Excess mortality related to the COVID-19 pandemic by age, sex, and cause of death in the Czech Republic

Abstract Background The aim of the study was to estimate the direct and indirect effects of the COVID-19 pandemic on excess all-cause mortality in the Czech Republic by sex, age group and cause of death. Methods National mortality data for the period 2015–2022 were used. For each of the COVID-19 pandemic years (2020–2022), national mortality rates were compared with 2015–2019, and mortality excess was estimated for all causes and selected causes of death separately by sex and age group. Results In the COVID-19 pandemic years 2020, 2021 and 2022, the overall excess in all-cause mortality was 15%, 27% and 6%, respectively; excess deaths due to causes other than COVID-19 were 6%, 4% and 1%, respectively. The overall mortality excess was larger in men than women, both for all causes (31% vs. 23% in 2021) and for COVID-19 deaths (relative risk 1.40 in 2021). There was no overall excess mortality in children and adolescents but in the age group 25–49 years, there were more non-COVID-19 deaths in the pandemic years. During the pandemic, there was no mortality increase in three main groups of causes of death (cardiovascular diseases, cancers, respiratory diseases) but there were increases by 20–40% in mortality from heart failure, diabetes mellitus and neurodegenerative diseases. Conclusions The large increase in all-cause mortality during the pandemic was driven by deaths coded as COVID-19. The lack of excess mortality from the major groups of chronic diseases suggests that the health system coped well with these conditions. The marked rise in deaths from conditions which have been linked with mitochondrial dysfunction merits further investigation.