{
  "abstract": "Introduction Emerging evidence suggests that young and middle-aged adults may experience postacute sequelae of COVID-19, increasing their risk of cardiovascular complications. However, it remains unclear whether these risks translated into higher all-cause mortality.Methods We analysed mortality and population data from 16 European countries to estimate excess mortality among individuals aged 20–64 years during the period 2020–2024. Excess mortality was defined as the difference between observed and expected age-standardised mortality rates. Expected values were modelled using three approaches based on different assumptions: (1) a long-trend linear model based on 2010–2019 data; (2) a non-linear model using the same baseline and (3) a short-trend linear model based on 2015–2019 data.Results In 2020 and 2021, all models consistently estimated substantial excess mortality in several countries, with the highest estimates in 2021 for Bulgaria (34.7%–37.3% in males, 45.1%–51.6% in females), Hungary (21.0%–28.9% in males, 30.7%–35.4% in females), Poland (19.1%–24.1% in males, 23.6–24.0 in females) and Slovakia (32.1%–36.6% in males, 34.2%–38.1% in females). In 2022, model estimates diverged, with significant excess mortality persisting only under the long-trend linear model. By 2023, residual excess mortality was found only among males in Austria (according to the long-trend linear and non-linear models) and Finland (according to the long-trend linear model), while in 2024 persisted only in Austria under the same models. Assuming a continuing linear mortality trend appeared to overestimate excess mortality in some age groups.Conclusions Our analysis indicates substantial excess mortality among adults aged 20–64 in 2020 and in 2021 in Europe but does not support a sustained postpandemic increase in all-cause mortality. The estimates were sensitive to the choice of the baseline period and modelling approach, underscoring the importance of presenting results under multiple analytical assumptions.",
  "authors": [
    {
      "affiliations": [
        "Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy",
        "Mother and Child Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy"
      ],
      "name": "Gianfranco Alicandro"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy"
      ],
      "name": "Alberto Giovanni Gerli"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy"
      ],
      "name": "Carlo La Vecchia"
    }
  ],
  "title": "Excess mortality at ages 20–64 from 2020 to 2024: a comparative analysis of 16 European countries",
  "uid": "5b7ae386-d884-5dc2-824c-2d0ae0d2b78b"
}