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  1. Article ; Online: Excess mortality due to COVID-19 in Germany.

    Stang, Andreas / Standl, Fabian / Kowall, Bernd / Brune, Bastian / Böttcher, Juliane / Brinkmann, Marcus / Dittmer, Ulf / Jöckel, Karl-Heinz

    The Journal of infection

    2020  Volume 81, Issue 5, Page(s) 797–801

    Abstract: ... The aim is to provide estimates of excess mortality in Germany during this time.: Methods: We analyzed ... excess mortality. The net excess number of deaths for weeks 10-23 was +8,071. The overall SMR was 1•03 ... of deaths of 2016-2019 to estimate expected weekly numbers for 2020. We estimated standardized mortality ...

    Abstract Objectives: The first wave of the SARS-CoV-2 pandemic in Germany lasted from week 10 to 23 in 2020. The aim is to provide estimates of excess mortality in Germany during this time.
    Methods: We analyzed age-specific numbers of deaths per week from 2016 to week 26 in 2020. We used weekly mean numbers of deaths of 2016-2019 to estimate expected weekly numbers for 2020. We estimated standardized mortality ratios (SMR) and 95% confidence intervals.
    Results: During the first wave observed numbers of deaths were higher than expected for age groups 60-69, 80-89, and 90+. The age group 70-79 years did not show excess mortality. The net excess number of deaths for weeks 10-23 was +8,071. The overall SMR was 1•03 (95%CI 1•03-1•04). The largest increase occurred among people aged 80-89 and 90+ (SMR=1•08 and SMR=1•09). A sensitivity analysis that accounts for demographic changes revealed an overall SMR of 0•98 (95%CI 0•98-0•99) and a deficit of 4,926 deaths for week 10-23, 2020.
    Conclusions: The excess mortality existed for two months. The favorable course of the first wave may be explained by a younger age at infection at the beginning of the pandemic, lower contact rates, and a more efficient pandemic management.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; Coronavirus Infections/epidemiology ; Coronavirus Infections/mortality ; Female ; Germany/epidemiology ; Humans ; Infant ; Infant, Newborn ; Influenza, Human/epidemiology ; Influenza, Human/virology ; Male ; Middle Aged ; Orthomyxoviridae ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/mortality ; SARS-CoV-2 ; Seasons ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-09-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 424417-5
    ISSN 1532-2742 ; 0163-4453
    ISSN (online) 1532-2742
    ISSN 0163-4453
    DOI 10.1016/j.jinf.2020.09.012
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  2. Article ; Online: Excess mortality due to COVID-19 in Germany

    Stang, Andreas / Standl, Fabian / Kowall, Bernd / Brune, Bastian / Böttcher, Juliane / Brinkmann, Marcus / Dittmer, Ulf / Jöckel, Karl-Heinz

    Journal of Infection

    2020  Volume 81, Issue 5, Page(s) 797–801

    Keywords Microbiology (medical) ; Infectious Diseases ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 424417-5
    ISSN 1532-2742 ; 0163-4453
    ISSN (online) 1532-2742
    ISSN 0163-4453
    DOI 10.1016/j.jinf.2020.09.012
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  3. Article: Excess mortality due to COVID-19 in Germany

    Stang, A. / Standl, F. / Kowall, B. / Brune, B. / Böttcher, J. / Brinkmann, M. / Dittmer, U. / Jöckel, K. H.

    J Infect

    Abstract: ... The aim is to provide estimates of excess mortality in Germany during this time METHODS: We analyzed age ... than expected for age groups 60-69, 80-89, and 90+ The age group 70-79 years did not show excess mortality ... 10-23, 2020 CONCLUSIONS: The excess mortality existed for two months The favorable course ...

    Abstract OBJECTIVES: The first wave of the SARS-CoV-2 pandemic in Germany lasted from week 10 to 23 in 2020 The aim is to provide estimates of excess mortality in Germany during this time METHODS: We analyzed age-specific numbers of deaths per week from 2016 to week 26 in 2020 We used weekly mean numbers of deaths of 2016-2019 to estimate expected weekly numbers for 2020 We estimated standardized mortality ratios (SMR) and 95% confidence intervals RESULTS: During the first wave observed numbers of deaths were higher than expected for age groups 60-69, 80-89, and 90+ The age group 70-79 years did not show excess mortality The net excess number of deaths for weeks 10-23 was +8,071 The overall SMR was 1•03 (95%CI 1•03-1•04) The largest increase occurred among people aged 80-89 and 90+ (SMR=1•08 and SMR=1•09) A sensitivity analysis that accounts for demographic changes revealed an overall SMR of 0•98 (95%CI 0•98-0•99) and a deficit of 4,926 deaths for week 10-23, 2020 CONCLUSIONS: The excess mortality existed for two months The favorable course of the first wave may be explained by a younger age at infection at the beginning of the pandemic, lower contact rates, and a more efficient pandemic management
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #779274
    Database COVID19

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  4. Article ; Online: Excess mortality due to Covid-19? A comparison of total mortality in 2020 with total mortality in 2016 to 2019 in Germany, Sweden and Spain.

    Kowall, Bernd / Standl, Fabian / Oesterling, Florian / Brune, Bastian / Brinkmann, Marcus / Dudda, Marcel / Pflaumer, Peter / Jöckel, Karl-Heinz / Stang, Andreas

    PloS one

    2021  Volume 16, Issue 8, Page(s) e0255540

    Abstract: Introduction: Excess mortality is a suitable indicator of health consequences of COVID-19 ... because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 ... in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration ...

    Abstract Introduction: Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account.
    Methods: Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019.
    Results: In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974-0.978), and 1.030 (1.023-1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144-1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007-1.011) and 1.083 (1.076-1.090), respectively, whereas results for Spain were virtually unchanged.
    Conclusion: In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.
    MeSH term(s) COVID-19/epidemiology ; COVID-19/mortality ; COVID-19/virology ; Cause of Death ; Databases, Factual ; Germany/epidemiology ; Humans ; Life Expectancy ; SARS-CoV-2/isolation & purification ; Spain/epidemiology ; Sweden/epidemiology
    Language English
    Publishing date 2021-08-03
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0255540
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  5. Article ; Online: Excess mortality due to Covid-19? A comparison of total mortality in 2020 with total mortality in 2016 to 2019 in Germany, Sweden and Spain.

    Bernd Kowall / Fabian Standl / Florian Oesterling / Bastian Brune / Marcus Brinkmann / Marcel Dudda / Peter Pflaumer / Karl-Heinz Jöckel / Andreas Stang

    PLoS ONE, Vol 16, Iss 8, p e

    2021  Volume 0255540

    Abstract: Introduction Excess mortality is a suitable indicator of health consequences of COVID-19 ... because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 ... for Spain were virtually unchanged. Conclusion In 2020, there was barely any excess mortality in Germany ...

    Abstract Introduction Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974-0.978), and 1.030 (1.023-1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144-1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007-1.011) and 1.083 (1.076-1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.
    Keywords Medicine ; R ; Science ; Q
    Subject code 310
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
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  6. Article: Estimation of Excess Mortality in Germany During 2020-2022.

    Kuhbandner, Christof / Reitzner, Matthias

    Cureus

    2023  Volume 15, Issue 5, Page(s) e39371

    Abstract: Background This study estimates the burden of COVID-19 on mortality in Germany. It is expected ... the burden of the COVID-19 pandemic on mortality by the number of officially reported COVID-19-related deaths ... such effects on mortality had been observed during the early COVID-19 pandemic so far. Possible influencing ...

    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.
    Language English
    Publishing date 2023-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.39371
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  7. Article ; Online: Excess mortality analysis for Germany for all three COVID-19 waves in 2020 - 2021

    Weber, Alexej

    medRxiv

    Abstract: ... second waves, the COVID-19 deaths are significantly higher than the excess mortality. We attribute ... the difference to the pre-dying effect. We then compare the excess mortality to the official COVID-19 death ... from excess mortality for different age bands. We also compare the impact of COVID-19 to past influenza waves ...

    Abstract Background and Aims: The reported case and death numbers of the coronavirus disease (COVID-19) are often used to estimate the impact of COVID-19. We observe that during the second half of the first and second waves, the COVID-19 deaths are significantly higher than the excess mortality. We attribute the difference to the pre-dying effect. We then compare the excess mortality to the official COVID-19 death numbers and calculate the infection fatality rates (IFRs) and the percentage of infected individuals from excess mortality for different age bands. We also compare the impact of COVID-19 to past influenza waves and analyze the vaccination effect on excess mortality. Methods: We forecast the baseline mortality from official data on deaths in Germany. Distributing a part of excess mortality into the near future, we lower the baseline simulating the pre-dying effect. From there, we compare the excess mortality to official COVID-19 deaths. From the observed mortality deficit, we estimate the percentage of infected individuals and then estimate the age-dependent IFRs. Results: In the first wave, we find an overall excess mortality of ca. 8 000. For the second wave, the overall excess mortality adds up to ca. 56 000. We find, that the pre-dying effect explains the difference between the official COVID-19 deaths and excess mortality in the second half of the waves to a high degree. Attributing the whole excess mortality to COVID-19, we find that the IFRs are significantly higher in the second wave. In the third wave, we find an excess mortality in mid-age bands which cannot be explained by the official COVID-19 deaths. For the senior band 80+, we find results in favor of a strong and positive vaccination effect for the third COVID-19 wave. Conclusions: We conclude that in the first and second COVID-19 waves, the COVID-19 deaths explain almost all excess mortality when the pre-dying effect is taken into account. In the third wave in 2021, the excess mortality is not very pronounced for the 80+ age band, probably due to vaccination. The partially unvaccinated 40-80 age group experiences a pronounced excess mortality in the third wave while there are too few official COVID-19 deaths to explain the excess. The no-vaccination scenario for the 80+ age band results in a similarly high excess mortality as for the more younger age bands, suggesting a very positive vaccination effect on reduction of COVID-19 deaths.
    Keywords covid19
    Language English
    Publishing date 2021-07-08
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.07.06.21260105
    Database COVID19

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  8. Article ; Online: Erklärbarkeit der altersadjustierten Übersterblichkeit mit den COVID-19-attribuierten Sterbefällen von Januar 2020 bis Juli 2021.

    Wollschläger, Daniel / Schmidtmann, Irene / Fückel, Sebastian / Blettner, Maria / Gianicolo, Emilio

    Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz

    2021  Volume 65, Issue 3, Page(s) 378–387

    Abstract: ... In contrast, age-adjusted excess all-cause mortality is a robust indicator of how the COVID-19 pandemic ... impacts public health. However, in addition to COVID-19 deaths, excess mortality potentially also reflects ... month-district combinations. The Spearman rank correlation between excess mortality and COVID-19 ...

    Title translation Explaining the age-adjusted excess mortality with COVID-19-attributed deaths from January 2020 to July 2021.
    Abstract Background: Estimating COVID-19 mortality is impeded by uncertainties in cause of death coding. In contrast, age-adjusted excess all-cause mortality is a robust indicator of how the COVID-19 pandemic impacts public health. However, in addition to COVID-19 deaths, excess mortality potentially also reflects indirect negative effects of public health measures aiming to contain the pandemic.
    Objectives: The study examines whether excess mortality in Germany between January 2020 and July 2021 is consistent with fatalities attributed to COVID-19 or may be partially due to indirect effects of public health measures.
    Methods: Excess mortality trends for the period from January 2020 to July 2021 were checked for consistency with deaths attributed to COVID-19 in both the German federal states and districts of Rhineland-Palatinate. The expected monthly mortality rates were predicted based on data from 2015-2019, taking into account the population demographics, air temperature, seasonal influenza activity, and cyclic and long-term time trends RESULTS: COVID-19-attributed mortality was included in the 95% prediction uncertainty intervals for excess mortality in 232 of 304 (76.3%) month-state combinations and in 607 of 684 (88.7%) month-district combinations. The Spearman rank correlation between excess mortality and COVID-19-attributed mortality across federal states was 0.42 (95% confidence interval [0.31; 0.53]) and 0.21 (95% confidence interval [0.13; 0.29]) across districts.
    Conclusions: The good agreement of spatiotemporal excess mortality patterns with COVID-19 attributed mortality is consistent with the assumption that indirect adverse effects from public health interventions to contain the COVID-19 pandemic did not substantially contribute to excess mortality in Germany between January 2020 and July 2021.
    MeSH term(s) COVID-19 ; Germany/epidemiology ; Humans ; Influenza, Human/epidemiology ; Mortality ; Pandemics ; SARS-CoV-2
    Language German
    Publishing date 2021-12-04
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1461973-8
    ISSN 1437-1588 ; 1436-9990
    ISSN (online) 1437-1588
    ISSN 1436-9990
    DOI 10.1007/s00103-021-03465-z
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