A new study by Federal Institute for Population Research (BiB) and the French Institute for Demographic Studies (INED), published in the Scientific journal Nature Communications, provides for the first time a detailed spatial analysis of excess mortality in Europe during the COVID-19 pandemic.

Based on previous developments, the researchers estimated the average life expectancy at birth in 2020 and 2021 without a pandemic. These values ​​were then compared with the actual measured life expectancy. The results were surprising: While some regions experienced excess mortality, mortality in other areas remained almost unchanged.

At the beginning of the Corona pandemic, Italy and Spain were particularly affected

In total, the study covers 569 regions in 25 European countries. In the first year of the pandemic, researchers recorded high excess mortality, especially in northern Italy, southern Switzerland, central Spain and Poland. “At its peak, life expectancy was more than two and a half years below the expected value, and this was in those regions where the first major European COVID-19 outbreaks occurred, namely northern Italy and central Spain,” says co-author Dr. Michael Mühlichen from BiB.

Using Italy as an example, the study shows how strong the regional differences were in some countries: in the regions of Bergamo and Cremona in the Milan metropolitan area, life expectancy in 2020 was just over four years below the expected value. In contrast, no increased mortality was measurable in some southern Italian provinces.

In parts of northern and western Germany, Denmark, western and southern France, as well as Norway and Sweden, mortality rates were even below the minimum in 2020.

Eastern Europe particularly affected in the second half of the pandemic

The patterns of excess mortality changed over time: “While 362 regions recorded significant excess mortality in the first year of the pandemic, the figure was as high as 440 in the following year,” reports Dr. Pavel Grigoriev, head of the Mortality Research Group at BiB.

Regionally, excess mortality shifted strongly to Eastern Europe in 2021 and affected men more than women. In Slovakia, Lithuania, Latvia, Hungary, and parts of Poland and the Czech Republic, life expectancy was more than two and a half years below the expected value. In comparison, many Western European regions had lower excess mortality in 2021, although it was mostly higher there than in the previous year.

“The reasons for the large regional differences are complex and can be traced back, among other things, to the different proportion of vulnerable people,” explains Mühlichen. “The extent to which relevant pre-existing conditions are regionally widespread depends on the age structure and risk behavior of the population, which in turn are influenced by socioeconomic conditions.”

East-West divide in Germany too – exceptions in Bavaria

Within Germany, a considerable east-west divide was evident in 2021. In Thuringia, the south and east of Saxony, and the south of Saxony-Anhalt and Brandenburg, the excess mortality was one and a half to two years.

In the former Federal Republic, with the exception of some Bavarian areas, it was less than a year. In the Free State, parts of Upper Palatinate and the Hof region were particularly conspicuous and recorded a comparatively high excess mortality or a loss of life expectancy.

The study also shows that the pandemic initially affected urban areas with high levels of international connectivity. From there, it spread to less connected and peripheral regions.

Study methodology: comparing life expectancy

“Deeper regional analyses enable a differentiated assessment of the differences in excess mortality that are often hidden when viewed at the country level,” emphasizes Grigoriev. “These findings help to better understand excess mortality during the pandemic and to incorporate this into preparedness measures for future pandemics.”

As for the methodology of the study, the extent of the excess and under-mortality determined depends on what the life expectancy recorded during the coronavirus pandemic is compared to. For this study, the long-term development of life expectancy in each region studied before 2020 was taken into account.

On this basis, the most likely values ​​for life expectancy in 2020 and 2021 were forecast using statistical methods. The deviation of these expected values ​​from the actual values ​​indicates the excess or under-mortality in the respective region.

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