Excess mortality in Greece during 2020: the role of COVID-19 and cardiovascular disease (2023)

Coronavirus Disease (COVID-19), whose outbreak started in late December 2019 in China, constitutes a considerable public health problem worldwide. According to the World Health Organization, over 83.5 million infected cases and approximately 1.8 million deaths (Case Fatality Rate, 2.2%) occurred during 2020, while over 20.5 million years of life have been lost so far1; particularly in the European Union, during 2020, the cumulative number of cases reached 16 million with 370,650 deaths (Case Fatality Rate, 2.4%). In Greece, COVID-19 appeared on February 26, 2020 and caused 138,850 infected cases and 4,838 deaths during 2020 (Case Fatality Rate, 3.4%), according to the data provided by the National Public Health Organization.

Mortality comprises one of the most significant indicators of a population's health status, while the excess mortality, which is defined as the increase of all-cause mortality over its historic average (usually the preceding 5-10years), forms the “gold standard” method being used globally for the estimation of an epidemic impact on the population's health.2 During 2020 (ISO week 52) and according to the data provided by the Hellenic Statistical Authority (ELSTAT), 130,288 deaths from all causes had been recorded in Greece.3 This is equivalent to 355 deaths per day. Compared to the average of the previous 5years (2015–2019), the mortality rate in 2020 increased by 6.7% (i.e., excess mortality), whereas a 4.6% increase was also observed when compared with the previous year, 2019. Moreover, deaths from COVID-19 were 4,838, which comprises 3.7% of total deaths in Greece during 2020 (Fig.1).

According to the report of the European Statistical Authority (EUROSTAT), COVID-19-specific mortality presented a considerable rise during March 2020, with a total of approximately 297,500 excess mortality that occurred in the European Unionbetween March and October 2020 when compared with the same period in 2016–2019.2 In Greece, as compared to several other countries such as the USA, France, Spain, Italy,and the UK where a significantly excess mortality was observed reaching up to even the 156% in Spain during the Spring of 2020, the share of deaths from COVID-19 until September 2020 was negligible. However, in November 2020, when the number of COVID-19-specific deaths tripled as compared to September 2020, the all-cause excess mortality exceeded even 30% (Fig.2), which was approximately 116 times higher than that of Norway, where population's compliance with infection preventive measures was even higher than 98%.4 Despite the fact that the increment of the excess mortality in Greece can largely coincide with the COVID-19 outbreak, it cannot be fully attributed to it, as similar increases have occurred in previous years, mainly due to the aging of the population, the adoption of unhealthier lifestyles, and the increased prevalence of newer risk factors.5

Excess mortality in Greece during 2020: the role of COVID-19 and cardiovascular disease (2)

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(Video) Excess Mortality and COVID-19: What is causing it?

Excess mortality in Greece for the period between January and December 2020 (ISO weeks 1–52).

Cardiovascular diseases (CVD) are the leading cause of death in Greece since the 1970s. According to national statistics, 37% of deaths in Greece during 2019 were attributed to CVD, followed by various types of cancer (26%) and respiratory infections (12%).3 Based on the ATTICA epidemiological study, the 10-year fatal or nonfatal incidence of CVD was 1,570 new cases per 10,000 individuals, while the causes of deaths were: 51.1% due to CVD, 30.0% due to neoplasms, 7.8% were due to infections (mainly pulmonary), and the remainder 11.1% were due to various other reasons.6 Moreover, in a systematic analysis of the Global Burden of Disease Study 2019, for Greece, ischemic heart disease had a 11.8% increase in mortality between 2009 and 2019, whereas stroke had a 20.3% increase.7

Even though the excess mortality for 2020 in Greece is a fact,it should be noted that it is much lower than that of otherEuropean countries. This excess mortality is mainly attributed to the epidemic of COVID-19, which was observed duringthe autumn outbreak and despite the restrictive measures that were in force for the entire population. Nevertheless, CVDremains the main cause of death and disability in Greece, accounting for one-third of deaths annually. As noted by Tousoulis D., “the residual cardiovascular risk that remains unexplained is considerable. Research on novel risk factors as a sole feature or as part of a cumulative condition may provide clues to the mechanism underlying CVD events”.5 Lockdown itself or changes in the organization of the health system may also have an impact on the excess mortality beyond COVID-19. It has also been reported that individuals with heart symptoms may have not asked for medical care because of the fear of infection. In addition, infarct-related symptoms such as chest pain, discomfort, or dyspnea could have been misinterpreted as being related to an acute respiratory infection. Viral infections, including COVID-19, may also play a role in increasing the burden of CVD in the future.8, 9, 10 Without a doubt, it is expected that cardiologists will be asked to handle much more complicated situations in clinical practice, calling for more evidence from laboratory and clinical research.

(Video) Excess Deaths During the COVID Times


Peer review under responsibility of Hellenic Society of Cardiology.


1. Pifarré I Arolas H., Acosta E., López-Casasnovas G., et al. Years of life lost to COVID-19 in 81 countries. Sci Rep. 2021;11(1):3504. [PMC free article] [PubMed] [Google Scholar]

2. EUROSTAT 2020. Accessed at https://ec.europa.eu/eurostat/statistics-explained on 24 February 2021.

(Video) Excess deaths in young adults, 2022 data

3. Hellenic Statistical Authority (ELSTAT). Accessed at https://www.statistics.gr/en/statistics/-/publication/SPO09/- on March 2020.

4. Kontis V., Bennett J.E., Rashid T., et al. Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries. Nat Med. 2020;26(12):1919–1925. [PubMed] [Google Scholar]

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6. Panagiotakos D.B., Georgousopoulou E.N., Pitsavos C., et al.ATTICA Study group Ten-year (2002-2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int J Cardiol. 2015 Feb 1;180:178–184. [PubMed] [Google Scholar]

7. GBD 2019 Diseases and Injuries Collaborators Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. [PMC free article] [PubMed] [Google Scholar]

(Video) Non covid excess deaths

8. Guo J., Huang Z., Lin L., Lv J. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Am Heart Assoc. 2020;9(7) [PMC free article] [PubMed] [Google Scholar]

9. Triposkiadis F., Boudoulas K.D., Xanthopoulos A., Boudoulas H. Fallacies in medical practice: Renin-angiotensin-aldosterone system inhibition and COVID-19 as a Paradigm. Hellenic J Cardiol. 2020 Nov 11;S1109–9666(20) 30249-9. [PMC free article] [PubMed] [Google Scholar]

10. Lazaridis C., Vlachogiannis N.I., Bakogiannis C., et al. Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery. Hellenic J Cardiol. 2020 Jun 10;S1109-9666(20) 30093-2. [PMC free article] [PubMed] [Google Scholar]


Excess mortality in Greece during 2020: the role of COVID-19 and cardiovascular disease? ›

According to the report of the European Statistical Authority (EUROSTAT), COVID-19-specific mortality presented a considerable rise during March 2020, with a total of approximately 297,500 excess mortality that occurred in the European Union between March and October 2020 when compared with the same period in 2016–2019 ...

What is the heart disease rate in Greece? ›

Age- and gender-specific prevalence of MI and CHD among Greek adults aged 20 years and older, the Saronikos study. The prevalence of diagnosed CHD was 7.1% (10.3% in men and 3.8% in women, P=0.000); the respective age-adjusted prevalence rate was 6.3% (8.9% in men and 3.8% in women).

What is the mortality rate in Greece? ›

The current infant mortality rate for Greece in 2023 is 2.349 deaths per 1000 live births, a 3.81% decline from 2022. The infant mortality rate for Greece in 2022 was 2.442 deaths per 1000 live births, a 3.67% decline from 2021.

How prevalent is cardiovascular disease in COVID-19? ›

As the number of COVID-19 patients increased, an association was quickly observed between cardiovascular disease (CVD) and COVID-19. Analysis of patients with COVID-19 in critical condition demonstrated that 20–35% of COVID-19 mortalities occurred in those with pre-existing CVD and risk factors.

What is the death rate per 1000 in Greece? ›

The death rate in Greece increased by 0.5 deaths per 1,000 inhabitants (+4.27 percent) in 2020 in comparison to the previous year. Therefore, the death rate in Greece reached a peak in 2020 with 12.2 deaths per 1,000 inhabitants.

What is the leading cause of death in Greece? ›

Cardiovascular diseases (CVD) are the leading cause of death in Greece since the 1970s.

What are the top illnesses that lead to death in Greece? ›

The top cause of death and disability in 2019 is Ischemic heart disease, of type Non-communicable diseases, which has decreased by −1.51 percent since 2009. The axis shows the percent change from -30 percent to 42 percent.

What are the top three causes of death in Greece? ›

Overall, the three risk factors that account for the most disease burden in Greece are dietary risks, tobacco smoking, and high blood pressure. The leading risk factors for children under 5 and adults aged 15-49 years were tobacco smoking and occupational risks, respectively, in 2010.

What is the most common disease in Greece? ›

Here are the top five common diseases in Greece:
  1. Cardiovascular Disease. The number one cause of death in Greece in 2014, cardiovascular diseases (CVDs) affect millions of people annually, worldwide. ...
  2. Cancer. ...
  3. Alzheimer's and other Dementias. ...
  4. Chronic Respiratory Diseases. ...
  5. Diabetes.
Aug 6, 2017

Why does Greece have such a high life expectancy? ›

Greece has been traditionally counted among the top countries in terms of life expectancy, mainly due to the country's Mediterranean diet and the warm and sunny temperate climate.

What impact does COVID-19 have on the cardiovascular system? ›

Patients with myocardial damage, myocardial ischemia, hypoxia, shock, electrolyte imbalances, or those using drugs that prolong the QT interval are all at risk of arrhythmias after COVID-19. Patients with suspected COVID-19 should have a baseline cardiac investigation (with ECG).

How does COVID affect cardiovascular disease? ›

SARS-CoV-2, the virus that causes COVID-19, most commonly affects the lungs but It can also lead to serious heart problems. Lung damage caused by the virus prevents oxygen from reaching the heart muscle, which in turn damages the heart tissue and prevents it from getting oxygen to other tissues.

Does Covid link to cardiovascular disease? ›

If you have a heart or circulatory condition, you may be more likely to experience severe complications from Covid-19. Your risk is also higher if you are over 60 years of age.

What is the under 5 mortality rate in Greece? ›

Greece - Demographics, Health and Infant Mortality Rates
Infant mortality rateUnder-five mortality rate (Male)Under-five mortality rate (Female)

How many doctors per 1,000 people in Greece? ›

Thus, in Greece there are 6.3 doctors per 1,000 inhabitants, when the average in OECD countries is 3.3 doctors per 1,000. China, Turkey and Colombia have fewer than 2 doctors per 1,000 people.

How many murders in Greece per year? ›

In 2020, homicide rate for Greece was 0.7 cases per 100,000 population. Though Greece homicide rate fluctuated substantially in recent years, it tended to decrease through 2001 - 2020 period ending at 0.7 cases per 100,000 population in 2020.

Why is there a crisis in Greece? ›

1 In 2001, Greece joined the Eurozone and adopted the common euro currency. But the situation deteriorated dramatically over the next two decades fast due to fiscal profligacy, which is defined as wasteful and excessive expenditure, caused deficits and debt levels to explode.

What are the health issues in Greece? ›

Several public health threats are associated with specific lifestyle choices of the Greek public; as published in the State of Health in the EU-Greece Country health profile 2019, smoking, alcohol consumption and unhealthy diet were associated with 40% of mortality, including an increase in mortality due to lung, ...

Why does Greece have a high obesity rate? ›

Today's European countries are moving away from this Mediterranean lifestyle and towards a more Western way of life. Indulging on the fast foods and limited daily activity are to blame on for this increase in obesity in Greece.

What genetic diseases do Greek people have? ›

Thalassemias are the most frequent genetic disorders in Greece. β-Thalassemia (β-thal) carrier frequency is ∼8%, while 1.5% of the population are carriers of the HbS [β6(A3)Glu→Val] mutation, sickle cell disease (SCD).

What is the Greek disease? ›

They concluded that the disease that killed the Greeks was typhus. "Epidemic typhus fever is the best explanation," said Dr. David Durack, consulting professor of medicine at Duke University.

Is there an obesity crisis in Greece? ›

Today Greece has the one of the highest obesity rates in the world. The proportion of overweight children – about 40 percent – may be the highest, except for some Pacific islands. The problem is especially bad in Crete, home to what could be the world's healthiest diet.

What are the three Greek problems? ›

Three such problems stimulated so much interest among later geometers that they have come to be known as the “classical problems”: doubling the cube (i.e., constructing a cube whose volume is twice that of a given cube), trisecting the angle, and squaring the circle.

How does Greece deal with death? ›

Death for Greeks is always attached to Orthodoxy and forgiveness by God for the sins that have been committed by the deceased on earth. The experience of death may be both a family and a community event, depending on the contribution the person has offered to the public, and in general his/her status.

Which two conditions are among the top three causes of death globally? ›

Cardiovascular diseases are the leading cause of death globally. The second biggest cause are cancers.

Are Greek people healthier? ›

The Greek diet is regarded as one of the healthiest in the world because it's based largely on fruit and vegetables, whole grains, fish, and a small amount of cheese and yogurt.

What disease destroyed Athens? ›

Smallpox is one of the most popularly mentioned causes of the plague of Athens. Although there is no consensus among classical scholars or clinicians, smallpox is a leading contender for the cause.

What tick borne disease is in Greece? ›

In Europe, Lyme disease is endemic from southern Scandinavia into the northern Mediterranean countries of Italy, Spain, Portugal, and Greece and east from the British Isles into central Russia.

What town in Greece is known for long life expectancy? ›

Ikaria is known as the island where the residents live longer than in any other region in Greece. In fact, Ikaria has been at the center of many studies by scientists who try to find the secrets in the daily life of the residents that provide them with this unique privilege.

What's the average salary in Greece? ›

The average salary in Greece was 16,235 euros per year in 2021, compared with 16,178 in 2020.
Average annual wages in Greece from 2000 to 2021 (in euros)
CharacteristicAverage annual wages in euros (2021 constant prices)
9 more rows
Feb 28, 2023

Why retire in Greece? ›

The land of stunning islands, pristine beaches with clear blue waters, green valleys, and breathtaking landscapes offers everything you could want for retirement. Great food, history, sunny weather, safety, and low living costs make Greece a great place to retire on an affordable monthly budget.

What are the cardiac complications of the COVID-19 vaccine? ›

Our study showed that myocarditis was the most reported post-COVID19 vaccination cardiac event. All reported cardiac events including myocarditis, TTC, MI, and VITT occurred most frequently after receiving mRNA vaccines (Moderna & Pfizer-BioNTech).

Where does Greece rank in life expectancy? ›

Countries ranked by life expectancy
#CountryLife Expectancy (both sexes)
19New Zealand82.80
92 more rows

What is the Greek obesity rate? ›

Scientists discussing the topic presented a startling picture of obesity in Greece–over 38% of the country's population is overweight and 32% are obese, while 21% of children under the age of 9 are overweight or obese.

What is the most common cause of under 5 mortality in developing world? ›

The leading causes of death in children under 5 years are preterm birth complications, birth asphyxia/trauma, pneumonia, diarrhoea and malaria, all of which can be prevented or treated with access to affordable interventions in health and sanitation.

Which country has the richest doctors? ›

Surprisingly, Luxembourg is considered the most lucrative country for doctors around the world. Luxembourg is a small country in Western Europe, its population is around 632000. Luxembourg is among the top 10 countries that offer high quality of life around the world.

Why does Greece have so many doctors? ›

Inadequate planning of human resources for health, inadequate health financing policy regarding primary care, gatekeeping mechanisms, and medical power constitute the primary themes explaining the trends of physicians' population in Greece.

Which country has the lowest doctor to patient ratio? ›

The average for 2020 based on 27 countries was 3.56 doctors per 1,000 people. The highest value was in Austria: 5.35 doctors per 1,000 people and the lowest value was in Brazil: 2.05 doctors per 1,000 people. The indicator is available from 1960 to 2021. Below is a chart for all countries where data are available.

What city in Greece has the highest crime rate? ›

Again, no surprise: the most dangerous city in Greece is Athens. Personal anecdote: I spent 3 days in Athens with my parents. In this short period, thieves stole both me and my father (on different days). Here you can read more about my experience of (un)safety in Athens.

What is the crime rate in Canada? ›

This statistic shows the reported rate of violent crime in Canada from 2000 to 2021. There were roughly 890 violent crimes reported per 100,000 residents in Canada in 2021.

What is the most common crime in Athens? ›

Petty Crime. Most crime is of the petty variety like the pick-pockets who work the crowded metro cars in central Athens. By keeping your hands in your pocket, or holding tight to purse, you make yourself a difficult target and what they are looking for are easy targets.

Which country has the highest percentage of heart disease? ›

The Russian Federation shows the highest death rates from cardiovascular disease of the 17 countries compared. Their death rate is over three times that of Australia for both males and females.

What countries have the highest rate of cardiovascular disease? ›

The highest number of CVD deaths occurred in China, followed by India, Russia, the US and Indonesia. At the country level, age-standardized mortality rates for total CVD were lowest in France, Peru and Japan where rates were six-fold lower in 2019 than in 1990.

Why do Mediterranean countries have low rates of heart disease? ›

A pathophysiological explanation

The Mediterranean diet is high in monounsaturated fat, principally olive oil, low in saturated fat, high in complex carbohydrates from legumes, and high in fiber, mostly from vegetables and fruits.

What is the percentage of heart disease in Canada? ›

about 1 in 12 (or 2.6 million) Canadian adults age 20 and over live with diagnosed heart disease. every hour, about 14 Canadian adults age 20 and over with diagnosed heart disease die.

What country has the lowest risk of heart disease? ›

The healthiest hearts in the world have been found in the Tsimane people in the forests of Bolivia, say researchers. Barely any Tsimane had signs of clogged up arteries - even well into old age - a study in the Lancet showed.

Which country has lowest rate of heart disease? ›

Introduction. Japan has the lowest coronary heart disease (CHD) mortality rate in the world [1].

What diseases are Greeks prone to? ›

Five of the Top Diseases in Greece
  • Coronary Heart Disease. According to WHO, Coronary Heart Disease (CHD) is one of the top diseases in Greece, responsible for 26.17% of the country's total deaths. ...
  • Stroke. ...
  • Malaria. ...
  • Legionnaires' disease. ...
  • West Nile virus.
Dec 28, 2016

What is the Greek sacred disease? ›

Epilepsy was first described in Babylonian texts more than 3,000 years ago. The ancient Greeks called it the 'sacred disease,' associating the disorder with the divine. The ancient Romans believed it to be contagious and called sufferers lunaticus, or moonstruck.

What cardiovascular disorder has the highest mortality rate? ›

Coronary heart disease is the most common type of heart disease, killing 382,820 people in 2020.

Which country has best cardiology? ›

Turkey. Turkey stands with the highest success rate for heart surgeries and CVDs treatment. The country is equipped with a highly experienced and qualified healthcare team, well-versed with updated treatment plans and the latest cardiac procedures.

What is the mortality rate of cardiovascular disease? ›

In 2019, 2.0 million people died from CVD. The age-standardized CVD death rates decreased from 203.3 deaths (95% UI: 176.0 to 227.1) per 100,000 population in 2000 to 137.2 deaths (95% UI: 110.3 to 165.5) per 100,000 population in 2019.

What foods are not allowed on the Mediterranean diet? ›

Don't eat these foods, or limit your consumption
  • Red meat.
  • Processed meat and foods.
  • Sweets.
  • Alcohol.
  • Butter.
  • Whole-fat dairy.
  • Sugary drinks.
Jan 4, 2023

Which ethnic group has the greatest risk for cardiovascular disease? ›

Coronary artery disease and heart attack

Black adults are more likely than white adults to die from a heart attack. Asian adults are less likely than other groups to have coronary artery disease.

Is mayonnaise allowed on the Mediterranean diet? ›

Just make sure you're eating healthy monounsaturated fats like avocado and not inflammatory vegetable fats found in mayonnaise. You won't find that creamy spread on the list of 25 Best Foods for a Toned Body.


1. What you need to know about ‘excess deaths’ from COVID-19
(Good Morning America)
2. Excess Deaths: Causes (Deep Dive)
(MedCram - Medical Lectures Explained CLEARLY)
3. Excess deaths - COVID-19 vaccines update 77
4. What do excess deaths tell us about the true human cost of Covid-19?
(Biotech and Bioinformatics with Prof Greg)
5. Death Counts from COVID-19 | Excess Mortality Explained
(Anthony Kuster)
6. Record excess deaths in Europe
(Dr. John Campbell)


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