{
  "abstract": "The COVID-19 pandemic and pandemic response may have long-term consequences. The cumulative impact may be better appraised when post-pandemic years are also considered. For 38 populations with reliable death registration data, we estimated excess deaths for 2020-2025 with granular age stratification. One model (Fa) compared deaths against the mean of 2017-2019. Three other trend models considered changes in mortality rates after 2003 (or after a country reached $20,000 per capita income) factoring trend-of-trends (TTa), including shrinkage (STTa), and factoring also the 2024-2025 data for trend-of-trends calculation (STTa). Slopes (weighted mean -0.62%/year in 2019) and slopes-of-slopes (weighted mean +0.104%/year{superscript 2}) for age-stratified mortality rates were highly heterogeneous across populations. On model average, 4 populations (Luxembourg, Ireland, Sweden, New Zealand) had cumulative death deficits during 2020-2025, while another 6 (Chile, Bulgaria, Japan, Greece, Slovakia, Italy) had >4% excess deaths. Differences were more prominent during 2020-2023, while 33/38 countries had death deficits in 2024-2025. Total 2020-2025 excess deaths were 0.92-2.49 million (2020-2023: 1.99 -2.88 million; 2024-2025: a deficit of 0.39-1.08 million). Lack of age stratification and use of unchanged linear trends for the baseline (as in Lee-Carter modeling) grossly biased excess death estimates upwards. Socioeconomically more vulnerable populations had higher pandemic deaths, but a more pronounced post-pandemic death deficit. Excess death estimates require careful consideration of changing population age structure and long-term mortality trajectories. Post-pandemic deficits, especially in more vulnerable populations, may reflect pandemic deaths of people with modest life expectancy, paid off in 2024-2025.",
  "abstract_shown": true,
  "affiliations": [
    "Stanford University School of Medicine"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "J. Ioannidis"
    },
    {
      "name": "M. Levitt"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fqwkybf68zqzn.bib",
  "cited_by": 1,
  "doi": "10.64898/2026.08.14.26360482",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.14.26360482v2.full",
  "id": "fqwkybf68zqzn",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.14.26360482v2",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "public and global health"
    ],
    [
      "openalex",
      "3317|Insurance, Mortality, Demography, Risk Management"
    ]
  ],
  "openalex": "W7203596489",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.14.26360482v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fqwkybf68zqzn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:29Z",
      "native_id": "10.64898/2026.08.14.26360482",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.14.26360482v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:public and global health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Long-term mortality rate changes and inverse patterns for pandemic and post-pandemic excess mortality",
  "title_text": "Long-term mortality rate changes and inverse patterns for pandemic and post-pandemic excess mortality",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:29Z",
  "url": "https://research.draconitic.com/paper/fqwkybf68zqzn",
  "venue": "medRxiv",
  "versions": []
}