Insee Première · March 2021 · n° 1847

2020: unprecedented rise in deaths in 70 years

In 2020, deaths from all causes totalled 668,800, which is 55,500 more than in 2019 (+9.1%). The number of deaths has been increasing every year since 2010 as the large generations of Baby Boomers reach ages with higher mortality rates. The rise observed in 2020, however, far exceeds that of previous years. In a scenario with constant life expectancy since 2019, the growth and ageing of the population in 2020 would have led to an increase in deaths of about 14,000. If the improvement in life expectancy had continued at the same rate as seen in the past decade, the increase in deaths would have been less, at somewhere around 6,000. Some of the difference between 2019 and 2020 (about 1,800 deaths) can be explained by the fact that 2020 is a leap year. Most of the rise in deaths in 2020 therefore relates to the increased mortality rates in older age groups, due to the Covid-19 pandemic, leading to a marked fall in life expectancy at birth, by a little over 6 months in comparison with 2019 [Papon, Beaumel, 2021].

In March-April 2020, there were an additional 27,300 deaths compared with the same period in 2019 (+27%). Excess mortality between September and December occurred at a lower rate of intensity but for a longer period, leading, in the end, to more excess deaths than in the first wave (+34,300, or +17%).

In the first fortnight of March 2020, just prior to the first lockdown, the average number of deaths per day from all causes was 1,800, which is of a similar order to the same period in 2019 (Chart 1). It then increased very rapidly, peaking on 1 April with 2,810 deaths. It then decreased quickly, going from an average daily death toll of 2,600 deaths in the first fortnight of April to 1,900 in the second fortnight. Between May and August 2020, the number of deaths is again in line with the average for previous years.

Deaths increase in autumn every year, up to the end of the year. The rise observed in 2020, however, is exceptionally high. Between September and mid-October, the average daily death toll is about 100 higher than for 2019. From mid-October onwards, the gap widens still further. A second lockdown is introduced from 30 October and daily deaths peak at 2,340 on 7 November. The fall in death rate then proves to be significantly slower than in the first wave, with the average number of daily deaths going from 2,260 in the first fortnight of November to 2,030 in the second half of December. Rather than coming to an end, the second wave appears to plateau at the end of 2020, especially as in January 2021, there is a slight increase in deaths once again.

The death toll for 2020 as a whole includes not just the two waves of mortality in the spring and autumn, but also mortality at the start of the year and between the two waves.

According to Santé Publique France (Public Health France), seasonal flu in 2020 caused few deaths (about 4,000 in 2020, compared with 8,100 in 2019 and 13,000 in 2018). There were 7,500 fewer deaths from all causes in January-February 2020 than in the same period in 2019 (and as many as 9,200 fewer taking into account 2020 being a leap year).

Conversely, the three heatwaves in summer 2020 led to slightly more deaths than the two heatwaves of 2019 (1,900 in comparison with 1,500) [Ouvrir dans un nouvel ongletSanté Publique France, 2020]. Between May and August 2020, deaths from all causes turned out to be slightly higher, by nearly 1,200, than those recorded during the same period in 2019.

The overall total of 55,500 additional deaths in 2020 compared with 2019 is significantly higher than those relating to flu outbreaks or heatwaves in the last five years, including the heatwave of 2003, which was more intense but much shorter [Desrivierre, Fabre, 2020]. Going further back in time, the second wave of what became known as the Hong-Kong flu epidemic, which struck France in December 1969 and January 1970, was accompanied by 31,900 more deaths than the number that occurred in the same two months a year earlier (+32%), an excess that is higher than that experienced in March-April 2020 but lower than the toll from the two waves of deaths in 2020. Excess mortality in 2020 compared with 2019 is largely due to the Covid-19 pandemic (Box).

Excess mortality in 2020 compared with 2019 was slightly more pronounced among men (+10%) than among women (+8%) (Chart 2). It also increased with age.

Amongst the oldest, the rise in deaths remains limited in the 60-69 age group (+4%), but is very marked from the age of 70 onwards. It leaps to 14% for the 70-79 age group and is high for those aged 80 to 89 (+9%) and older (+12%). In both waves, the rise is very high, with little difference between those in their seventies, eighties or older: +31% in March-April and +20% in September-December for people aged 70 or over. Excess mortality can also be seen to be greater in elderly men than in elderly women (+4 percentage points in both waves).

In total for the year as a whole, the deaths of people aged over 70 increased by 52,100. Despite this rise, there was little change in the pattern of deaths. Out of all deaths in 2020, 79% are of people aged over 70, compared with 78% in 2019; nearly half are accounted for by people aged 85 or over in 2020, as in 2019.

Among the under-25s, there were fewer deaths in 2020 than in 2019 (−6%), while the number of deaths among people aged 25-49 remained virtually stable. In the under-25s age group, the fall in deaths is far more marked among men (−7%) than among women (−4%). It is particularly notable in the two periods of lockdown, especially the first one. However, as there are not many deaths in these age groups, this equates to a fall of about 400 deaths in a year.

The Covid-19 pandemic has not affected the regions in a uniform way. Over the year 2020, the departments where deaths are at least 10% higher than in 2019 are in the eastern half of Metropolitan France, including the Île-de-France region. The only exceptions are Eure (+12%) and Loir-et-Cher (+11%) (Chart 3a). In Metropolitan France, three groups of regions stand out. Firstly, excess mortality for the year as a whole is highest in Île-de-France (+19%) and Auvergne-Rhône-Alpes (+15%) (Chart 4). Regions geographically close to the first two form the next group, also with very high excess mortality in 2020 but slightly lower than in the first two regions (between +8% and +13%). These are: Grand Est, Bourgogne-Franche-Comté, Hauts-de-France and Provence-Alpes-Côte d’Azur. Lastly, in seven regions which are more in the west of France (except for Corsica), excess mortality is relatively low, between +1% and +6%.

The chronology of the pandemic also differed very greatly from one region to another. It began in Hauts-de-France with a rise in deaths from early March. In March-April 2020 there were 28% more deaths than in the same period in 2019, with a +61% spike in Oise, which has been identified as the location of one of the very first sources of Covid-19 contamination (Chart 3b). The second wave of excess mortality in this region in the autumn was less intense (+19% compared with September-December 2019) (Chart 3c), but because it lasted longer, in the end it resulted in a similar number of additional deaths as in the first wave.

The Grand Est region also recorded a rise in deaths at a very early stage, as from 11 March.

The average number of daily deaths increased very sharply between the first and second fortnight of March 2020 (+86%, versus +8% in the same fortnights the previous year). With the exception of Ardennes, during this second half of March, there were more deaths in all of the region’s departments, especially in Haut-Rhin (+145%) which was probably the starting point for the spread of the pandemic in this region. The peak was reached on 1 April, as was the case nationally, after which the number of deaths fell rapidly. Between 1 March and 30 April, the number of deaths recorded in the region was 55% higher than in 2019, and up to 85% higher in Vosges and 117% higher in Haut-Rhin. From 1 May up until the end of September, the region returned to similar levels of deaths to those seen in 2019. The second wave of excess mortality began around 20 October and in relative terms was less intense in the Grand Est region (+15% between 1 September and 31 December). In the end, two thirds of the excess deaths in this region in the year as a whole are attributable to the March-April period.

In Bourgogne-Franche-Comté, the number of deaths began rising from 12 March, just after the Grand Est region. The increase in spring (+27% in March-April 2020 compared with March-April 2019) was half the rate seen in Grand Est and the same as in Hauts-de-France. In this region, the autumn wave of excess deaths was as intense as the one in spring but lasted longer. In the end, two thirds of the excess deaths there in 2020 are attributable to the second wave of the pandemic, owing to its duration.

From 16 March, Île-de-France recorded a much sharper rise in mortality than anywhere else. In the second fortnight of March, the areas most affected are in the north of the region, near Oise and Roissy airport [Allard et al., 2020]. The excess mortality rate between 1 March and 30 April is 91% in the region. Seine-Saint-Denis (+125%) and Hauts-de-Seine (+113%) are particularly affected. Even in Paris and Yvelines, slightly less affected, the level of excess deaths is 70%. Île-de-France was much less affected, however, by the second wave of excess deaths in 2020, with excess mortality of 14% for the September to December period. So, in the end, 80% of the rise in deaths there occurred in spring.

The second wave of Covid-19 which happened in the autumn had a greater impact on those regions that had been less affected by the spring outbreak, especially Auvergne-Rhône-Alpes. Between 1 September and 31 December, this region experienced the highest excess death rate (+38%). This rate is lower than the one in Île-de-France in the spring, but lasted twice as long. Departments in this region experienced the highest rises in the whole country during this period, in particular Haute-Loire, Savoie, Loire and Haute-Savoie. In this region, 90% of the annual rise in deaths in 2020 compared with 2019 is explained by the autumn period.

Provence-Alpes-Côte d’Azur is the region with the third highest excess mortality rate in the autumn, after Auvergne-Rhône-Alpes and Bourgogne-Franche-Comté, with an excess death rate of 22% in that period, as opposed to 12% in the spring. Hautes-Alpes was the worst affected area (+42%), followed by Alpes-de-Haute-Provence, Vaucluse and Bouches-du-Rhône (around +25%).

Changes in mortality differed greatly in the overseas departments. In Mayotte, which was struck by a dengue fever epidemic in early 2020, it rose very sharply right from the start of the year. Regardless of time of year, the excess death rate is at least 20% compared with 2019. For the year as a whole, Mayotte is the French department with the highest excess mortality, with a quarter more deaths than in the previous year.

In Guadeloupe, the excess death rate in comparison with 2019 is 8%, with a very marked rise at the end of the year (+24%). In the other overseas departments, the number of deaths in 2020 is either about the same as in 2019 (Martinique and Réunion) or lower (French Guiana).

Deaths increased in 2020 in almost all European countries. France sits around mid-table, with a rate of +9% [Ourliac, 2021]. According to data available in mid-March, the rise in deaths is lower in France than in all the bordering countries, with the notable exception of Germany, which was relatively protected (+5%) and Luxembourg (+8%). The rise is equal to or greater than 14% in seven European countries: Spain, Poland, Belgium, Slovenia, Bulgaria, the Czech Republic and Italy.

In spring, with the outbreak of the first wave of the Covid-19 pandemic, mortality only increased in seven countries in Europe, whereas in the second wave, in the autumn, the health crisis appears to have spread more widely. In countries where mortality had already risen a lot in spring, as in France, the excess mortality rate in the autumn was of the same order in overall terms, except for the United Kingdom, where it was lower.