Excess mortality during the COVID-19 pandemic: sharp regional contrasts within Europe

The COVID-19 pandemic resulted in excess mortality throughout Europe. A new study, conducted jointly by the French Institute for Demographic Studies (INED) and Germany’s Federal Institute for Population Research (BiB) and published in the prestigious journal Nature Communications, provides the first detailed analysis of regional disparities in excess mortality in Europe in the pandemic years 2020 and 2021.

After identifying 569 European regions (spatial units) located in 25 European Union countries, the study researchers took the historical trend through 2019 for each of them and used it to estimate what life expectancy at birth would have been in 2020 and 2021 without the pandemic. They then compared those projections to actual, observed life expectancy in those regions in the same years. The results show sharp spatial disparities at the regional scale, disparities often difficult to discern in national-scale analyses. 

Nearly 4 years of life expectancy lost in northern Italy in 2020

According to Florian Bonnet, the main author of the study, life expectancy for 2020 decreased by over two and half years in regions of northern Italy, southern Switzerland, central Spain, and eastern Poland. In the northern Italian provinces of Bergamo, Cremona, and Piacenza—pandemic epicenters in February 2020—the drop in expected life span was particularly dramatic: nearly 4 years (see map). A different situation was observed in German, Danish, Norwegian, Swedish, and southern Italian regions, where life expectancies diverged very little from the established figures. In France, the greater Paris region and spatial units close to the German border saw the sharpest life expectancy losses­—a year-and-a-half to two years—whereas the western side of the country was spared. 

Excess mortality shifts to eastern Europe in 2021

In 2021, excess mortality moved east. It was in regions of Poland, Czechia, Hungary, and Slovakia where the number of years of life lost was highest, at over two years; equivalent losses were found in only one region in Italy and one in Spain, countries that had been hit very hard in 2020. In Germany, a marked contrast is observed between the strongly impacted east and the much less impacted west. In France, the values were more homogeneous in 2021 than 2020, with overall life expectancy losses at close to one year. As in 2020, excess mortality in France in 2021 was highest in the department of Seine-Saint-Denis, immediately north of Paris. 

When the regions were ranked, with greatest loss of life expectancy ranked 1, French regions came in higher than 80

Lastly, researchers totaled years of life lost in each of the 569 regions (2020 figure + 2021 figure), then ranked them from greatest loss of life expectancy (1) to region where life expectancy was least affected. Eastern Europe proved the most heavily impacted part of the EU, encompassing a majority of the 50 hardest-hit regions: 36 in Poland, 6 in Slovakia, 2 in Czechia, 1 in Hungary, and 2 in Lithuania. The remaining 3 hardest-hit regions were the northern Italian provinces of Bergamo, Cremona, and Piacenza, heavily impacted in 2020 as indicated above; they fell between 15th and 30th place. In France, the greatest loss of life expectancy was in the department of Seine-Saint-Denis, in 81st place, followed by Val d’Oise in 115th, and Essonne in 130th. All other French departments came in above 150.