This paper examines the uneven geography of COVID-19-related excess mortality during the first wave of the pandemic in Europe, before assessing the factors behind the geographical differences in impact. The analysis of 206 regions across 23 European countries reveals a distinct COVID-19 geography. Excess deaths were concentrated in a limited number of regions—expected deaths exceeded 20% in just 16 regions—with more than 40% of the regions considered experiencing no excess mortality during the first 6 months of 2020. Highly connected regions, in colder and dryer climates, with high air pollution levels, and relatively poorly endowed health systems witnessed the highest incidence of excess mortality. Institutional factors also played an important role. The first wave hit regions with a combination of weak and declining formal institutional quality and fragile informal institutions hardest. Low and declining national government effectiveness, together with a limited capacity to reach out across societal divides, and a frequent tendency to meet with friends and family were powerful drivers of regional excess mortality.

中文翻译：

---

机构和第一波 COVID-19 大流行的不平衡地理

在评估影响地理差异背后的因素之前，本文研究了欧洲第一波大流行期间与 COVID-19 相关的超额死亡率的不均衡地理分布。对 23 个欧洲国家/地区的 206 个地区的分析揭示了独特的 COVID-19 地理环境。超额死亡集中在少数几个地区——预计死亡人数仅在 16 个地区超过 20%——超过 40% 的地区被认为在 2020 年前 6 个月没有出现超额死亡率。高度连通的地区，寒冷和干燥空气污染严重的气候和相对贫乏的卫生系统见证了超额死亡率的最高发生率。制度因素也发挥了重要作用。第一波对正规机构质量薄弱且不断下降以及非正规机构脆弱的地区造成的打击最为严重。国家政府效率低下且不断下降，以及跨越社会鸿沟的能力有限，以及与朋友和家人会面的频繁趋势是区域死亡率过高的强大驱动力。