 was close to the expected number with respect to the empirical standard deviation; approximately 4,000 excess deaths occurred. By contrast, in 2021, the observed number of deaths was two empirical standard deviations above the expected number and even more than four times the empirical standard deviation in 2022. In total, the number of excess deaths in the year 2021 is about 34,000 and in 2022 about 66,000 deaths, yielding a cumulated 100,000 excess deaths in both years. The high excess mortality in 2021 and 2022 was mainly due to an increase in deaths in the age groups between 15 and 79 years and started to accumulate only from April 2021 onward. A similar mortality pattern was observed for stillbirths with an increase of about 9.4% in the second quarter and 19.4% in the fourth quarter of the year 2021 compared to previous years. Conclusions These findings indicate that something must have happened in spring 2021 that led to a sudden and sustained increase in mortality, although no such effects on mortality had been observed during the early COVID-19 pandemic so far. Possible influencing factors are explored in the discussion.

Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality

“…Unfortunately causes of death are not yet available in France for the year 2022, but the higher estimated number of excess deaths than that of COVID-19-attributed deaths likely reflects a long-term indirect impact of the pandemic increasing mortality related to modifications of patient management and healthcare system organization. A similar pattern was also reported in Germany [26] and Korea [27], suggesting a similar impact of the pandemic on healthcare systems and mortality not only in France. Further research is needed to better understand the various features contributing to this perturbation of mortality trends.…”

Reports of deaths are an exaggeration: all-cause and NAA-test-conditional mortality in Germany during the SARS-CoV-2 era

“…At the end of the previous section, we have found that four mathematical models found four inherently different all-cause EMCs for Germany between 2020 and 2021: from −11 500 (our study) to 30 000-38 000 [51][52][53] to 122 000 [15,18] (with them having reduced from initially 195 000 [19] published in the first WHO report) to 203 000 [54]. In this section, we aim at resolving how these different estimates arose from a prima facie unambiguous dataset of a German AMC.…”

“…This last number even under-quotes the RKI count of 115 537. We found another three articles reporting all-cause EMCs for Germany between 2020 and 2021, which differed by a full order of magnitude; first, a two-paper study from German and Swedish scientists [ 51 , 52 ] who proposed a total EMC of 6317 + 23 399 = 29 716; second, an article by German scientists [ 53 ] who used a similar method and proposed a total EMC of 4015 + 33 980 = 37 995; third, an article by the ‘COVID-19 Excess Mortality Collaborators’ [ 54 ], funded by the ‘Bill & Melinda Gates Foundation’, who claimed the highest EMC, namely, a mean 203 000 within a narrow range from 193 000 to 210 000. Note that the latter source, although calculating all-cause EMC, denominate this value exclusively ‘due to COVID-19’.…”

“…The Wang et al model [ 54 ] took the same Destatis data, but of 2016–2019 only [ 14 ]. De Nicola et al [ 51 , 52 ] as well as Kuhbandner & Reitzner [ 53 ] likewise used Destatis data, but life tables (annual AMRs instead of AMCs) of 2017–2019 [ 55 ]. The WHO-endorsed models [ 15 , 18 ] relied on AMCs of 2015–2019 taken from the Human Mortality Database [ 56 ].…”

“…Thereby, the years 2017–2019 contributed equally to forming the prognosis for 2020, for both yearly and weekly data, with only applying the most elaborated of the three approaches. The latter approach was also used in Kuhbandner & Reitzner [ 53 ], with additionally distinguishing members of the population into males and females. For an immediate comparison, we recall our model approach to calculate an expected AMC: we estimate age-cohort-specific AMRs of 2020 and 2021 by extrapolating exponential fits to the AMR courses between 2000 and 2019 (or, alternatively, constant fits between 2014 and 2019), multiply these extrapolated AMRs by their corresponding proportions of the demographic distribution as prognosticated by Destatis [ 29 ], and sum all so-weighted cohorts’ AMCs.…”