{"doi":"10.1101/2025.09.01.25334892","title":"Post-pandemic mortality patterns and COVID-19 burden considering multiple death causes","abstract":"<h4>ABSTRACT</h4>  <h4>Background</h4>  Post-pandemic mortality rates can explore the residual COVID-19 burden and changes in other causes of death. Considering weighted multiple causes of death from death certificates (underlying and others) may help compare post-versus pre-pandemic mortality patterns, while potentially reducing the impact of cause misattribution. Estimates of post-pandemic impact are critical also for proper continuing public health policies (e.g. vaccinations). <h4>Methods</h4>  We retrospectively analyse national all-cause mortality rate ratios between 2024 and pre-pandemic years (2017-2019) for gender-stratified 10-year age groups in Austria. In weighted analyses, the underlying death cause was weighted 50% and other causes shared the remaining 50%. Sensitivity analyses explored different weightings. Death-specific causes were also compared between 2024 and 2019. Lastly, number needed to vaccinate (NNV) was estimated for 5-year age groups in hypothetical scenarios. <h4>Results</h4>  Despite 1,212 reported COVID-19 deaths in 2024, all-cause mortality rates were equal or lower in 2024 compared to 2019 in all strata at risk from COVID-19 (i.e., aged 60 years and over). All-cause mortality rates in 2024 were higher than in 2019 in adolescent and young adult strata. The ratio of weighted over unweighted COVID-19 death rates was 0.52-0.58 for age strata 60 years and older and even lower in sensitivity analyses, indicating that COVID-19 deaths were likely overestimated. Estimated NNV exceeded 1,700 up to 80 years old, even with 100% assumed vaccine effectiveness. <h4>Conclusions</h4>  Post-pandemic COVID-19 deaths had no visible impact on mortality patterns in Austria and were likely overcounted. Increased post-pandemic mortality patterns in the young are particularly worrisome.","journal":null,"year":2025,"id":11524,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.0538,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-09-06","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":946,"name":"Michael Levitt","orcid":"0000-0002-8414-7397","position":1,"is_corresponding":false},{"id":3313,"name":"Stefan Pilz","orcid":"0000-0002-7959-1311","position":2,"is_corresponding":false},{"id":148,"name":"John P. A. Ioannidis","orcid":"0000-0003-3118-6859","position":3,"is_corresponding":false},{"id":14474,"name":"Uwe Riedmann","orcid":"0000-0002-2541-9604","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}