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.