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

Mühlichen, Michael; Sauerberg, Markus; Grigoriev, Pavel

doi:10.1007/s44197-023-00141-0

Cited by 4 publications

(1 citation statement)

References 38 publications

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“…Previous research on the impact of the COVID-19 pandemic on mortality in Germany was mostly restricted to the national level [30], albeit with some exceptions [31][32][33], and focused primarily on the first year of the pandemic. Substantial spatial variation in standardized mortality ratio excess was found during the first wave of the COVID-19 pandemic [34].…”

Section: Introductionmentioning

confidence: 99%

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

Marinetti,

Jdanov,

Grigoriev

et al. 2023

PLoS ONE

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The mortality impact of COVID-19 has mainly been studied at the national level. However, looking at the aggregate impact of the pandemic at the country level masks heterogeneity at the subnational level. Subnational assessments are essential for the formulation of public health policies. This is especially important for federal countries with decentralised healthcare systems, such as Germany. Therefore, we assess geographical variation in the mortality impact of COVID-19 for the 16 German federal states in 2020 and 2021 and the sex differences therein. For this purpose, we adopted an ecological study design, using population-level mortality data by federal state, age, and sex, for 2005–2021 obtained from the German Federal Statistical Office. We quantified the impact of the pandemic using the excess mortality approach. We estimated period life expectancy losses (LE losses), excess premature mortality, and excess deaths by comparing their observed with their expected values. The expected mortality was based on projected age-specific mortality rates using the Lee-Carter methodology. Saxony was the most affected region in 2020 (LE loss 0.77 years, 95% CI 0.74;0.79) while Saarland was the least affected (-0.04, -0.09;0.003). In 2021, the regions with the highest losses were Thuringia (1.58, 1.54;1.62) and Saxony (1.57, 1.53;1.6) and the lowest in Schleswig-Holstein (0.13, 0.07;0.18). Furthermore, in 2021, eastern regions experienced higher LE losses (mean: 1.13, range: 0.85 years) than western territories (mean: 0.5, range: 0.72 years). The regional variation increased between 2020 and 2021, and was higher among males than among females, particularly in 2021. We observed an unequal distribution of the mortality impact of COVID-19 at the subnational level in Germany, particularly in 2021 among the male population. The observed differences between federal states might be partially explained by the heterogeneous spread of the virus in 2020 and by differences in the population’s propensity to follow preventive guidelines.

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Section: Introductionmentioning

confidence: 99%

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

Marinetti,

Jdanov,

Grigoriev

et al. 2023

PLoS ONE

Self Cite

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Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study

Tetzlaff,

Sauerberg,

Grigoriev

et al. 2024

The Lancet Public Health

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Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021)

Bonnet,

Grigoriev,

Sauerberg

et al. 2024

Nat Commun

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Since its emergence in December 2019, the COVID-19 pandemic has resulted in a significant increase in deaths worldwide. This article presents a detailed analysis of the mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce age and sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a forecasting approach based on CP-splines that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). We also estimate that eight regions suffered losses exceeding 20 years of life per 1000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic’s impact.

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

Cited by 4 publications

References 38 publications

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study

Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021)

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