Beyond death counts: how COVID-19 affected excess mortality and productive life-years lost across 28 European states, 2020–2023

Introduction: Excess mortality attributable to COVID-19 has been extensively investigated in the public health literature. This study extends the scope of previous findings by estimating three interrelated measures, excess deaths, excess Years of Life Lost, and excess Years of Potential Productive Life Lost, in 28 European countries across 2020-2023. Materials and methods: Using annual sex- and 5-year age-specific mortality data for 2002-2019, we applied a multiverse modelling strategy combining all possible baseline windows with four alternative trend specifications. Expected mortality for 2020-2023 was obtained from the best-performing specification, derived using model selection criteria, after trimming outlying forecasts. We define excess mortality burden in terms of three measures: excess deaths, excess Years of Life Lost (eYLL), and excess Years of Potential Productive Life Lost (eYPPLL). Excess mortality was estimated by comparing observed and expected deaths, and was used to obtain eYLL and eYPPLL. Sensitivity analyses included alternative trend assumptions, time-series forecasts, and varying life-expectancy and labour market parameters. Results: We identified a total of 1,540,034 excess deaths, corresponding to 16,695,365 eYLL and 1,997,095 eYPPLL. Central and Eastern Europe bore the heaviest burden of excess deaths, while the Northern countries were the least affected by COVID-19 mortality. We identified a relatively high health burden in the working population, particularly among men and in Central and Eastern Europe. The male excess in productive life-years lost (eYPPLL) was the strongest among all three measures, further highlighting mortality burden in younger-aged men. These results underscore varying labour market vulnerability to the pandemic across European states. Conclusion: Our findings underscore marked geographic and sex differences in excess deaths and life-years lost, with particularly high disparities among the working-age population. These patterns emphasise the need for strengthening health systems' resilience and tailoring post-pandemic recovery efforts to the most affected populations.