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Peer-reviewedCC BY 4.0European journal of epidemiology

Post-pandemic mortality patterns and COVID-19 burden considering multiple death causes

  • Uwe Riedmann1
  • Michael Levitt2
  • Stefan Pilz1
  • John PA Ioannidis3,4
4 affiliations
  1. 1Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
  2. 2Department of Structural Biology, Stanford University, CA 94305 Stanford, USA
  3. 3Stanford Prevention Research Center, Departments of Medicine, Epidemiology and Population Health, and Biomedical Data Science, Stanford University, Stanford, CA, USA
  4. 4Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 3180 Porter Drive, Room A117, Stanford Research Park, Palo Alto, CA 94304, USA
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Abstract

Post-pandemic mortality rates can explore the residual COVID-19 burden and changes in other causes of death. Considering weighted multiple causes of death from death certificates (underlying and others) may help compare post-versus pre-pandemic mortality patterns, while potentially reducing the impact of cause misattribution. Estimates of post-pandemic impact are critical also for proper continuing public health policies (e.g. vaccinations). We retrospectively analyse national all-cause mortality rate ratios between 2024 and pre-pandemic years (2017–2019) for sex-stratified 10-year age groups in Austria. In weighted analyses, the underlying death cause was weighted 50% and other causes shared the remaining 50%. Sensitivity analyses explored different weightings. Cause-specific weightings were also compared between 2024 and 2019. Despite 1212 reported COVID-19 deaths in 2024, all-cause mortality rates were equal or lower in 2024 compared to 2019 in all strata at risk from COVID-19 (i.e., aged 60 years and over). All-cause mortality rates in 2024 were higher than in 2019 in adolescent and young adult strata. The ratio of weighted over unweighted COVID-19 death rates was 0.51–0.58 for age strata 60 years and older and even lower in sensitivity analyses, indicating that COVID-19 deaths were possibly overestimated. Post-pandemic COVID-19 deaths had no visible impact on mortality patterns in Austria and were possibly overcounted. Increased post-pandemic mortality patterns in the young are particularly worrisome.

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Cite

BibTeXRIS
BibTeX
@article{riedmann2026postpandemic,
  title = {{Post-pandemic mortality patterns and COVID-19 burden considering multiple death causes}},
  author = {Uwe Riedmann and Michael Levitt and Stefan Pilz and John PA Ioannidis},
  journal = {European journal of epidemiology},
  year = {2026},
  month = sep,
  doi = {10.1007/s10654-026-01462-7},
  url = {https://doi.org/10.1007/s10654-026-01462-7},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Post-pandemic mortality patterns and COVID-19 burden considering multiple death causes
AU  - Uwe Riedmann
AU  - Michael Levitt
AU  - Stefan Pilz
AU  - John PA Ioannidis
PY  - 2026
DA  - 2026/09/23
JO  - European journal of epidemiology
DO  - 10.1007/s10654-026-01462-7
UR  - https://doi.org/10.1007/s10654-026-01462-7
AB  - Post-pandemic mortality rates can explore the residual COVID-19 burden and changes in other causes of death. Considering weighted multiple causes of death from death certificates (underlying and others) may help compare post-versus pre-pandemic mortality patterns, while potentially reducing the impact of cause misattribution. Estimates of post-pandemic impact are critical also for proper continuing public health policies (e.g. vaccinations). We retrospectively analyse national all-cause mortality rate ratios between 2024 and pre-pandemic years (2017–2019) for sex-stratified 10-year age groups in Austria. In weighted analyses, the underlying death cause was weighted 50% and other causes shared the remaining 50%. Sensitivity analyses explored different weightings. Cause-specific weightings were also compared between 2024 and 2019. Despite 1212 reported COVID-19 deaths in 2024, all-cause mortality rates were equal or lower in 2024 compared to 2019 in all strata at risk from COVID-19 (i.e., aged 60 years and over). All-cause mortality rates in 2024 were higher than in 2019 in adolescent and young adult strata. The ratio of weighted over unweighted COVID-19 death rates was 0.51–0.58 for age strata 60 years and older and even lower in sensitivity analyses, indicating that COVID-19 deaths were possibly overestimated. Post-pandemic COVID-19 deaths had no visible impact on mortality patterns in Austria and were possibly overcounted. Increased post-pandemic mortality patterns in the young are particularly worrisome.
SN  - 0393-2990
SN  - 1573-7284
ER  -