Abstract
Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.
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Data availability
The national datasets underlying the findings of this study are not publicly available due to country-specific data protection regulations. The data are stored in controlled-access repositories at national institutes and may be obtained upon direct request to the respective national authorities (see https://euromomo.eu/about-us/partners for detailed contact information). However, updated national z-scores and aggregated data from the weekly EuroMOMO mortality monitoring are publicly available at from the EuroMOMO website: https://euromomo.eu/graphs-and-maps. Specific data inquiries may also be directed to the EuroMOMO hub at euromomo@ssi.dk. Source data are provided with this paper.
Code availability
The algorithm used nationally to calculate expected mortality and analyze the differences between observed and expected mortality per ISO week (as applied in the EuroMOMO network’s weekly mortality monitoring) is available on GitHub: “JensXII/MOMO” (https://github.com/JensXII/MOMO).
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Acknowledgements
The “Excess mortality monitoring in Europe to assess impact of communicable diseases” is a project of the European Centre for Disease Prevention and Control (ECDC) run under the framework contract No. ECDC/2022/025. We thank ECDC and WHO for their continuous support.
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S.K.N. and L.S.V. drafted the first version of the manuscript. S.K.N. performed the pooled analyses and provided the tables and figures. S.K.N., J.N., C.S., A.K., L.R., A.C., T.B., S.N.M., M.A., T.L., G.D., O.L., I.P., B.Z., M.A.H., K.M., I.P., A.P., T.M., E.K., N.R., F.K.D., C.D.B., J.M., A.V., K.E., N.C., L.A., J.K., C.M., S.S., A.P.R., N.K., I.L.G., D.G.B., I.G., A.F., R.W., N.A., T.C., M.B., D.T.B., N.W., M.H., P.J., R.P., N.B., B.S., T.G.K., K.M., and L.S.V. provided data, performed national analyses and/or contributed to the writing of the manuscript and approved the final version. The authors alone are responsible for the views presented in this manuscript and they do not necessarily reflect the views, decisions, or policies of the institutions with which the authors are affiliated.
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Nørgaard, S.K., Nielsen, J., Schjørring, C.B. et al. Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons. Nat Commun (2026). https://doi.org/10.1038/s41467-025-67981-1
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DOI: https://doi.org/10.1038/s41467-025-67981-1
