In Reply

Letter to the Editor Increased Mortality in Germany and in the Individual German States During the SARS-CoV-2/COVID-19 Pandemic in 2020 and 2021 by Peter Morfeld, Barbara Timmermann, Philip Lewis, and Thomas Erren in issue 33–34/2022

We emphasized that “the usual standardization by five-year age groups was not performed” (1) and referred to (2): “SMRs as calculated for Germany in our study are potentially overestimated because we cannot adjust for age ... appropriately.” In this respect, we agree with the authors of the Letter to the Editor about the methodological evaluation of the overall SMRs. “However, demographic shift plays only a minor role in the comparison of adjacent periods [that is, 2021 as compared to 2020]; especially changes in the SMR curve that occur during one year are almost unaffected.” (1). “Thus, we focus on changes of SMRs” (2): e.g., the course of SMR (Figure 1, [1]) and the SMR changes in the federal states (Figure 2, [1]). Accordingly, we reported exclusively about SMR comparisons in both the Results section (with the exception of the first descriptive sentences) and the Discussion section (1). During the COVID-19 pandemic, we repeatedly asked for mortality data to be made available in a more detailed manner, for example in (2); we therefore welcome the fact that this has been implemented by the German Federal Statistical Office. We also welcome the initiative of the authors of the Letter to the Editor to take up this important topic.

DOI: 10.3238/arztebl.m2022.0349

On behalf of the authors:

Peter Morfeld

Universität zu Köln, Institut und Poliklinik für Arbeitsmedizin, Umweltmedizin und Präventionsforschung, Uniklinik Köln, Cologne, Germany

Conflict of interest statement:

The author declares that no conflict of interest exists.

References

1. Morfeld P, Timmermann B, Lewis P, Erren T: Increased mortality in Germany and in the individual German states during the SARS-CoV-2-/COVID-19 pandemic in 2020 and 2021. Dtsch Arztebl Int 2022; 119: 560–1

2. Morfeld P, Timmermann B, Gross JV, et al.: Before, during, and after the first wave of COVID-19: mortality analyses reveal relevant trends in Germany and its states until June 2020. Gesundheitswesen 2021; 83: e41–e48