Volume 45 - Article 45 | Pages 1355–1372  

COVID-19 fatality in Germany: Demographic determinants of variation in case-fatality rates across and within German federal states during the first and second waves

By Saskia Morwinsky, Natalie Nitsche, Enrique Acosta


Background: Germany experienced one of the lowest COVID-19 case-fatality rates (CFRs) in Western Europe in the first pandemic wave, and further CFR decreases in the spring and summer of 2020. However, Germany’s CFR increased markedly during the second wave, becoming one of the highest in Western Europe. Furthermore, CFRs varied considerably across German federal states. The drivers of this CFR time trend and the state differences remain unclear.

Objective: We aim to identify the contribution to the CFR differences across and within German states of (1) the population age structure, (2) the age structure of confirmed infection rates, and (3) the age-specific fatality.

Methods: We use data documenting COVID-19 cases and deaths from the COVerAGE-DB, applying demographic decomposition methods proposed by Kitagawa and Horiuchi.

Results: The CFR decrease between spring and autumn 2020 in Germany resulted from a shift toward younger ages in confirmed infection rates and decreasing age-specific fatality. The CFR increase that followed was predominantly driven by a shift toward older ages in the age composition of confirmed infection rates. Although most of the CFR variation across German states resulted from differences in the population age distribution, differences in the age structure of detected infection rates contributed substantially to this variation.

Conclusions: Differences in German CFRs depended mainly on the age structure of the population and the confirmed infection rates. Age-specific fatality played a noteworthy role only in CFR changes over time.

Contribution: We provide previously undocumented information for Germany on the factors modulating differences in the COVID-19 fatality across states and over time.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

APC curvature plots: Displaying nonlinear age-period-cohort patterns on Lexis plots
Volume 41 - Article 42

Most recent similar articles in Demographic Research

Measuring short-term mobility patterns in North America using Facebook advertising data, with an application to adjusting COVID-19 mortality rates
Volume 50 - Article 10    | Keywords: COVID-19, data collection, Facebook, mortality, North America, short-term mobility

Immigrant mortality advantage in the United States during the first year of the COVID-19 pandemic
Volume 50 - Article 7    | Keywords: COVID-19, immigrants, mortality

Leaving and returning to the parental home during COVID times in France, Italy, Germany, Spain, and the United Kingdom
Volume 50 - Article 3    | Keywords: behavior, COVID-19, intentions, leaving the parental home, motivations

The COVID-19 pandemic and fertility responses: TFR simulation analysis using parity progressions in South Korea
Volume 49 - Article 32    | Keywords: COVID-19, fertility intentions, marriage intentions, simulation

Partnership satisfaction in Czechia during the COVID-19 pandemic
Volume 49 - Article 24    | Keywords: COVID-19, family, pandemic, partnership, separation