Cohort-resolved excess mortality in Germany (2000-2024): Patterns and implications for the SARS-CoV-2 era.

Area of Science:

• Epidemiology
• Public Health
• Demography

Background:

• Aggregate mortality statistics may obscure critical subgroup-specific trends during pandemics.
• Understanding demographic variations in mortality is crucial for effective public health interventions.

Purpose of the Study:

• To analyze all-cause mortality in Germany from 2000-2024 using a cohort-resolved framework.
• To identify age-specific excess and under-mortality patterns before, during, and after the SARS-CoV-2 pandemic.
• To assess the relationship between mortality anomalies and SARS-CoV-2 mRNA injection rates across different age groups.

Main Methods:

• Utilized a weekly, cohort-resolved analysis of all-cause mortality across 15 age groups in Germany (2000-2024).
• Modeled expected mortality using pre-pandemic exponential trends and quantified deviations as normalized excess all-cause mortality rates (NEAMR).
• Performed cross-correlation analyses between NEAMR and SARS-CoV-2 mRNA injection rates.

Main Results:

• Sustained NEAMR observed in adults aged 75-79 and 35-49 from late 2021 through 2024, absent in aggregate data.
• Persistent under-mortality detected in cohorts aged 30-34 and 55-59.
• Cross-correlations indicated divergence between NEAMR and mRNA injection rates in most cohorts, particularly during the 2021 'alpha-to-delta' transition.
• Historical excess mortality peaks in older cohorts suggest potential generational vulnerabilities.

Conclusions:

• Cohort-resolved mortality surveillance reveals significant age-specific patterns missed by aggregate statistics.
• Findings underscore the need for high-resolution data to accurately assess public health outcomes and inform targeted interventions.
• Further research is warranted to investigate the drivers of observed mortality anomalies and their relationship with vaccination strategies.