It is well accepted that COVID-19-related mortality shows a strong age dependency. However, temporal changes in the age distribution of excess relative mortality between waves of the pandemic are less frequently investigated. We aimed to assess excess absolute mortality and the age-distribution of all-cause mortality during the second and third waves of the COVID-19 pandemic in Hungary compared to the same periods of non-pandemic years. Rate ratios for excess all-cause mortality with 95% confidence intervals and the number of excess deaths for the second (week 41 of 2020 through week 4 of 2021) and third waves (weeks 7–21 of 2021) of the COVID pandemic for the whole of Hungary compared to the same periods of the pre-pandemic years were estimated for 10-year age strata using Poisson regression. Altogether, 9771 (95% CI: 9554–9988) excess deaths were recorded during the second wave of the pandemic, while it was lower, 8143 (95% CI: 7953–8333) during the third wave. During the second wave, relative mortality peaked for ages 65–74 and 75–84 (RR 1.37, 95%CI 1.33–1.41, RR 1.38, 95%CI 1.34–1.42). Conversely, during the third wave, relative mortality peaked for ages 35–44 (RR 1.43, 95%CI 1.33–1.55), while those ≥65 had substantially lower relative risks compared to the second wave. The reduced relative mortality among the elderly during the third wave is likely a consequence of the rapidly increasing vaccination coverage of the elderly coinciding with the third wave. The hugely increased relative mortality of those 35–44 could point to non-biological causes, such as less stringent adherence to non-pharmaceutical measures in this population.

人们普遍认为，与 COVID-19 相关的死亡率显示出强烈的年龄依赖性。然而，大流行浪潮之间超额相对死亡率的年龄分布的时间变化研究较少。我们旨在评估与非大流行年份同期相比，匈牙利 COVID-19 大流行第二波和第三波期间超额绝对死亡率和全因死亡率的年龄分布。COVID 大流行第二波（2020 年第 41 周至 2021 年第 4 周）和第三波（2021 年第 7-21 周）超额全因死亡率的比率和 95% 置信区间超额死亡人数使用泊松回归估计整个匈牙利与大流行前年份同期相比的 10 年年龄层。总共 9771 (95% CI: 9554–9988) 在第二波大流行期间记录了额外的死亡人数，而在第三波大流行期间则较低，为 8143 (95% CI: 7953–8333)。在第二波期间，相对死亡率在 65-74 岁和 75-84 岁时达到峰值（RR 1.37，95%CI 1.33-1.41，RR 1.38，95%CI 1.34-1.42）。相反，在第三波期间，相对死亡率在 35-44 岁达到峰值（RR 1.43，95%CI 1.33-1.55），而与第二波相比，≥65 岁的相对风险显着降低。第三波期间老年人的相对死亡率降低可能是与第三波同时发生的老年人疫苗接种覆盖率迅速增加的结果。35-44 岁人群的相对死亡率大幅增加可能指向非生物学原因，例如该人群对非药物措施的遵守不那么严格。