Excess mortality during the SARS-CoV-2 pandemic in the City of Frankfurt/Main, Germany, in 2020 and 2021, adjusted for age trends and pandemic phases

AIMS: Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population. METHODS: Population data for Frankfurt/Main for 2016–2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMR(crude), the mean mortality rate from the years 2016–2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMR(adjusted), this procedure was performed separately for five age groups, and the numbers of expected deaths per age group were added. RESULTS: SMR(crude) was 1.006 (95% CI: 0.980–1.031) in 2020, and 1.047 (95% CI: 1.021–1.073) in 2021. SMR(adjusted) was 0.976 (95% CI: 0.951–1.001) in 2020 and 0.998 (95% CI: 0.973–1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3. CONCLUSION: Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt /Main, mortality would have been greatly overestimated.