Lives saved, lives lost and under-reported Covid-19 deaths: Excess and non-excess mortality in relation to cause-specific mortality during the Covid-19 pandemic in Sweden

The number of confirmed COVID-19 deaths differed across countries for several reasons, including the timing and pathways of the spread of the virus and societies’ responses to it. Patterns also differed between regions and groups within countries. We combine data on excess mortality with data on cause-of-death specific mortality in the case of Sweden to identify which groups had excess mortality beyond what can be captured by analyses of Covid-19 specific deaths. We also explore the possibility that some groups may have benefited in terms of reduced all-cause mortality, potentially due to home-centered living conditions during the pandemic. In contrast to the idea that the pandemic primarily hastened inevitable deaths, our results show that many of those who died in 2020 would not have done so in this year without the occurrence of the pandemic. We also find indication of underreporting of COVID-19 mortality, mainly during the first part of 2020 when widespread testing had not yet been implemented. This pattern is most pertinent for individuals with a migrant background. We also found groups for which mortality decreased substantially during the pandemic, even when accounting for COVID-19 mortality. Progression across the first and second waves of the pandemic during 2020 shows that more groups appeared to have become protected over time and that there was less replacement mortality and under-reporting of COVID-19 deaths towards the end of 2020.