Excess mortality in Denmark, Finland, Norway and Sweden during the COVID-19 pandemic 2020-2022

Abstract

Background: The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020-2022.

Methods: Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010-2019 used as reference period. We then compared excess mortality across the countries in 2020-2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses.

Results: While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29-122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14-90), 130 (83-177) and 88 (48-128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022.

Conclusion: Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates-arguably the most accurate available for any region in capturing pandemic-related excess deaths-may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic.

Figure 1

Weekly observed number of deaths (per 100 000) with a trend line (solid line using loess smoothing), using the Danish 2020 population as standard population (age- and sex-standardized), 2010–2022, by country

Figure 2

Weekly number of excess deaths (per 100 000) (with 95% prediction interval) in the pandemic period, weeks 11–52, by country, using the Danish 2020 population as standard population (age- and sex-standardized). Positive values indicate higher than expected weekly mortality, while negative values indicate lower than expected weekly mortality

Figure 3

Annual number of excess deaths (per 100 000) (with 95% prediction interval) by country and year, using the Danish 2020 population as standard population (age- and sex-standardized)