"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...
Discussion
... The analysis of the yearly excess mortality showed a marked difference between the pandemic years 2020, 2021, and 2022. Cumulated over all age ranges and months, in the year 2020, the observed number of deaths was close to the expected number; yet, in 2021, the observed number of deaths was far above the expected number (with an excess mortality of 34,000 deaths, more than twice the empirical standard deviation), and further increased in 2022 (with an excess mortality of 66,000 deaths, above four times the standard deviation). An age-dependent analysis showed that the strong excess mortality observed in 2021 and 2022 was mainly due to an above-average increase in deaths in the age groups between 15 and 79 years. The analysis of the monthly excess mortality in the age groups between 15 and 79 years showed that the high excess mortality started to accumulate from April 2021 onward. A similar pattern was observed for the number of stillbirths, which was similar to the previous years until March 2021, after which also a sudden and sustained increase was observed."
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