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Comparative Study
. 2021 Aug 3;16(8):e0255540.
doi: 10.1371/journal.pone.0255540. eCollection 2021.

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  1 , Fabian Standl  1 , Florian Oesterling  2 , Bastian Brune  3   4 , Marcus Brinkmann  5 , Marcel Dudda  3   4 , Peter Pflaumer  6 , Karl-Heinz Jöckel  1 , Andreas Stang  1   7
Affiliations
Comparative Study

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 et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Weekly standardized mortality ratio (SMR) by calendar week in Spain, Germany and Sweden (no consideration of life expectancy).
Fig 2
Fig 2. Cumulative standardized mortality ratio (SMR) by calendar week in Spain, Germany and Sweden (no consideration of life expectancy).
Fig 3
Fig 3. Weekly standardized mortality ratio (SMR) by calendar week in Spain, Germany and Sweden (with consideration of life expectancy).
Fig 4
Fig 4. Cumulative standardized mortality ratio (SMR) by calendar week in Spain, Germany and Sweden (with consideration of life expectancy).
See this image and copyright information in PMC

References

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