Spatial, Cause-Specific and Seasonal Effects of Excess Mortality Associated with the COVID-19 Pandemic: The Case of Germany, 2020–2022

Michael Muehlichen , Federal Institute for Population Research (BiB)
Markus Sauerberg, Federal Institute for Population Research
Pavel Grigoriev, Federal Institute for Population Research (BiB), Germany

Since the beginning of the COVID-19 pandemic, only few studies on excess mortality have considered both cause-specific and sub-national differences. Located at the intersection of the European north-south and east-west gradients of (excess) mortality, Germany represents a fascinating context for such detailed analysis, as the German example might provide implications for the overall European pattern. Our analyses rely on official cause-of-death statistics consisting of 7.74 million individual death records reported for the German population during 2015–2022. We conduct differential mortality analyses by age, sex, cause, month and district (N=400), using decomposition and standardisation methods, comparing each strata of the mortality level observed during 2020–2022 with its expected value. Our results show remarkable spatial differences to the disadvantage of the south of eastern Germany in both 2020 and 2021. Excess mortality in the most affected districts is driven widely by older ages and deaths reported during the second wave, particularly from COVID-19 but also from cardiovascular and mental diseases. In 2022, however, the spatial pattern completely changed with the northwest showing the highest levels of excess mortality, while the east widely experienced a rise again in life expectancy. Our results for 2020 and 2021 suggest that increased psychosocial stress influenced the outcome of excess mortality in the most affected areas during the second wave of the pandemic. Cause-specific and seasonal data for 2022 will become available by March 2024 and will help us understand the fundamentally changed pattern of excess mortality.

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 Presented in Session P2. Health, Mortality, Ageing - Aperitivo