Excess mortality from COVID-19: weekly excess death rates by age and sex for Sweden and its most affected region

• Published in: European journal of public health Vol. 31; no. 1; pp. 17 - 22
• Main Authors: Modig, Karin, Ahlbom, Anders, Ebeling, Marcus
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2021; Oxford Publishing Limited (England)
• Subjects: Adult; Age; Age Distribution; Age factors in disease; Aged; Aged, 80 and over; Analysis; Cause of Death; Child, Preschool; Comorbidity; COVID-19; COVID-19 - mortality; Death; Death & dying; Fatalities; Female; Global Health; Humans; Infant; Life Expectancy; Life span; Male; Medicin och hälsovetenskap; Men; Middle Aged; Mortality; Mortality - trends; Mortality rates; Pandemics; Population structure; Public health; Regions; SARS-CoV-2; Sex; Sex Distribution; Sex factors in disease; Socioeconomic Factors; Sweden - epidemiology; Women; Sweden
• ISSN: 1101-1262; 1464-360X; 1464-360X
• DOI: 10.1093/eurpub/ckaa218

Abstract Background Sweden has one of the highest numbers of COVID-19 deaths per inhabitant globally. However, absolute death counts can be misleading. Estimating age- and sex-specific mortality rates is necessary in order to account for the underlying population structure. Furthermore, given the difficulty of assigning causes of death, excess all-cause mortality should be estimated to assess the overall burden of the pandemic. Methods By estimating weekly age- and sex-specific death rates during 2020 and during the preceding 5 years, our aim is to get more accurate estimates of the excess mortality attributed to COVID-19 in Sweden, and in the most affected region Stockholm. Results Eight weeks after Sweden’s first confirmed case, the death rates at all ages above 60 were higher than for previous years. Persons above age 80 were disproportionally more affected, and men suffered greater excess mortality than women in ages up to 75 years. At older ages, the excess mortality was similar for men and women, with up to 1.5 times higher death rates for Sweden and up to 3 times higher for Stockholm. Life expectancy at age 50 declined by <1 year for Sweden and 1.5 years for Stockholm compared to 2019. Conclusions The excess mortality has been high in older ages during the pandemic, but it remains to be answered if this is because of age itself being a prognostic factor or a proxy for comorbidity. Only monitoring deaths at a national level may hide the effect of the pandemic on the regional level.