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Gill B, Kehler T, Schneider M. Meaning and prediction of 'excess mortality': a comparison of Covid-19 and pre-Covid-19 mortality data in 31 Eurostat countries from 1965 to 2021. Biol Methods Protoc 2024; 9:bpae031. [PMID: 38835854 PMCID: PMC11147805 DOI: 10.1093/biomethods/bpae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
Determining 'excess mortality' makes it possible to compare the burden of disasters between countries and over time, and thus also to evaluate the success of mitigation measures. However, the debate on coronavirus disease 2019 (Covid-19) has exposed that calculations of excess mortalities vary considerably depending on the method and its specification. Moreover, it is often unclear what exactly is meant by 'excess mortality'. We define excess mortality as the excess over the number of deaths that would have been expected counter-factually, that is without the catastrophic event in question. Based on this definition, we use a very parsimonious calculation method, namely the linear extrapolation of death figures from previous years to determine the excess mortality during the Covid-19 pandemic. But unlike most other literature on this topic, we first evaluated and optimized the specification of our method using a larger historical data set in order to identify and minimize estimation errors and biases. The result shows that excess mortality rates in the literature are often inflated. Moreover, they would have exhibited considerable excess mortalities in the period before Covid-19, if this value had already been of public interest at that time. Three conclusions can be drawn from this study and its findings: (i) All calculation methods for current figures should first be evaluated against past figures. (ii) To avoid alarm fatigue, thresholds should be introduced which would differentiate between 'usual fluctuations' and 'remarkable excess'. (iii) Statistical offices could provide more realistic estimates.
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Affiliation(s)
- Bernhard Gill
- Institute for Sociology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Theresa Kehler
- Institute for Sociology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Michael Schneider
- Institute for Sociology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
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Marinetti I, Jdanov D, Grigoriev P, Klüsener S, Janssen F. Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021. PLoS One 2023; 18:e0295763. [PMID: 38127957 PMCID: PMC10734971 DOI: 10.1371/journal.pone.0295763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
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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Affiliation(s)
- Isabella Marinetti
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Dmitri Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
- National Research University Higher School of Economics, Moscow, Russia
| | - Pavel Grigoriev
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Sebastian Klüsener
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
- University of Cologne, Cologne, Germany
- Vytautas Magnus University, Kaunas, Lithuania
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute—KNAW/University of Groningen, The Hague, The Netherlands
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3
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Kolobova M, Jdanov D, Jasilionis D, Shkolnikov VM, Rau R. Variation in mortality burden of the COVID-19 pandemic across federal states in Germany. Eur J Public Health 2023; 33:930-936. [PMID: 37470231 PMCID: PMC10567244 DOI: 10.1093/eurpub/ckad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Intra-annual excess mortality is the most reliable measure of losses of lives due to short-term risk factors. The objectives of our study are (i) to estimate excess mortality across German states in the course of the coronavirus disease 2019 (COVID-19) pandemic years 2020 and 2021 and (ii) to identify possible regional-level determinants of spatial inequality in pandemic-related excess mortality. METHODS We use weekly mortality data series for the calculation of weekly death rates, standardized by age for each federal state of Germany. We estimate the expected level of mortality as state-specific mortality trends and excess mortality in 2020 and 2021. We explore ecological statistical relationships between excess mortality, COVID-19 morbidity, and selected regional socioeconomic indicators using fixed-effects regression models. RESULTS Our study shows that during the first pandemic year, there was South-to-North gradient in excess mortality in Germany, with excess mortality being higher in the South. Over the course of the second pandemic year 2021, this gradient changed to become an East-to-West gradient, with excess mortality being higher in the East. The results of the study show stronger effects of COVID-19 morbidity on excess mortality in East Germany. State-level indicators reflecting economic activity, employment, and capacity of intensive care units show significant correlations with excess mortality across the states. CONCLUSIONS The results show pronounced state-level differences in the magnitude of excess mortality during the COVID-19 pandemic in Germany. Economic activity, employment and capacity of intensive care units were the most important state-level characteristics associated with the observed spatial variations in excess mortality.
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Affiliation(s)
- Marina Kolobova
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Dmitri Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Rostock, Germany
- Vytautas Magnus University, Kaunas, Lithuania
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Rostock, Germany
- International Laboratory for Population and Health, National Research University Higher School of Economics, Moscow, Russia
| | - Roland Rau
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Rostock, Rostock, Germany
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Rockenfeller R, Günther M, Mörl F. Reports of deaths are an exaggeration: all-cause and NAA-test-conditional mortality in Germany during the SARS-CoV-2 era. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221551. [PMID: 37538740 PMCID: PMC10394418 DOI: 10.1098/rsos.221551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
Counts of SARS-CoV-2-related deaths have been key numbers for justifying severe political, social and economical measures imposed by authorities world-wide. A particular focus thereby was the concomitant excess mortality (EM), i.e. fatalities above the expected all-cause mortality (AM). Recent studies, inter alia by the WHO, estimated the SARS-CoV-2-related EM in Germany between 2020 and 2021 as high as 200 000. In this study, we attempt to scrutinize these numbers by putting them into the context of German AM since the year 2000. We propose two straightforward, age-cohort-dependent models to estimate German AM for the 'Corona pandemic' years, as well as the corresponding flu seasons, out of historic data. For Germany, we find overall negative EM of about -18 500 persons for the year 2020, and a minor positive EM of about 7000 for 2021, unveiling that officially reported EM counts are an exaggeration. In 2022, the EM count is about 41 200. Further, based on NAA-test-positive related death counts, we are able to estimate how many Germans have died due to rather than with CoViD-19; an analysis not provided by the appropriate authority, the RKI. Through 2020 and 2021 combined, our due estimate is at no more than 59 500. Varying NAA test strategies heavily obscured SARS-CoV-2-related EM, particularly within the second year of the proclaimed pandemic. We compensated changes in test strategies by assuming that age-cohort-specific NAA-conditional mortality rates during the first pandemic year reflected SARS-CoV-2-characteristic constants.
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Affiliation(s)
- R. Rockenfeller
- Mathematical Institute, University of Koblenz, Koblenz, Germany
| | - M. Günther
- Computational Biophysics and Biorobotics, Institute for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Stuttgart, Germany
- Friedrich–Schiller–Universität, Jena, Germany
| | - F. Mörl
- Forschungsgesellschaft für Angewandte Systemsicherheit und Arbeitsmedizin mbH, AG Biomechanik and Ergonomie, Erfurt, Germany
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Kuhbandner C, Reitzner M. Estimation of Excess Mortality in Germany During 2020-2022. Cureus 2023; 15:e39371. [PMID: 37378220 PMCID: PMC10292034 DOI: 10.7759/cureus.39371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
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.
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Steul K, Heudorf U, Uphoff H, Kowall B. Excess mortality during the SARS-CoV-2 pandemic in the City of Frankfurt/Main, Germany, in 2020 and 2021, adjusted for age trends and pandemic phases. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc08. [PMID: 37261058 PMCID: PMC10227495 DOI: 10.3205/dgkh000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population. Methods Population data for Frankfurt/Main for 2016-2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMRcrude, the mean mortality rate from the years 2016-2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMRadjusted, this procedure was performed separately for five age groups, and the numbers of expected deaths per age group were added. Results SMRcrude was 1.006 (95% CI: 0.980-1.031) in 2020, and 1.047 (95% CI: 1.021-1.073) in 2021. SMRadjusted was 0.976 (95% CI: 0.951-1.001) in 2020 and 0.998 (95% CI: 0.973-1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3. Conclusion Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt /Main, mortality would have been greatly overestimated.
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Affiliation(s)
- Katrin Steul
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ursel Heudorf
- Institute of Hygiene and Environmental Medicine, Justus Liebig University, Giessen, Germany
| | - Helmut Uphoff
- Department of Infectious Disease Epidemiology, Hessian State Examination and Investigation Office in Health Care (HLPUG), Dillenburg, Germany
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany
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Myck M, Oczkowska M, Garten C, Król A, Brandt M. Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland. BMC Public Health 2023; 23:177. [PMID: 36703167 PMCID: PMC9878483 DOI: 10.1186/s12889-022-14909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
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.
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Affiliation(s)
- Michał Myck
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441, Szczecin, Poland. .,University of Greifswald, 17489, Greifswald, Germany. .,Institute for the Study of Labor, 53113, Bonn, Germany.
| | - Monika Oczkowska
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441 Szczecin, Poland
| | - Claudius Garten
- grid.5675.10000 0001 0416 9637TU Dortmund University, August-Schmidt-Straße 4, 44227 Dortmund, Germany
| | - Artur Król
- Centre for Economic Analysis (CenEA), ul. Cyfrowa 2, 71-441 Szczecin, Poland
| | - Martina Brandt
- grid.5675.10000 0001 0416 9637TU Dortmund University, August-Schmidt-Straße 4, 44227 Dortmund, Germany
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8
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Catalano R, Casey JA, Gemmill A, Bruckner T. Expectations of non-COVID-19 deaths during the pre-vaccine pandemic: a process-control approach. BMC Public Health 2023; 23:155. [PMID: 36690971 PMCID: PMC9870657 DOI: 10.1186/s12889-022-14829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/07/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Debate over "social distancing" as a response to the pandemic includes the claim that disrupting clinical and public health programming dependent on human-to-human contact increased non-COVID-19 deaths. This claim warrants testing because novel pathogens will continue to emerge. Tests, however, appear frustrated by lack of a convention for estimating non-COVID-19 deaths that would have occurred had clinical and public health programming during the pre-vaccine pandemic remained as efficacious as in the pre-pandemic era. Intending to hasten the emergence of such a convention, we describe and demonstrate "new-signal, prior-response expectations" suggested by research and methods at the intersection of epidemiology and process control engineering. METHODS Using German data, we estimate pre-pandemic public health efficacy by applying Box-Jenkins methods to 271 weekly counts of all-cause deaths from December 29 2014 through March 8 2020. We devise new-signal, prior-response expectations by applying the model to weekly non-COVID-19 deaths from March 9 2020 through December 26 2020. RESULTS The COVID-19 pandemic did not coincide with more non-COVID-19 deaths than expected from the efficacy of responses to pre-pandemic all-cause deaths. CONCLUSIONS New-signal, prior-response estimates can contribute to evaluating the efficacy of public health programming in reducing non-COVID-19 deaths during the pre-vaccine pandemic.
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Affiliation(s)
- Ralph Catalano
- School of Public Health, University of California, Berkeley, CA, 94720, USA.
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tim Bruckner
- Program in Public Health and Center for Population, Inequality and Policy, University of California, Irvine, USA.
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9
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Riou J, Hauser A, Fesser A, Althaus CL, Egger M, Konstantinoudis G. Direct and indirect effects of the COVID-19 pandemic on mortality in Switzerland. Nat Commun 2023; 14:90. [PMID: 36609356 PMCID: PMC9817462 DOI: 10.1038/s41467-022-35770-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
The direct and indirect impact of the COVID-19 pandemic on population-level mortality is of concern to public health but challenging to quantify. Using data for 2011-2019, we applied Bayesian models to predict the expected number of deaths in Switzerland and compared them with laboratory-confirmed COVID-19 deaths from February 2020 to April 2022 (study period). We estimated that COVID-19-related mortality was underestimated by a factor of 0.72 (95% credible interval [CrI]: 0.46-0.78). After accounting for COVID-19 deaths, the observed mortality was -4% (95% CrI: -8 to 0) lower than expected. The deficit in mortality was concentrated in age groups 40-59 (-12%, 95%CrI: -19 to -5) and 60-69 (-8%, 95%CrI: -15 to -2). Although COVID-19 control measures may have negative effects, after subtracting COVID-19 deaths, there were fewer deaths in Switzerland during the pandemic than expected, suggesting that any negative effects of control measures were offset by the positive effects. These results have important implications for the ongoing debate about the appropriateness of COVID-19 control measures.
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Affiliation(s)
- Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Federal Office of Public Health, Bern, Switzerland
| | - Anthony Hauser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Federal Office of Public Health, Bern, Switzerland
| | - Anna Fesser
- Federal Office of Public Health, Bern, Switzerland
| | - Christian L Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Garyfallos Konstantinoudis
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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10
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Levitt M, Zonta F, Ioannidis JPA. Comparison of pandemic excess mortality in 2020-2021 across different empirical calculations. ENVIRONMENTAL RESEARCH 2022; 213:113754. [PMID: 35753371 PMCID: PMC9225924 DOI: 10.1016/j.envres.2022.113754] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 05/02/2023]
Abstract
Different modeling approaches can be used to calculate excess deaths for the COVID-19 pandemic period. We compared 6 calculations of excess deaths (4 previously published [3 without age-adjustment] and two new ones that we performed with and without age-adjustment) for 2020-2021. With each approach, we calculated excess deaths metrics and the ratio R of excess deaths over recorded COVID-19 deaths. The main analysis focused on 33 high-income countries with weekly deaths in the Human Mortality Database (HMD at mortality.org) and reliable death registration. Secondary analyses compared calculations for other countries, whenever available. Across the 33 high-income countries, excess deaths were 2.0-2.8 million without age-adjustment, and 1.6-2.1 million with age-adjustment with large differences across countries. In our analyses after age-adjustment, 8 of 33 countries had no overall excess deaths; there was a death deficit in children; and 0.478 million (29.7%) of the excess deaths were in people <65 years old. In countries like France, Germany, Italy, and Spain excess death estimates differed 2 to 4-fold between highest and lowest figures. The R values' range exceeded 0.3 in all 33 countries. In 16 of 33 countries, the range of R exceeded 1. In 25 of 33 countries some calculations suggest R > 1 (excess deaths exceeding COVID-19 deaths) while others suggest R < 1 (excess deaths smaller than COVID-19 deaths). Inferred data from 4 evaluations for 42 countries and from 3 evaluations for another 98 countries are very tenuous. Estimates of excess deaths are analysis-dependent and age-adjustment is important to consider. Excess deaths may be lower than previously calculated.
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Affiliation(s)
- Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA 94305, USA
| | - Francesco Zonta
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, 201210, China
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA; Department of Statistics, Stanford University, Stanford, CA 94305, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA 94305, USA.
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11
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Höhle M. Comment “On the role of data, statistics and decisions in a pandemic” by Jahn et al. ASTA ADVANCES IN STATISTICAL ANALYSIS 2022; 106:383-386. [PMID: 35754744 PMCID: PMC9206418 DOI: 10.1007/s10182-022-00451-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022]
Abstract
We comment the paper by Jahn et al. (On the role of data, statistics and decisions in a pandemic, 2022).
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Affiliation(s)
- Michael Höhle
- Department of Mathematics, Stockholm University, 10691 Stockholm, Sweden
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12
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Jahn B, Friedrich S, Behnke J, Engel J, Garczarek U, Münnich R, Pauly M, Wilhelm A, Wolkenhauer O, Zwick M, Siebert U, Friede T. Authors’ response: on the role of data, statistics and decisions in a pandemic. ASTA ADVANCES IN STATISTICAL ANALYSIS 2022; 106:403-405. [PMID: 35967605 PMCID: PMC9362421 DOI: 10.1007/s10182-022-00460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Sarah Friedrich
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Joachim Behnke
- Zeppelin University Friedrichshafen, Friedrichshafen, Germany
| | - Joachim Engel
- Pädagogische Hochschule Ludwigsburg, Ludwigsburg, Germany
| | | | - Ralf Münnich
- Economic and Social Statistics, Trier University, Trier, Germany
| | - Markus Pauly
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Adalbert Wilhelm
- Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Olaf Wolkenhauer
- Department of Systems Biology & Bioinformatics, University of Rostock and Leibniz-Institute for Food Systems Biology, Technical University of Munich, Munchen, Germany
| | | | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital; Harvard Medical School, Boston, MA USA
- Center for Health Decision Science and Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
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Schabus M, Eigl ES, Widauer SS. The coronavirus pandemic: Psychosocial burden, risk-perception, and attitudes in the Austrian population and its relation to media consumption. Front Public Health 2022; 10:921196. [PMID: 36033772 PMCID: PMC9399513 DOI: 10.3389/fpubh.2022.921196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 01/22/2023] Open
Abstract
Objective The aim was to assess the psychosocial burden, risk-perception and attitudes regarding the coronavirus pandemic among the Austrian population after the second infection wave in Austria. Methods A self-designed questionnaire was available online from 17th January to 19th February 2021. Knowledge, attitudes, fears, and psychosocial burdens were collected in a comprehensive convenience sample of 3,848 adults from the Austrian general population. Results 67.2% reported their greatest fear was that a close relative could be infected; the fear of dying from COVID-19 oneself, however, was mentioned least frequently (15.2%). Isolation from family and friends (78%), homeschooling for parents (68.4%), and economic consequences (67.7%) were perceived as most stressful factors during the pandemic. Personal risk for COVID-19-associated (ICU) hospitalization was overestimated 3- to 97-fold depending on age group. Depending on the media mainly consumed, the sample could be divided into two subsamples whose estimates were remarkably opposite to each other, with regular public media users overestimating hospitalization risk substantially more. Conclusion The results show a high degree of psychosocial burden in the Austrian population and emphasize the need for more objective risk communication in order to counteract individually perceived risk and consequently anxiety. Altogether data call for a stronger focus and immediate action for supporting mental well-being and general health in the aftermath of the coronavirus pandemic.
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Wollschläger D, Schmidtmann I, Fückel S, Blettner M, Gianicolo E. [Explaining the age-adjusted excess mortality with COVID-19-attributed deaths from January 2020 to July 2021]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:378-387. [PMID: 34862925 PMCID: PMC8643124 DOI: 10.1007/s00103-021-03465-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
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.
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Affiliation(s)
- Daniel Wollschläger
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Irene Schmidtmann
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | | | - Maria Blettner
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Emilio Gianicolo
- Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Lecce, Italien
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Vorwort der Herausgeber. ASTA WIRTSCHAFTS- UND SOZIALSTATISTISCHES ARCHIV 2022. [PMCID: PMC8924941 DOI: 10.1007/s11943-022-00304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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De Nicola G, Kauermann G. An update on excess mortality in the second year of the COVID-19 pandemic in Germany. ASTA WIRTSCHAFTS- UND SOZIALSTATISTISCHES ARCHIV 2022. [PMCID: PMC8922398 DOI: 10.1007/s11943-022-00303-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
In this short note, we apply the method of De Nicola et al. (2022) to the most recent available data, thereby providing up-to-date estimates of all-cause excess mortality in Germany for 2021. The analysis reveals a preliminary excess mortality of approximately 2.3% for the calendar year considered. The excess is mainly driven by significantly higher excess mortality in the 60-79 age group.
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