Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland

Abstract

Background Given the nature of the spread of SARS-CoV-2, strong regional patterns in the fatal consequences of the COVID-19 pandemic related to local characteristics such as population and health care infrastructures were to be expected. In this paper we conduct a detailed examination of the spatial correlation of deaths in the first year of the pandemic in two neighbouring countries – Germany and Poland, which, among high income countries, seem particularly different in terms of the death toll associated with the COVID-19 pandemic. The analysis aims to yield evidence that spatial patterns of mortality can provide important clues as to the reasons behind significant differences in the consequences of the COVID-19 pandemic in these two countries. Methods Based on official health and population statistics on the level of counties, we explore the spatial nature of mortality in 2020 in the two countries – which, as we show, reflects important contextual differences. We investigate three different measures of deaths: the officially recorded COVID-19 deaths, the total values of excessive deaths and the difference between the two. We link them to important pre-pandemic regional characteristics such as population, health care and economic conditions in multivariate spatial autoregressive models. From the point of view of pandemic related fatalities we stress the distinction between direct and indirect consequences of COVID-19, separating the latter further into two types, the spatial nature of which is likely to differ. Results The COVID-19 pandemic led to much more excess deaths in Poland than in Germany. Detailed spatial analysis of deaths at the regional level shows a consistent pattern of deaths officially registered as related to COVID-19. For excess deaths, however, we find strong spatial correlation in Germany but little such evidence in Poland. Conclusions In contrast to Germany, for Poland we do not observe the expected spatial pattern of total excess deaths and the excess deaths over and above the official COVID-19 deaths. This difference cannot be explained by pre-pandemic regional factors such as economic and population structures or by healthcare infrastructure. The findings point to the need for alternative explanations related to the Polish policy reaction to the pandemic and failures in the areas of healthcare and public health, which resulted in a massive loss of life.

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

“…A higher number of available hospital beds was associated with lower mortality from COVID-19 and with lower all-cause and ‘other’ excess mortality. In previous research, a negative correlation of German excess mortality with the number of hospital beds has been found as well [ 8 ], thus indicating a possible role of lacking healthcare infrastructure in regions that were particularly challenged by the pandemic.…”

“…Regarding COVID-19, the association with variables related to population structure was weak due to the use of an age-standardised measure as outcome variable. The crude number of COVID-19 deaths, however, was positively correlated with the share of older people [ 8 ]. A higher number of available hospital beds was associated with lower mortality from COVID-19 and with lower all-cause and ‘other’ excess mortality.…”

“…For supplementary analyses, we conducted spatial regression models to estimate the area-level correlations of cause-specific SDRs and SDR ratios—for both sexes combined—with pre-pandemic contextual factors [ 8 , 26 ]. We applied queen neighbourhood as spatial weight matrix [ 27 ] because distance-based weights are not suitable for German districts due to their large variation in size.…”