Reinhard Wagner

The so far puzzling increase in deaths in Spain and Europe in 2022

Tenagua, winter of 2022/23

1. Excess mortality in young people in Europe and Spain

EXECUTIVE SUMMARY

Definition of the problem

Attentive observers of the European Mortality Monitoring (EuroMOMO)¹ have noted a significant increase in mortality in the 0 - 14 age group for months, but also in the 15 - 44 age group mortality is above 2020 and 2021 levels.
EuroMOMO explicitly points out the disconcerting facts in its weekly bulletins and intends to address them by means of a revised calculation model.²

In the Spanish autonomous region of the Canary Islands, early October 2022, press reports accumulated about an increase in excess mortality in the 0 - 14 age group, which may be verified by data from the Monitoring System of Daily Mortality from all causes of the Carlos III Institute of Health (MoMoISCIII)³ at national and regional levels.
This issue was also the subject of debate in the Canarian Parliament, where the Canarian Minister of Health, Blas Trujillo, declared that ISCIII officials "'recognise that there is failing a lot' and that 'they have to bring it up to date'".⁴

The data show excess mortality in children, and the institutions charged with monitoring excess mortality are trying to solve the problem methodologically. Thus, both mortality monitors run the risk of losing sight of possible and conceivable public health threats when approaching a revision of their calculation models.

Once it is affirmatively clarified whether there is a significant excess mortality in young people, the problem is expanded:

2. What are the causes for the increase?

3. What are the underlying factors that lead to the causes found to be increasing in importance?

Method

Data in the form of tables and graphs accessible to the public on the websites of EuroMOMO¹ , MoMoISCIII³ and the National Statistics Institute (INE)⁵ have been analysed and cross-checked.

Results

At the European level, the significant increase in excess mortality in the 0 - 14 age group from week 21/2021 and the excess mortality in the 15 - 44 age group in 2022 above the levels of 2020 and 2021 are particularly evident in the graphs of cumulative excess mortality:

GRAPH 1

The cumulative excess mortality in Europe for all age groups
compared to age groups 0 - 14 and 15 - 44
in 2020 (grey), 2021 (dark blue) and 2022 (light blue).⁶

For all age groups taken together, the sharp increase in excess mortality at the beginning of the COVID-19 pandemic is clearly visible, but this quantitative jump is missing in the two youngest age groups; in children aged 0 - 14 years there is even a significant reduction in mortality, which continues throughout most of 2021 and only turns into an increase in mortality from week 21 onwards, which continues virtually unchanged in 2022.

In the 15 - 44 age group, what is noticeable is that the excess mortality in 2022 is higher than in 2020 and 2021 and that the underlying increase started around week 26/2021.

For Spain, this phenomenon has been confirmed for children and the years 2020 to 2022 by data from the Carlos III Institute of Health's Monitoring System of Daily Mortality from all causes (MoMoISCIII).³

TABLE 1

Excess mortality in Spain for all age groups compared to age group 0 - 14 years, 2017 to 2022, annual data⁷

(Decreases in green, increases in red. Colours are my own, RW.)

Year	All	Age group 0 - 14 years
2022	33923	149
2021	29310	76
2020	73222	-49
2019	-2862	63
2018	11349	141
2017	13476	124

At the national level, in 2019 and even 2020, the first year of the pandemic, there was a decrease in excess mortality in the 0 - 14 age group. From July 2021, which is in line with European developments, it increased considerably, almost doubling in 2022 compared to 2021 and exceeding the excess in 2018 by 6 %.
The 2021-2022 increase is much more pronounced for children.

GRAPH 2

Excess mortality in Spain,

all age groups compared with age group 0 - 14 years,
2022, monthly data⁸

In contrast to the general population, which suffered many additional deaths that summer, the excess with children fell from June onwards and started to rise again in September.
In January 2023, excess mortality for the children drops from 57 to 6, and for the total population from 1,289 to -412, then rises to 21 and 544, respectively, in February.

GRAPH 3

Canary Islands,
comparison of all age groups with the age group 0-14 years,
01.01.2017 to 31.12.2022, annual data⁹

Comparación niños y población, 2017 - 2022

In the Canary Islands, with the population as a whole, the first year of the COVID-19 pandemic passes within the normal range, with excess mortality below the level of 2018, which was reached in 2021. The year 2022, however, shows an extraordinary excess mortality, tripling that of the previous year, almost THIRTEEN times higher than in the first year of the pandemic.
The excess mortality of children increases more sharply than that of the population as a whole.

GRAPH 4

Canary Islands, age group 0-14 years,
01.01.2017 to 31.12.2022, monthly data¹⁰

Exceso de mortalidad desde 2017, mensualmente

For children, in 2022, with a negative value until July, there is a very steep, long-lasting and atypical rise from August onwards, which does not reach 2018 values. For most of 2022, excess mortality is above the average for the years since 2017.
The trend does not continue in January 2023, but does in February.

However, both institutions question this, speaking of their own failures that will have to be corrected at the methodological level.^{2, 4}
Nevertheless, data from the National Statistics Institute (INE)⁵ confirm the findings:

GRAPH 5

Spain, deaths in age groups 1-24 years from all causes,
1980 to 2021¹¹
^{Age
groups, from top to bottom, on the left side of the
graph:

20-24, 15-19, 1-4, 5-9, 10-14 years.}

In 2021, there was a synchronised increase in deaths in the age groups 1 - 24 years compared to 2020, a phenomenon not seen in recent decades and contrary to the evolution of mortality in the population as a whole.

TABLE 2

Spain, changes in deaths 2019 - 2020 - 2021,
all ages and age groups up to 29 years of age¹¹
^{Own calculation of variations, R.W.

Significant decreases in green, significant increases in red.

[For a complete overview see TABLES 2 to 4 under}
^{1.2.2.2.
2017 - 2022 (abajo, detallado) La evolución de las
defunciones desde 2019 y sus variaciones]}

Years / Age group	2019	Variation		2020	Variation		2021	Variation	2022
All	418.703	75.073	17,9%	493.776	-43.032	-8,7%	450.744
< 1 year	977	-87	-8,9%	890	-29	-3,3%	861
1 - 4	247	-59	-23,9%	188	1	0,5%	189
5 - 9	145	-6	-4,1%	139	31	22,3%	170
10 - 14	216	-27	-12,5%	189	26	13,8%	215
15 - 19	394	-15	-3,8%	379	59	15,6%	438
20 - 24	583	26	4,5%	609	88	14,4%	697
25 - 29	770	53	6,9%	823	-17	-2,1%	806

In 2020, there had been a sharp decline in deaths of children and adolescents up to 19 years of age, while deaths in the population as a whole increased sharply.

Conversely, in 2021 in Spain there were significant increases in deaths in the younger age groups of the population, while deaths in the population as a whole decreased by almost 9%.

For the first six months of 2022, the INE notes an upward trend:
"Mortality rose during the first six months of 2022 among those under 40 years of age and in the age group 80 and over. The highest increase was among those aged one to 14 years, 16.8%. On the other hand, the largest decrease was recorded in the 61-70 age group, of 1.6%. "¹²TABLE 3

Main causes of the increase in deaths in the year 2021

in age groups between 5 and 24 years,¹¹
by number and/or by increase well above their trends in recent years (red)

Group	Increase deaths	Main causes
Group	Increase deaths	Cause	Increase	Cause	Increase	Cause	Increase
5-9 years	31 persons 22,3%	Tumours	19 persons 35%	Of these: Leukaemia	13 persons 93%	Blood	4 persons 200%
5-9 years	31 persons 22,3%	Tumours	19 persons 35%	Other malign tumours of he skin and soft tissues	6 persons 200%	Blood	4 persons 200%
10-14 years	26 persons 13,8%	Suicides	9 persons 69%	Bone tumours	5 persons 42%
15-19 years	59 persons 15,6%	Accidents	51 persons 51%	Digestive system	11 persons 220%	Nervous system	14 persons 37%
20-24 years	88 persons 14,4%	Accidents Of these: Other transport accidents	98 persons 31% 26 persons 289%	Circulation	14 persons 42%	Suicides	26 persons 26%

The fact of the synchronised increase in deaths in the 5 - 24 age groups as opposed to their decrease in the population as a whole is very unusual, the variations in the different causes of death, possibly responsible for the increase - seen in the perspective of the last years and with my possibilities of data analysis - are not - with the exceptions of

leukaemia and skin and soft tissue tumours in the age group 5 to 9 years,
bone tumours in the 10 - 14 year age group,
suicides in the 10 - 14 and 20 - 24 age groups,
diseases of the digestive and nervous systems in the age group 15 - 19 years, and
other transport accidents in the 20 - 24 age group.

These seven causes not only appear to contribute to the increase but in doing so also contradict their trends of recent years.

All of this raises suspicions that we are seeing a combination of a return to pre-pandemic levels (or the continuation of pre-pandemic processes) with a differentiated increase by age group of as yet unknown origin.

According to INE provisional data for the first half of 2022¹³, the main causes' upward trend compared to 2020 continued, sometimes at a reduced pace.

Overall, for external causes of death, especially suicides, the 2020-2021 trends have continued in the first half of 2022. (Tumours declined.)¹⁴

Discussion

Instead of trying to solve methodological problems before having analysed the causes of excess deaths in young people, it is necessary, using the data available to us, to investigate the possible causal factors of these worrying phenomena.

Attempts must be made to falsify or exclude hypothetical factors, which individually or (synergistically) together, also with other as yet completely unknown factors, could influence mortality - either by reducing it, as in the case of children and adolescents up to 19 years of age during the first year of the pandemic, or by increasing it, as at present with people up to 24 or 39 years of age, respectively:

Measures taken against the Sars-COV-2 virus: Hypothetically, the decrease in mortality during the first year of the pandemic could be linked to a decrease in accidents as a cause of death (school closures, reduction of activities outside the home, less involvement in traffic...) and to a general decrease in infectious diseases achieved by health measures.
Conversely, the removal of general infection reduction measures could have a kind of catch-up effect: Increased susceptibility to pathogens from which children and young people were unusually protected.¹⁵
Socio-economic changes in the living situation of this age group.
Deteriorated care (psychological, psychotherapeutic, psychiatric) due to overloading of the health system.
Sars-COV-2 virus. So far, it has been practically unimportant in this age group, although the numerical ratio between infected/sick and non-infected/sick children and adolescents in deaths should be compared with that of the age group as a whole.
Vaccination against the virus. The numerical ratio of vaccinated to unvaccinated children in deaths should be compared with this ratio for the age group as a whole.
The psychological effects of the pandemic: increased problems of outlook on life, media overload, uncertainty, fear, etc.
Psychological effects of the measures taken: imposed responsibility for the health and well-being of older people, social distancing and isolation, reduced self-esteem, end of routines that provide security, undermining of life planning, anxiety, depression .....
Changes in the mental state of the affected age group due to other factors, such as side effects of the use of social networks and media in general, increased competitiveness, current awareness of climate disaster, war and fear of war, pessimistic economic outlook and its effects on the primary group (family) and peer group (friends): Anxiety, despair, depression.

---> Continue reading: 1.1. EuroMOMO: 1.1.1. Data

Notes

1) https://euromomo.eu/
(updated every Thursday) presents itself like this:
"EuroMOMO is a European mortality monitoring activity, aiming to detect and measure excess deaths related to seasonal influenza, pandemics and other public health threats.
Official national mortality statistics are provided weekly from the 28 European countries or subnational regions in the EuroMOMO collaborative network, supported by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), and hosted by Statens Serum Institut, Denmark."

2) EuroMOMO: https://euromomo.eu/bulletins/2022-43/, last accessed 05/11/2022.
See also 4. Materials.

3) https://momo.isciii.es/panel_momo/#section-momo, updated every Thursday.
The stated objective of the "all-cause daily mortality monitoring system (MoMo)" of the Instituto de Salud Carlos III (MoMo-ISCIII) - based on the "framework of the 'Preventive action plan against the effects of excessive temperatures'.... - was to identify deviations of observed daily mortality from that expected from historical mortality series. Subsequently, its use was extended to other situations throughout the year to indirectly estimate the impact of any major public health event."
(Own translation, R.W.)
(https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/MoMo/Paginas/MoMo.aspx)

4) For example:
El exceso de mortalidad infantil llega al Parlamento Canario (Excessive infant mortality reaches the Canary Islands Parliament), 12/10/2022,
https://diario16.com/el-exceso-de-mortalidad-infantil-llega-al-parlamento-canario/

Salud Pública investiga el exceso de mortalidad de niños en Canarias (Public Health investigates excess child mortality in the Canary Islands), EFE, 10/10/2022,
https://diariodeavisos.elespanol.com/2022/10/mortalidad-de-ninos-en-canarias/
Own translation, R.W.

5) https://www.ine.es/index.htm

6) EuroMOMO Bulletin, Week 43, 2022,
https://euromomo.eu/bulletins/2022-43, last accessed 05/11/2022

7) MoMoISCIII data, downloaded from https://momo.isciii.es/panel_momo/#section-momo on 06/01/2023.
Own table, R.W.

8) MoMoISCIII data, downloaded from https://momo.isciii.es/panel_momo/#section-momo on 06/01/2023.
Own graph, R.W.
In order to achieve comparability of the respective trends, the children's deaths were multiplied by 100.
Updated on 24/02/2023.

9) MoMoISCIII data, downloaded from https://momo.isciii.es/panel_momo/#section-momo on 07/01/2023.
Own graph, R.W.
In order to achieve comparability of the respective trends, the children's deaths were multiplied by 100.
See also 4. Materials.

10) MoMoISCIII data, downloaded from https://momo.isciii.es/panel_momo/#section-momo on 07/01/2023.
Own graph and own calculation of the average (Media), R.W.
See also 4. Materials.

11) https://www.ine.es/dyngs/INEbase/operacion.htm?c=Estadistica_C&cid=1254736176780&menu=resultados&idp=1254735573175#!tabs-1254736194710
Select "Definitivos" -->Principales series desde (since) 1980 -->Series nacionales, por comunidad autónoma y provincia de residencia (capítulos y lista reducida) --->Defunciones por causas (lista reducida) por sexo y grupos de edad --> "Seleccionar todos" (everything) in "Causa de muerte" (death), in "Sexo" choose "Total", in "Edad" (age) select the desired age groups, for example from 1 to 24 years, and in "Periodo" select the years. A table for download is produced, in this case also downloaded on the 01/01/2023 and documented in 4. Materials, and the corresponding graph.

12) https://www.ine.es/prensa/edcm_2021.pdf, page 12. See also in 4. Materials.

13) https://www.ine.es/dynt3/inebase/es/index.htm?padre=9035&capsel=9036

14) https://www.ine.es/prensa/edcm_2021.pdf, p. 13. See also in 4. Materials.

15) This hypothesis can be considered falsified in view of the lack of relevance of infectious diseases as a cause of death in the age groups up to 24 years.

Siehe auch allgemein:
https://medical-tribune.ch/10124898/2022/kinder-und-covid-19-wie-geht-es-weiter/

Die globale Perspektive:
Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021 Nov 1;175(11):1142-1150. doi: 10.1001/jamapediatrics.2021.2482. PMID: 34369987; PMCID: PMC8353576.

20) https://www.eldiario.es/canariasahora/tenerifeahora/sociedad/colegio-medicos-santa-cruz-tenerife-pide-recursos-atender-tsunami-patologias-psiquiatricas_1_9610446.html

21) https://www.eldiario.es/sociedad/venta-antidepresivos-dispara-espana-10-ano_1_9312450.html

https://fefe.com/wp-content/uploads/2022/09/Ob-julio-22.pdf

22) https://www.eldiario.es/sociedad/pandemia-arrasa-salud-mental-menores_1_7996083.html

"Los expertos auguran un 'repunte de las conductas suicidas' y mayor representación del suicidio como causa de muerte en personas jóvenes.

El suicidio es la segunda o tercera causa de muerte entre los menores de 21 años y la tercera en la adolescencia, una situación que 'probablemente va a empeorar', valora la presidenta de la Sociedad de Psiquiatría Infantil. (...) 'Estamos avisando de que esto se puede prevenir, lo que nos va a venir encima',..." (2 de junio de 2021)

Reinhard Wagner

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