why are northern european (except for sweden) all cause deaths up in 2021 vs 2020?

covid deaths are way down, but overall deaths are up considerably. this is a puzzle that warrants attention.

all cause mortality is the gold standard. it’s the one truly comparable, inclusive number that ignores definitions and that sums everything.

it’s also going in the wrong direction in many paces that are seeing lower covid deaths.

this is a striking outcome that really demands explication because, at the end of the day, health policy is about ALL health, not one narrow and definitionally driven outcome like “covid” and if deaths are spiking, something is probably wrong.

consider denmark.

covid vaccination rates are very high.

obviously, this is not stopping cases. but deaths are WAY down from last year.

perhaps this is the variant, perhaps it’s the vaccine, perhaps it’s cohort depletion in risk groups. there is no a priori way to know for sure. but that’s what makes all cause deaths appealing:

we don’t need to know these things. we just need the full butcher bill. all trade offs, known and unknown are already included.

with covid deaths down so much from last year (~2/3 drop) we would, all else equal, expect to see lower all cause deaths. but we do not. we see the opposite.

i plotted 2021 benchmarked against 2020 for direct comparison.

provocatively, all cause deaths were lower in february and march and seemed to be going into decline. then, they reversed and have been consistently high since then. this aligns with the timing of vaccine rollout with more than a little precision. clearly, this does not prove causality, but given what we know about adverse events, it’s not a signal i’d dismiss out of hand either.

so i took a look at the neighbors:

vaccine uptake is similar and covid deaths look much lower everywhere.

yet this same all cause deaths issue keeps cropping up.

germany looks much the same and also finds alignment with vaccine rollout for the flip to excess ACM.

the netherlands is a near carbon copy with an even sharper reversal.

norway is also seeing a similar effect, but somewhat time shifted. tantalizingly, their vaccine program ran about 1 month behind denmark’s in terms of uptake. that’s consistent with there being some signal here.

finland is the same pattern.

sweden is, as ever, and interesting and provocative outlier with 2021 all cause mortality deeply down from 2020.

precisely why sweden is an outlier here is an interesting and open question.

they had pretty much in line all cause deaths last year as well (roughly the avg of the trailing 5-6 years) and were generally in line with the neighbors. this makes “cohort depletion” seem an unlikely answer.

data from gatopal™ harold of world.

the ACD rise in the neighbors does not seem covid driven. those deaths look down sharply year on year for H2 2021 vs H2 2020 in all countries.

there is concordance with vaccine rollout, but, sweden did this too, so that is a meaningful potential counter-example to simply dismiss as well.

perhaps there is some diversity in vaccines used?

i’m not sure i have a really sound answer.

but it’s a big and unexpected outcome and it’s not being much discussed.

and i think it should be.

and you know how cats are with puzzles…

help, ideas, pointers, and data on this would be appreciated.