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53,800 more deaths than expected in 2022: higher excess mortality than in 2020 and 2021
Nathalie Blanpain (INSEE)
In 2022, the observed deaths significantly exceeded those expected in the absence of a Covid-19 epidemic or other unusual events such as episodes of influenza or extreme heat, etc.
Excess mortality, i.e. the excess of observed deaths over those expected, was slightly higher in 2022 (8.7%) than in 2021 (6.9%) and 2020 (7.8%). Yet, probably thanks to vaccination and herd immunity, the Covid-19 epidemic was less deadly in 2022: there were 38,300 deaths of people with Covid-19 in hospitals and establishments for elderly according to Public Health France, significantly less than in 2021 (59,100). The number of death certificates with a “Covid-19” mention is also falling. Deaths from causes other than Covid-19 therefore increased in 2022. The year uncharacteristically had two episodes of influenza, due to a late epidemic in March-April and an early one in December. Extreme heat events in summer caused more deaths in 2022 than in 2021.
Finally, the Covid-19 epidemic may have led to an increase in deaths since 2020 due to indirect effects, such as postponements of operations, a drop in screening for other diseases, etc. However, these possible impacts have not yet been measured. There may also be an interruption or pause in the downward trend in mortality at each age, but it is not yet possible to identify it.
INSEE PREMIERE
No. 1951 _
Released: 06/06/2023
STUDY DOCUMENTATION
Summary
In 2022, observed deaths exceeded those expected by 53,800
The excess of deaths measures the impact of Covid-19, but also that of other unusual events
In 2022, higher excess mortality than in 2021 and 2020
Before 55 and after 85, higher excess mortality than in 2021
Increase in the excess mortality of women and maintenance of that of men
In 2022, observed deaths exceeded those expected by 53,800
What is the level of excess mortality in 2022? To answer this question, observed deaths from all causes are compared to those expected in the absence of a Covid-19 outbreak or other unusual events, taking into account the growing and aging population, as well as than the downward trend in the risk of death at each age that could be observed before the appearance of Covid-19. The gap between observed and expected deaths measures both the direct and indirect effects of the Covid-19 epidemic, but also the effects of other unusual phenomena specific to the year 2022,
If the mortality probabilities by sex and age had fallen between 2020 and 2022 at the same rate as over the 2010-2019 period ( methods ), 621,200 deaths would have occurred in 2022, i.e. 8,000 more than in 2019 ( Figure 1 ). This increase would have been the combined result of two factors ( figure 2 ): +28,600 deaths due to the increase and aging of the population which mechanically increase the number of deaths, with a probability of dying at each age identical to that of 2019, and -20,600 deaths due to the downward trend in mortality probabilities.
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The year 2022 finally counted 675,000 deaths, i.e. 53,800 more deaths than expected. This excess of deaths is greater in 2022 than in 2021 (42,700) and than in 2020 (48,400), years which had already experienced a high excess mortality, mainly explained by the Covid-19 epidemic. In 2022, the difference between the number of observed and expected deaths varies from 48,000 to 58,000 deaths depending on the assumption used, more or less rapid decline in mortality probabilities for the calculation of expected deaths (extension of the trends of 2005 to 2019 or from 2014 to 2019).
The excess of deaths measures the impact of Covid-19, but also that of other unusual events
Since the start of the epidemic, Public Health France (SpFrance) has been counting, for surveillance purposes, the deaths of people with Covid-19 in hospital or in establishments for the elderly, whether or not the virus is the cause. initial of death ( sources ). The Center for Epidemiology on the Medical Causes of Death (CépiDc) estimates the number of death certificates with a mention of Covid-19 for all places of death combined, including at home.
Covid-19 deaths and the gap between observed and expected deaths do not reflect the same thing ( Figure 3). Deaths linked to Covid-19, monitored by SpFrance and by CépiDc, include deaths of frail people who would have been the consequence of another cause in the absence of an epidemic (diabetes, cardiovascular disease, etc.). These deaths are not counted in the difference between the number of expected and observed deaths, because they are counted in the observed, but also in the expected. Conversely, the gap between observed and expected deaths may be increased by deaths indirectly caused by Covid-19 (following postponements of care, reduced screening, etc.), as well as by additional deaths due to intense flu or high heat.containment (reduction of road accidents, certain contagious diseases thanks to the reduction of contacts, etc.).
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In 2022, there were 8.7% more deaths than expected, compared to 6.9% in 2021 and 7.8% in 2020. This difference, which can be described as excess mortality, is therefore in 2022 higher than those of 2020 and 2021. The excess mortality of 2022 is quite close to that of the same months in 2021, except in July and December when it is significantly higher: 13% in July 2022, against 1% in July 2021; 25% in December 2022, compared to 15% in December 2021 ( figure 5). The December 2022 peak (25%) is the third highest excess mortality peak over the entire period from 2020 to 2022, after those observed during the first two waves of Covid-19 in 2020 (33% in April and 31% in november).
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However, even if the number of deaths by underlying cause is not yet known, the Covid-19 epidemic was most likely less deadly in 2022 than in 2021: there were 38,300 deaths of people with Covid-19 in 2022 according to SpFrance, significantly less than in 2021 (59,100); the CépiDc also records a drop in the number of death certificates with Covid-19 mention between 2021 and 2022. This lower mortality linked to Covid-19 is visible only in the first half of the year, from January to May, with approximately 20,000 fewer deaths linked to Covid-19 (according to SpFrance or CépiDc). Early 2022, a large majority of the population had received at least two doses of the vaccine, which was not the case at the beginning of the previous year. For example, the 1April 2021, only 7% of 70-74 year olds were vaccinated with two injections, compared to 85% on August 1, 2021 [Open in a new tabSp France, 2023b ]. Vaccination is one of the factors that has reduced the mortality rate linked to Covid-19: for example, in October 2021, among those aged 20 or over, this rate is nine times lower for fully vaccinated people than for those not vaccinated [Open in a new tabDres, 2021 ]. In addition, the Omicron variant, predominant from the start of 2022, resulted in less severe forms compared to the previous variants (Alpha and Delta).
It was therefore deaths due to causes other than Covid-19 that increased in 2022. First of all, the year 2022 had two unusual episodes of influenza: a first late epidemic in March-April, then an early second in December [Open in a new tabSpFrance, 2023a ], even though the flu was almost absent in 2021 [Open in a new tabSpFrance, 2023c ]. The peak in mortality in December 2022 particularly affected France and the countries of Northern Europe [Open in a new tabEurostat, 2023 ]. In addition, heat waves caused more deaths in 2022 (2,800 from all causes) than in 2021 (200) [Open in a new tabSp France, 2022a ]. High temperatures for much of the summer may also have led to deaths outside of heat waves.
In addition, the Covid-19 epidemic may have led to an increase in deaths in 2021 and 2022 due to indirect effects, such as postponements of operations or the drop in screening for other diseases in 2020 [Open in a new tabSpFrance, 2022b ]. The detailed analysis of the causes of death by the CépiDc will provide additional explanations for this increase.
Before 55 and after 85, higher excess mortality than in 2021
In 2022, observed deaths are higher than expected deaths for all age groups, with excess mortality varying from +4% for 55-64 year olds to +11% for 75-84 year olds. Compared to 2021, it increased before age 55 and after age 85 ( figure 6). Deaths of people under the age of 15 are notably more numerous than expected in 2022 (+6%), whereas they were lower in 2021 (-3%). Between ages 15 and 34, excess mortality also increased significantly (+10%, compared to +3% in 2021); it has also increased, to a lesser extent, among 35-54 year olds. However, according to SpFrance, deaths in hospital of people under 55 with Covid-19 were fewer in 2022 than in 2021 [Open in a new tabSp France, 2023b ]. An increase in deaths indirectly linked to the epidemic (postponement of operations, drop in screenings, etc.) or to another unusual event (influenza, episodes of intense heat, etc.), and/or a drop in deaths avoided could explain this higher excess mortality at these ages. Before age 55, the difference between the number of observed and expected deaths is 3,500 people in 2022, which represents 7% of the total difference (53,800).
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Excess mortality is stable for 75-84 year olds: in 2022, as in 2021, they are the most severely affected (11% more deaths than expected). This stability suggests that the various downward effects on the number of deaths (vaccination, less virulent Omicron variant, etc.) would have been offset by the upward effects (flu, heat waves and/or increase in other deaths).
Excess mortality increased between 2021 and 2022 for those aged 85 or over, and especially for those aged 95 or over. After an increase in deaths following a crisis, the “harvest” effect reduces mortality in the following years because some of the most vulnerable people have died. In 2021, this effect had probably contributed to a significant reduction in the mortality of older people [ Blanpain, Papon, 2021 ]. In 2022, it appears to have been more than offset by excess deaths. As for the youngest, deaths in hospital for octogenarians and nonagenarians linked to Covid-19 were fewer in 2022 than in 2021 [Open in a new tabSp France, 2023b ]. It is therefore deaths due to other causes that must have contributed to increasing the excess mortality of the oldest.
Increase in the excess mortality of women and maintenance of that of men
In 2022, the excess mortality of women increased (8%, compared to 5% in 2021), while that of men is stable (9%). It is above all the increase in the mortality of women aged 85 or over that explains the increase. For example, among women aged 85 to 94, deaths exceeded expected deaths by 7% in 2022, compared to 4% in 2021. As for the stability of excess mortality among men, it comes from an increase among 85 years or more compensated by a drop between 55 and 84 years.
Among women aged 15 to 34, excess mortality is particularly high in 2022 (16%), whereas it was moderate in 2021 (3%). The excess mortality of men of the same age has also increased (8%, compared to 3% in 2021). About 6,900 deaths of women or men between the ages of 15 and 34 took place, 600 more than expected. In 2022, fatal road accidents increased for 18-34 year olds (+12%, i.e. +109 people). However, they are far from fully explaining the rise in excess mortality at these ages, which is therefore due to other factors.
https://www.insee.fr/fr/statistiques/7628176
