Cohort-resolved excess mortality in Germany (2000-2024): Patterns and implications for the SARS-CoV-2 era

Understanding the impact of the SARS-CoV-2 pandemic on mortality
requires more than aggregate statistics. While whole-population
indicators have informed policy, they risk concealing
subgroup-specific patterns. We analysed all-cause mortality in Germany
from 2000 to 2024 using a weekly, cohort-resolved framework across 15
age groups to detect excess and under-mortality before, during, and
after the pandemic.

Expected mortality was modelled using exponential trends from two
decades of pre-pandemic data. Deviations from expectation were
quantified as normalised excess all-cause mortality rates (NEAMR),
enabling the identification of significant, age-specific anomalies.

We found sustained excess mortality in adults aged 75-79 and 35-49
from late 2021 through 2024 -- patterns absent in whole-population
trends. Conversely, cohorts aged 30-34 and 55-59 showed persistent
under-mortality. Earlier peaks in older cohorts (e.g., 85-89 in 2003,
95+ in 2013) suggest generational vulnerabilities potentially linked
to early-life adversity.

Cross-correlation analyses indicate that associations between NEAMR
and SARS-CoV-2 mRNA injection rates often diverge from expected
protective patterns, especially during the 2021 `alpha'-to-`delta'
transition. These findings highlight the need for high-resolution
mortality surveillance. Cohort-resolved analysis reveals signals that
aggregate data obscure, offering a more accurate assessment of public
health outcomes across demographic groups.