A recent study analysed excess mortality in German federal states during the “first three years of the covid-19 pandemic” using an actuarial approach. The “first three years of the pandemic” are April 2020 through to March 2023.
The study found moderate average excess mortality in 2020, with significant regional variation, which increased slightly in 2021, maintaining regional patterns. In the “third pandemic year,” April 2022 to March 2023, excess mortality rose sharply, with regional differences diminishing and new states becoming the most affected.
In 2022/23, vaccination rates and trust in institutions were notably associated with excess mortality. States which had higher trust in institutions had higher vaccination rates. And higher vaccination rates were linked to larger increases in excess mortality. Higher vaccination rates were also linked to smaller declines in covid deaths and case fatality rates; in other words, proportionally more covid deaths were recorded in states with higher vaccination rates.
“This robust finding underscores the need for urgent investigation into potential unintended effects of vaccination or other previously neglected mortality drivers,” the study abstract states.
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Table of Contents
Introduction
Actuarial science applies mathematical and statistical methods to assess risk in insurance, pension, finance, investment and other industries. A study titled ‘Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis’ published on 12 November 2025 in Royal Society Open Science used this approach to estimate and analyse excess deaths during the three years April 2020 to March 2023.
The study aimed to estimate excess mortality in individual German federal states during the “covid pandemic.” The results showed substantial variation in excess mortality across federal states, both in the initial extent and in its trajectory over the three years. It refers to April 2020 to March 2021 as the first pandemic year, April 2021 to March 2022 as the second pandemic year and April 2022 to March 2023 as the third pandemic year.
The average excess mortality was moderate in the first year of the pandemic, but some German states, such as Saxony, experienced exceptionally high excess mortality, while others, including Lower Saxony, Mecklenburg-Western Pomerania and Schleswig-Holstein, showed a mortality deficit.
In the second year of the pandemic, excess mortality increased only slightly on average, with a distribution pattern across federal states similar to that observed in the first pandemic year.
The third year of the pandemic saw a sharp increase in excess mortality across nearly all federal states, accompanied by a reduction in inter-state variability. A change in the distribution pattern of excess mortality was also observed, with different federal states exhibiting the highest levels of excess mortality compared to the first two years – indicating that a new factor contributing to excess mortality emerged in the third year.
The study’s findings raised two fundamental questions in the authors’ minds:
- Which factors were responsible for excess mortality in the first two years of the pandemic?
- Which additional factors emerged in the third pandemic year and contributed to the sharp increase and altered regional distribution of excess mortality?
To answer these questions, the study’s authors, in the first instance, compared excess deaths to reported covid infections and deaths.
Covid Impact and Excess Deaths
The excess mortality during the first two years of the covid pandemic in Germany was strongly positively correlated with the reported numbers of covid deaths and infections. This suggested that the variation in excess mortality across federal states was mainly attributed to the varying extent of covid impact in different federal states.
However, the number of reported covid deaths substantially exceeded the number of observed excess mortality deaths – reported covid deaths were 3.5 times higher than the observed excess mortality deaths in the first pandemic year and twice as many in the second pandemic year. At the same time, fewer non-covid-related deaths were reported than statistically expected. The study authors considered two possibilities for this phenomenon:
- measures taken against covid reduced the number of non-covid-related deaths, which is unlikely; or,
- covid replaced other commonly occurring causes of death – possible mechanisms include the inhibition of viral reproduction of other common viruses, or a proportion of deaths reported as covid deaths were in fact due to other causes.
The authors deduce that the second possibility, that covid replaced other commonly occurring causes of death, is more likely and go on to say: “Regardless of which of the two possibilities primarily accounts for the observed pattern, it is important to note that the excess mortality observed in Germany during the first two pandemic years was on par with the excess mortality seen in previous severe influenza seasons, such as the 2017/2018 flu season.”
The study noted that in the first pandemic year, there were 22,405 more deaths than expected (including 78,185 reported covid deaths) and in the second year, 26,973 excess deaths (including 53,883 reported covid deaths). For comparison, in 2017/2018, there were an estimated 25,100 deaths due to influenza.
“This suggests that the reported number of covid-19 deaths [between April 2020 and March 2022] significantly overestimated the true burden of covid-19 on excess mortality, which remained within the range typically seen during major influenza waves in Germany,” the authors said.
Covid Vaccines and Excess Deaths
According to the study, the trajectory of excess mortality deaths and reported covid deaths over the first two years of the pandemic showed an inverse trend. Excess mortality slightly increased from the first to the second pandemic year, while the number of reported covid deaths strongly decreased. This suggests that covid alone cannot fully explain the excess mortality observed in the second year of the pandemic. “The increase in excess mortality during that period must be attributed, at least in part, to the emergence of additional factors beyond covid-19,” the authors said.
The emergence of additional factors beyond covid, such as covid vaccination, may have contributed to the increase in excess mortality during the second year, the study authors said.
In an attempt to establish whether covid vaccines had contributed to excess deaths in the second year (2021/2022), the authors of the study performed a change score analysis.
A change score analysis is a statistical method that is used to assess the difference in a variable measured at two time points. It involves calculating the difference between a variable measured at two time points and helps researchers to understand what has contributed to the change over time.
The change score analysis revealed that the increase in excess mortality from the first to the second pandemic year was higher in federal states with higher vaccination rates, which suggests that covid vaccinations may have increased excess mortality. However, the results were not conclusive; adjusting for excess mortality in the first pandemic year reversed this relationship.
A change score analysis … revealed that the increase in excess mortality from the first to the second pandemic year was higher in federal states with higher vaccination rates, suggesting that the vaccinations may have increased rather than decreased excess mortality. From a purely statistical perspective, this could indeed suggest that the newly emerging factor contributing to excess mortality in the second year of the pandemic is the covid-19 vaccination. However, when adjusting for excess mortality in the first pandemic year, this relationship reversed, suggesting that higher vaccination rates were linked to smaller increases in excess mortality. However, given the high negative correlation between excess mortality in the first pandemic year and vaccination rates, this analysis should be interpreted cautiously, as shared variance makes it challenging to attribute the effect to either factor independently.
Kuhbandner C, Reitzner M. 2025 Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis. R. Soc. Open Sci. 12: 250790. https://doi.org/10.1098/rsos.250790
The study’s findings for the third year were more conclusive. Firstly, the authors ruled out that covid was the reason for excess deaths during the twelve months from April 2022 to March 2023, the third pandemic year.
Although covid-19 is a plausible explanation for excess mortality in the first and, to some extent, the second pandemic year, this does not account for the strong increase in excess mortality observed in the third pandemic year.
Kuhbandner C, Reitzner M. 2025 Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis. R. Soc. Open Sci. 12: 250790. https://doi.org/10.1098/rsos.250790
In the third pandemic year, excess mortality increased strongly, despite a decrease in reported covid deaths. No significant correlation was observed between reported covid deaths and excess mortality, ruling out covid as a primary explanation for the increase in excess mortality.
The data also suggest that long-term effects of SARS-CoV-2 infections, such as “long covid,” are not a significant contributing factor to excess mortality in the third pandemic year.
Readers of The Exposé will not be, but the study’s authors seemed surprised that the analysis found a positive association between covid vaccination rates and excess mortality in the third pandemic year, with excess mortality being highest in federal states with the highest vaccination rates.
Regarding the examined state-specific indicators, the only relevant correlational pattern with excess mortality in the third year of the pandemic is observed in relation to the covid-19 vaccination rates. Surprisingly, all correlations suggest a positive rather than negative association between vaccination rates and excess mortality in the third pandemic year. Specifically, excess mortality in the third year of the pandemic was highest in the federal states with the highest vaccination rates.
Kuhbandner C, Reitzner M. 2025 Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis. R. Soc. Open Sci. 12: 250790. https://doi.org/10.1098/rsos.250790
The authors identified two links between deaths and covid vaccines which indicate covid vaccines did not prevent covid deaths but, instead, may have caused them:
- From the second to the third year of the pandemic (2020/2021 to 20201/2022), the number of reported covid deaths and the SARS-CoV-2 case fatality rate decreased less sharply in states with higher vaccination rates; and,
- states with higher vaccination rates showed an increase in both covid deaths and case fatality rates in the third pandemic year (2022/2023).
The authors found a “surprising” positive correlation between excess mortality and the vaccination rate of a federal state, which persisted even when controlling for prior levels of excess mortality, and in states with higher vaccination rates.
The sharp rise in excess mortality in the third pandemic year is unlikely to be attributable to covid-19, given the continued decline in reported covid-19 deaths … Instead, a surprisingly strong positive correlation emerges with the vaccination rate of a federal state, a correlation that persists even when controlling for prior levels of excess mortality. Moreover, the higher the vaccination rate, the smaller the decline in reported covid-19 deaths and the SARS-CoV-2 case fatality rate from the second to the third pandemic year. In states with higher vaccination rates, there is even a slight increase in both indicators rather than a decrease.
Kuhbandner C, Reitzner M. 2025 Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis. R. Soc. Open Sci. 12: 250790. https://doi.org/10.1098/rsos.250790
The study found that the vaccination pattern in Germany closely mirrors the pattern observed in the increase in excess mortality:
The excess mortality trend is characterised by three key features: (i) a sharp increase in excess mortality starting from the second year of the pandemic, (ii) a significant reduction in the variance across federal states, and (iii) a shift in the ranking order of the federal states with the highest excess mortality. These same three characteristics are also reflected in the vaccination pattern: (i) from the second year of the pandemic onward, covid-19 vaccinations became a new factor in all federal states, (ii) a large proportion of the population was vaccinated in each federal state, that is, all states were strongly affected by this factor, and (iii) the federal states with the highest vaccination rates have risen in the ranking order of the federal states with the highest excess mortality.
Kuhbandner C, Reitzner M. 2025 Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis. R. Soc. Open Sci. 12: 250790. https://doi.org/10.1098/rsos.250790
The correlation analysis in the study reveals a clear pattern, but it is crucial to acknowledge that a hidden confounding factor, coincidentally correlated with vaccination rates, may be responsible for the observed increase in excess mortality, the authors noted. Adding that the reported associations between vaccination rates and excess mortality are correlational in nature and do not imply a causal relationship.
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