Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 5;118(9):145-151.
doi: 10.3238/arztebl.m2021.0147.

The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic

Alexander Rommel  1 , Elena von der Lippe, Dietrich Plass, Thomas Ziese, Michaela Diercke, Matthias An der Heiden, Sebastian Haller, Annelene Wengler; BURDEN 2020 Study Group
Affiliations

The COVID-19 Disease Burden in Germany in 2020—Years of Life Lost to Death and Disease Over the Course of the Pandemic

Alexander Rommel et al. Dtsch Arztebl Int. .

Abstract

Background: The SARS-CoV-2 pandemic presented major challenges to the health sector in 2020. The burden of disease arising from COVID-19 can be expressed as the number of years of life lost to disease or death. For example, death at age 40 involves a loss of far more years of life than death at age 80.

Methods: The disability-adjusted life years (DALY) lost to COVID-19 were calculated as the sum of the years of life lost through death (YLL) and the number of years lived with disability (YLD), on the basis of laboratory-confirmed notifiable cases of SARS-CoV-2 infection in Germany in 2020 (documented as of 18 January 2021). The methodology was based on that used in the Global Burden of Disease Study. Pre-existing diseases do not enter into the determination of YLL; rather, the residual life expectancy that is applied in this calculation corresponds to a mean age-specific level of morbidity.

Results: 305 641 years of life were lost to COVID-19 in Germany in 2020. The percentage of DALY lost by persons under 70 was 34.8% in men and 21.0% in women. 99.3% of the COVID-19 disease burden was accounted for by death (YLL). The daily average years of life lost due to death was lower for COVID-19 than for the major non-communicable diseases. Persons who died of COVID-19 lost a mean of 9.6 years of life; those who were under 70 when they died lost a mean of 25.2 years of life. Men lost more years of life than women (11.0 vs. 8.1 years).

Conclusion: The effects of COVID-19 on public health can be expressed through the burden of disease indicators. This method yields additional information that should be put to use early in the course of future outbreaks.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The trend, over time, of years of life lost (YLL) among persons with COVID-19 in Germany (daily values and daily averages, 2020) and YLL due to selected other causes of death (daily averages, 2017) Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); other diseases – cause-of-death statistics, 2017, life tables 2016/2018; authors’ own calculations COPD, chronic obstructive pulmonary disease
Figure 2
Figure 2
Years of life lost (YLL) among persons with COVID-19 in Germany in 2020 by age and sex (absolute figures and per 100 000 people) Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); life tables 2016/2018; authors’ own calculations
Figure 3
Figure 3
Years lived with disability (YLD) among persons with COVID-19 in Germany in 2020 by age and sex (absolute figures and per 100 000 people) Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); authors’ own calculations
Figure 4
Figure 4
Overall COVID-19 disease burden (DALY) in Germany in 2020 at the level of the spatial planning regions (Raumordnungsregionen), per 100 000 population; a comparison with a plot based on non-age-standardized data is shown in eFigure 7. Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021), life tables 2016/2018, European standard population 2013; authors’ own calculations DALY, disability-adjusted life years
eFigure 1
eFigure 1
Reported cases of SARS-CoV-2 and reported deaths from COVID-19 in Germany in 2020 over the course of the year Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021)
eFigure 2
eFigure 2
Reported SARS-CoV-2 cases (not including fatal cases) and deaths from COVID-19 in Germany in 2020 by age and sex Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021)
eFigure 3
eFigure 3
Distribution of severity grades of SARS-CoV-2 cases in Germany in 2020 (not including fatal cases) by calendar week Source: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021); authors’ own calculations
eFigure 4
eFigure 4
Estimated excess mortality in Germany in 2020 compared to the number of reported deaths from COVID-19 Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 5
eFigure 5
Estimated excess mortality in Germany in 2020 compared to the number of reported deaths from COVID-19, by age group Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 6
eFigure 6
Modeling of background mortality in Germany, 2015–2020 Source: Destatis, special analysis of fatality figures (33); authors‘ own calculations
eFigure 7
eFigure 7
Overall COVID-19 disease burden (DALY) in Germany in 2020 at the level of the spatial planning regions (Raumordnungsregionen), per 100 000 population Sources: data reported in 2020 as required by the Infection Protection Act (data as of 18 January 2021), life tables 2016/2018, European standard population 2013; authors’ own calculations DALY, disability-adjusted life years
See this image and copyright information in PMC

Comment in

  • Mortality, Burden Of Disease, Life Expectancy, And Methodology.
    Morfeld P. Morfeld P. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):487-488. doi: 10.3238/arztebl.m2021.0240. Dtsch Arztebl Int. 2021. PMID: 34491167 Free PMC article. No abstract available.
  • Inadequate Explanation.
    Gandjour A. Gandjour A. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):488. doi: 10.3238/arztebl.m2021.0241. Dtsch Arztebl Int. 2021. PMID: 34491168 Free PMC article. No abstract available.
  • Overestimated Numbers.
    Kowall B, Jöckel KH, Stang A. Kowall B, et al. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):488-489. doi: 10.3238/arztebl.m2021.0242. Dtsch Arztebl Int. 2021. PMID: 34491169 Free PMC article. No abstract available.
  • Methodological Error.
    Sönnichsen A, Mühlhauser I, Meyer G. Sönnichsen A, et al. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):489. doi: 10.3238/arztebl.m2021.0243. Dtsch Arztebl Int. 2021. PMID: 34491170 Free PMC article. No abstract available.
  • In Reply.
    Rommel A. Rommel A. Dtsch Arztebl Int. 2021 Jul 12;118(27-28):489-490. doi: 10.3238/arztebl.m2021.0244. Dtsch Arztebl Int. 2021. PMID: 34491171 Free PMC article. No abstract available.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Robert Koch-Institut. COVID-19-Dashboard Auswertungen basierend auf den aus den Gesundheitsämtern gemäss IfSG übermittelten Meldedaten. https://experience.arcgis.com/experience/478220a4c454480e823b17327b2bf1d4(last accessed on 9 February 2021)
    1. Kyu HH, Abate D, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1859–1922. - PMC - PubMed
    1. Schilling J, Lehfeld A, Schumacher D, et al. Krankheitsschwere der ersten COVID-19-Welle in Deutschland basierend auf den Meldungen gemäss Infektionsschutzgesetz. Journal of Health Monitoring. 2020;5:2–20.
    1. Robert Koch-Institut. Coronavirus-Krankheit-2019 (COVID-19) (SARS-CoV-2) Falldefinitionen des Robert Koch-Instituts zur Übermittlung von Erkrankungs- oder Todesfällen und Nachweisen von Krankheitserreger, 2020. www.rki.de/DE/Content/Infekt/IfSG/Falldefinition/falldefinition_node.htm... (last accessed on 9 February 2021)
    1. Rommel A, von der Lippe E, Plass D, et al. BURDEN 2020—Burden of disease in Germany at the national and regional level. Bundesgesundheitsbl. 2018;61:1159–1166. - PubMed