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. 2021 Mar 5;118(9):145-151.
doi: 10.3238/arztebl.m2021.0147.

The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic

Alexander Rommel  1 , Elena von der Lippe, Dietrich Plass, Thomas Ziese, Michaela Diercke, Matthias An der Heiden, Sebastian Haller, Annelene Wengler; BURDEN 2020 Study Group
Affiliations

The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic

Alexander Rommel et al. Dtsch Arztebl Int. .

Abstract

Background: The SARS-CoV-2 pandemic presented major challenges to the health sector in 2020. The burden of disease arising from COVID-19 can be expressed as the number of years of life lost to disease or death. For example, death at age 40 involves a loss of far more years of life than death at age 80.

Methods: The disability-adjusted life years (DALY) lost to COVID-19 were calculated as the sum of the years of life lost through death (YLL) and the number of years lived with disability (YLD), on the basis of laboratory-confirmed notifiable cases of SARS-CoV-2 infection in Germany in 2020 (documented as of 18 January 2021). The methodology was based on that used in the Global Burden of Disease Study. Pre-existing diseases do not enter into the determination of YLL; rather, the residual life expectancy that is applied in this calculation corresponds to a mean age-specific level of morbidity.

Results: 305 641 years of life were lost to COVID-19 in Germany in 2020. The percentage of DALY lost by persons under 70 was 34.8% in men and 21.0% in women. 99.3% of the COVID-19 disease burden was accounted for by death (YLL). The daily average years of life lost due to death was lower for COVID-19 than for the major non-communicable diseases. Persons who died of COVID-19 lost a mean of 9.6 years of life; those who were under 70 when they died lost a mean of 25.2 years of life. Men lost more years of life than women (11.0 vs. 8.1 years).

Conclusion: The effects of COVID-19 on public health can be expressed through the burden of disease indicators. This method yields additional information that should be put to use early in the course of future outbreaks.

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Figures

Figure 1
Figure 1
The trend, over time, of years of life lost (YLL) among persons with COVID-19 in Germany (daily values and daily averages, 2020) and YLL due to selected other causes of death (daily averages, 2017) Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); other diseases – cause-of-death statistics, 2017, life tables 2016/2018; authors’ own calculations COPD, chronic obstructive pulmonary disease
Figure 2
Figure 2
Years of life lost (YLL) among persons with COVID-19 in Germany in 2020 by age and sex (absolute figures and per 100 000 people) Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); life tables 2016/2018; authors’ own calculations
Figure 3
Figure 3
Years lived with disability (YLD) among persons with COVID-19 in Germany in 2020 by age and sex (absolute figures and per 100 000 people) Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); authors’ own calculations
Figure 4
Figure 4
Overall COVID-19 disease burden (DALY) in Germany in 2020 at the level of the spatial planning regions (Raumordnungsregionen), per 100 000 population; a comparison with a plot based on non-age-standardized data is shown in eFigure 7. Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021), life tables 2016/2018, European standard population 2013; authors’ own calculations DALY, disability-adjusted life years
eFigure 1
eFigure 1
Reported cases of SARS-CoV-2 and reported deaths from COVID-19 in Germany in 2020 over the course of the year Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021)
eFigure 2
eFigure 2
Reported SARS-CoV-2 cases (not including fatal cases) and deaths from COVID-19 in Germany in 2020 by age and sex Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021)
eFigure 3
eFigure 3
Distribution of severity grades of SARS-CoV-2 cases in Germany in 2020 (not including fatal cases) by calendar week Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); authors’ own calculations
eFigure 4
eFigure 4
Estimated excess mortality in Germany in 2020 compared to the number of reported deaths from COVID-19 Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 5
eFigure 5
Estimated excess mortality in Germany in 2020 compared to the number of reported deaths from COVID-19, by age group Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 6
eFigure 6
Modeling of background mortality in Germany, 2015–2020 Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 7
eFigure 7
Overall COVID-19 disease burden (DALY) in Germany in 2020 at the level of the spatial planning regions (Raumordnungsregionen), per 100 000 population Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021), life tables 2016/2018, European standard population 2013; authors’ own calculations DALY, disability-adjusted life years
See this image and copyright information in PMC

Comment in

  • Mortality, Burden Of Disease, Life Expectancy, And Methodology.
    Morfeld P. Morfeld P. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):487-488. doi: 10.3238/arztebl.m2021.0240. Dtsch Arztebl Int. 2021. PMID: 34491167 Free PMC article. No abstract available.
  • Inadequate Explanation.
    Gandjour A. Gandjour A. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):488. doi: 10.3238/arztebl.m2021.0241. Dtsch Arztebl Int. 2021. PMID: 34491168 Free PMC article. No abstract available.
  • Overestimated Numbers.
    Kowall B, Jöckel KH, Stang A. Kowall B, et al. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):488-489. doi: 10.3238/arztebl.m2021.0242. Dtsch Arztebl Int. 2021. PMID: 34491169 Free PMC article. No abstract available.
  • Methodological Error.
    Sönnichsen A, Mühlhauser I, Meyer G. Sönnichsen A, et al. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):489. doi: 10.3238/arztebl.m2021.0243. Dtsch Arztebl Int. 2021. PMID: 34491170 Free PMC article. No abstract available.
  • In Reply.
    Rommel A. Rommel A. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):489-490. doi: 10.3238/arztebl.m2021.0244. Dtsch Arztebl Int. 2021. PMID: 34491171 Free PMC article. No abstract available.

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