Spatial patterns of excess mortality in the first year of the COVID-19 pandemic in Germany

In order to quantify the impact of the SARS-CoV-2/COVID-19 pandemic, several studies have estimated excess mortality rather than infections or COVID-19-related deaths. The current study investigates excess mortality in Germany in 2020 at a small-scale spatial level (400 counties) and under consideration of demographic changes. Mortality is operationalized using standardized mortality ratios (SMRs), visualized on maps, and analyzed descriptively. Regional mortality and COVID- 19-related morbidity are tested for spatial dependence by the Moran's I index. It is, furthermore, tested whether all-cause mortality is associated with COVID-19-related morbidity by correlation coefficients. Excess mortality only occurrs in a minority of counties. There are large regional disparities of all-cause mortality and COVID-19-related morbidity. In older age groups, both indicators show spatial dependence. (Excess) mortality in older age groups is impacted by COVID-19, but this association is not found for young and middle sge groups.