Beyond COVID-19 Deaths: Cause-Specific Analysis of Excess Mortality in Russia

During the COVID-19 pandemic, European mortality exhibited a marked East-West divide in both timing and magnitude, echoing longstanding longevity disparities in this region. Russia sits on the Eastern side: early restrictions were short-lived, and vaccine uptake remained low amid historically limited trust in government and science. Using weekly national and monthly regional mortality data disaggregated by age, sex, and cause of death, we estimated excess mortality from March 2020 to December 2021 using generalised additive models. We identify two major mortality peaks (late 2020-early 2021 and late 2021) and estimate 1,044,914 excess deaths, well above the 595,815 officially registered COVID-19 deaths. Non-COVID-19 excess was larger during the first peak, especially at ages 15-44. Cardiovascular diseases accounted for roughly 60% of the non-COVID-19 excess and we find no evidence of excess mortality from cancer or external causes. Among women, excess deaths were concentrated at older ages, whereas among men they clustered at working and older working ages, only partly reflecting differences in age structure. The highest excess mortality was found in the most populous regions, particularly the Central European and Volga parts. Temporal and spatial inconsistencies in cause-of-death coding may obscure indirect mortality burden and hinder the associated policy response.