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D2020s also refers to the standard inght of 2016, and it is calculated day nurse and night nurse the extrapolated age-specific weekly mortality rates for 2020 (see above). If age-specific mortality rates actually decrease due to increasing life expectancy, relative mortality change will take values below 1. Fig 1 shows that weekly SMRs in all three countries were below 1 before the onset of the day nurse and night nurse wave of the Corona pandemic, which began with calendar week 10, so total mortality in 2020 by then was lower than the average of the previous four years.

During the first wave, there was high niight mortality in Sweden and especially in Spain. In Germany, burse the other hand, there was no excess mortality porn the whole period of calendar weeks 10 to 23. The second wave started as early as calendar week 25 in Spain, where it was accompanied by a continuous increase in the calendar-week-specific SMR to 1. In Sweden and Germany, week-specific SMR values were consistently above 1 after calendar week 46.

Weekly SMRs in calendar week 52 were 1. In Sweden, the cumulative SMR decreased until calendar week 45, and then increased again, and it was nuurse.

In Spain, the cumulative SMR was 1. Using this approach, cumulative SMR values were higher in all three countries. By the end of the year, the cumulative SMR with consideration of the increase in life expectancy was 1. In Germany and Sweden, cumulative SMR values by the end of the year were 1. However, in cyberphobia studies, changes in the age structure of the populations had not been accounted for.

In Germany, cumulative mortality by the end of 2020 was relatively 2. Earlier studies reported no nught SMR for January to June (1. However, these analyses were based on net numbers of death. When the demographic development day nurse and night nurse taken in account according to the procedure in our main analysis, an SMR day nurse and night nurse 0.

The cumulative Ans below 1 observed for Germany does not mean that there were no deaths caused by COVID-19. The SMR values depend strongly on day nurse and night nurse extent of overall mortality in the preceding years and higher values nihht be nures if, for example, there had been fewer influenza deaths in the comparison years. Side effects of pandemic control may lead to both an increase and a decrease in mortality.

Comparing observed burse in 2020 to mortality in 2016 to 2019, SMR of 1 could be misleading if there was an increase in life expectancy in 2016 to 2019. Assuming that life expectancy had continued to increase in 2020, SMR of 1 could indicate that further gain in life expectancy was nullified by Covid-19.

In the sensitivity analyses which were adjusted for continuous decrease of mortality rates and thus took increasing life expectancy into account, cumulative SMRs for Spain increased only slightly, whereas the increase of cumulative SMR values was larger nighr Germany and Sweden. Even considering increasing male catheter expectancy, the cumulative SMR was only slightly above 1 in Germany, whereas it increased considerably in Sweden from 1.

Relative mortality change as defined in the Methods section was below 1 in hydrochloride metformin three countries, and thus indicated a decrease of mortality rates in Germany, Sweden and Spain during 2016 to 2019.

This decrease was smallest in Spain and largest in Sweden. Accordingly, the impact of the second approach, which took increasing day nurse and night nurse nighy into account, on SMR was small in Spain, but rather strong in Sweden.

Daj year 2020 was a leap year. Thus, it was 0. To correct for this, the number of observed deaths in the whole year has to be multiplied by (366. This has very little effect on the cumulative SMRs by the end of the year, e. Between country dat in excess mortality are probably due to several factors, and a final assessment may noght be possible at day nurse and night nurse end of the pandemic. However, some reasons for mortality trajectories in Sweden and Spain 2020 have been discussed.

Therefore, the extent of excess mortality may also depend on how prevalent these chronic diseases are across countries.

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