The Impact of the COVID-19 Pandemic in Greece, 2020–January 2023: An Analysis Based on National Digital COVID-19 and Vaccination Registries
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Sources, Methodology, and Definitions
National Digital Registry of COVID-19 Patients
2.2. Statistical Analysis
3. Results
3.1. COVID-19 Cases
3.2. COVID-19 Deaths
3.3. COVID-19 Mortality and Vaccination Against COVID-19
3.4. COVID-19 Mortality and Comorbidities
3.5. Distribution of COVID-19 Deaths by Number of Vaccine Doses and Comorbidities: Age Group 70+
3.6. Distribution of COVID-19 Deaths by Number of Vaccine Doses and Comorbidities: Age Group 55–69
3.7. Logistic Regression Analysis of the Risk of Dying from COVID-19
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
| AAR | After-action review |
| AMKA | Greek social security number |
| CI | Confidence interval |
| COPD | Chronic obstructive pulmonary disease |
| COVID-19 | Coronavirus disease 2019 |
| ECDC | European Centre for Disease Prevention and Control |
| EU | European Union |
| ICU | Intensive care unit |
| IDIKA S.A. | e-Government Center for Social Security Services S.A. |
| NCD | Noncommunicable disease |
| OR | Odds ratio |
| PCR | Polymerase chain reaction |
| SARS-CoV-2 | Severe acute respiratory syndrome coronavirus 2 |
| SPSS | Statistical Package for the Social Sciences |
| WHO | World Health Organization |
References
- Cucinotta, D.; Vanelli, M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020, 91, 157–160. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Pak, A.; Adegboye, O.A.; Adekunle, A.I.; Rahman, K.M.; McBryde, E.S.; Eisen, D.P. Economic consequences of the COVID-19 outbreak: The need for epidemic preparedness. Front. Public Health 2020, 8, 241. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Nicola, M.; Alsafi, Z.; Sohrabi, C.; Kerwan, A.; Al-Jabir, A.; Iosifidis, C.; Agha, M.; Agha, R. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. Int. J. Surg. 2020, 78, 185–193. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Johns Hopkins University. COVID-19 Dashboard. Available online: https://coronavirus.jhu.edu/map.html (accessed on 28 January 2023).
- Msemburi, W.; Karlinsky, A.; Knutson, V.; Aleshin-Guendel, S.; Chatterji, S.; Wakefield, J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature 2023, 613, 130–137. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Kourlaba, G.; Kourkouni, E.; Maistreli, S.; Tsopela, C.-G.; Molocha, N.-M.; Triantafyllou, C.; Koniordou, M.; Kopsidas, I.; Chorianopoulou, E.; Maroudi-Manta, S.; et al. Willingness of the Greek general population to get a COVID-19 vaccine. Glob. Health Res. Policy 2021, 6, 3. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- World Health Organization Regional Office for Europe; European Centre for Disease Prevention and Control. Joint ECDC–WHO Regional Office for Europe Weekly COVID-19 Surveillance Bulletin; ECDC and WHO Regional Office for Europe: Stockholm, Sweden; Copenhagen, Denmark, 2023. [Google Scholar]
- European Centre for Disease Prevention and Control. COVID-19 Vaccine Tracker. Available online: https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#uptake-tab (accessed on 10 June 2023).
- Pana, T.A.; Bhattacharya, S.; Gamble, D.T.; Pasdar, Z.; Szlachetka, W.A.; Perdomo-Lampignano, J.A.; Ewers, K.D.; McLernon, D.J.; Myint, P.K. Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: An ecological study. BMJ Open 2021, 11, e042034. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- El Mouhayyar, C.; Jaber, L.T.; Bergmann, M.; Tighiouart, H.; Jaber, B.L. Country-level determinants of COVID-19 case rates and death rates: An ecological study. Transbound. Emerg. Dis. 2022, 69, e906–e915. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Kumar, G.; Mukherjee, A.; Turuk, A.; Bhalla, A.; Talukdar, A.; Shivnitwar, S.K.; Ojha, U.; Menon, G.R.; Sahu, D.; Panda, S.; et al. Characterizing the third wave of COVID-19: An analysis from the National Clinical Registry of COVID-19. Indian J. Med. Res. 2022, 155, 478–484. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Krause, R.; Smolle, J. COVID-19 mortality and local burden of infectious diseases: A worldwide country-by-country analysis. J. Infect. Public Health 2022, 15, 1370–1375. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Tchicaya, A.; Lorentz, N.; Leduc, K.; de Lanchy, G. COVID-19 mortality with regard to healthcare service availability, health risks, and socio-spatial factors at the departmental level in France: A spatial cross-sectional analysis. PLoS ONE 2021, 16, e0256857. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Haas, E.J.; Angulo, F.J.; McLaughlin, J.M.; Anis, E.; Singer, S.R.; Khan, F.; Brooks, N.; Smaja, M.; Mircus, G.; Pan, K.; et al. Impact and effectiveness of the mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: An observational study using national surveillance data. Lancet 2021, 397, 1819–1829. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Ministry of Health of the Hellenic Republic. Therapeutic Prescribing Protocols. Available online: https://www.moh.gov.gr/articles/health/domes-kai-draseis-gia-thn-ygeia/kwdikopoihseis/therapeytika-prwtokolla-syntagografhshs/ (accessed on 10 June 2023).
- European Centre for Disease Prevention and Control. Data on SARS-CoV-2 Variants in the EU/EEA; ECDC: Stockholm, Sweden, 2023. [Google Scholar]
- World Health Organization Regional Office for Europe. Greece: National Digital Registry of COVID-19 Patients (2021). Available online: https://www.who.int/europe/publications/m/item/greece-national-digital-registry-of-covid-19-patients-(2021) (accessed on 10 February 2023).
- Yanez, N.D.; Weiss, N.S.; Romand, J.-A.; Treggiari, M.M. COVID-19 mortality risk for older men and women. BMC Public Health 2020, 20, 1742. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Bhaskaran, K.; Bacon, S.; Evans, S.J.; Bates, C.J.; Rentsch, C.T.; MacKenna, B.; Tomlinson, L.; Walker, A.J.; Schultze, A.; Morton, C.E.; et al. Factors associated with deaths due to COVID-19 versus other causes: Population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet Reg. Health Eur. 2021, 6, 100109. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Funk, S.; Salathé, M.; Jansen, V.A.A. Modelling the influence of human behaviour on the spread of infectious diseases: A review. J. R. Soc. Interface 2010, 7, 1247–1256. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Farshbafnadi, M.; Kamali Zonouzi, S.; Sabahi, M.; Dolatshahi, M.; Aarabi, M.H. Aging and COVID-19 susceptibility, disease severity, and clinical outcomes: The role of entangled risk factors. Exp. Gerontol. 2021, 154, 111507. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Eurostat. Ageing Europe: Looking at the Lives of Older People in the EU—2019 Edition; Publications Office of the European Union: Luxembourg, 2019. [Google Scholar]
- Vos, T.; Lim, S.S.; Abbafati, C.; Abbas, K.M.; Abbasi, M.; Abbasifard, M.; Abbasi-Kangevari, M.; Abbastabar, H.; Abd-Allah, F.; Abdelalim, A.; et al. 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, 1204–1222. [Google Scholar] [CrossRef] [PubMed]
- Organisation for Economic Co-Operation and Development. Greece: Country Health Profile 2021; OECD Publishing: Paris, France, 2021. [Google Scholar]
- Organisation for Economic Co-Operation and Development. Greece: Country Health Profile 2019; OECD Publishing: Paris, France, 2019. [Google Scholar]
- Elmusharaf, K.; Grafton, D.; Jung, J.S.; Roberts, E.; Al-Farsi, Y.; Al Nooh, A.A.; Bin Belaila, B.; ElShamy, A.; Al-Zuabi, H.; Al Mutawa, K.A.; et al. The case for investing in the prevention and control of non-communicable diseases in the six countries of the Gulf Cooperation Council: An economic evaluation. BMJ Glob. Health 2022, 7, e008670. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Bertram, M.Y.; Sweeny, K.; Lauer, J.A.; Chisholm, D.; Sheehan, P.; Rasmussen, B.; Upreti, S.R.; Dixit, L.P.; George, K.; Deane, S. Investing in non-communicable diseases: An estimation of the return on investment for prevention and treatment services. Lancet 2018, 391, 2071–2078. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Nugent, R.; Bertram, M.Y.; Jan, S.; Niessen, L.W.; Sassi, F.; Jamison, D.T.; Pier, E.G.; Beaglehole, R. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet 2018, 391, 2029–2035. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Graña, C.; Ghosn, L.; Evrenoglou, T.; Jarde, A.; Minozzi, S.; Bergman, H.; Buckley, B.S.; Probyn, K.; Villanueva, G.; Henschke, N.; et al. Efficacy and safety of COVID-19 vaccines. Cochrane Database Syst. Rev. 2022, 12, CD015477. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Jabłońska, K.; Aballéa, S.; Toumi, M. The real-life impact of vaccination on COVID-19 mortality in Europe and Israel. Public Health 2021, 198, 230–237. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Ferdinands, J.M.; Rao, S.; Dixon, B.E.; Mitchell, P.K.; DeSilva, M.B.; Irving, S.A.; Lewis, N.; Natarajan, K.; Stenehjem, E.; Grannis, S.J.; et al. Waning of vaccine effectiveness against moderate and severe COVID-19 among adults in the United States from the VISION network: Test-negative, case-control study. BMJ 2022, 379, e072141. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Menni, C.; May, A.; Polidori, L.; Louca, P.; Wolf, J.; Capdevila, J.; Hu, C.; Ourselin, S.; Steves, C.J.; Valdes, A.M.; et al. COVID-19 vaccine waning and effectiveness and side effects of boosters: A prospective community study from the ZOE COVID Study. Lancet Infect. Dis. 2022, 22, 1002–1010. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- World Health Organization. SAGE Updates COVID-19 Vaccination Guidance. Available online: https://www.who.int/news/item/28-03-2023-sage-updates-covid-19-vaccination-guidance (accessed on 13 April 2023).
- O’Mahoney, L.L.; Routen, A.; Gillies, C.; Ekezie, W.; Welford, A.; Zhang, A.; Karamchandani, U.; Simms-Williams, N.; Cassambai, S.; Ardavani, A.; et al. The prevalence and long-term health effects of long COVID among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. eClinicalMedicine 2023, 55, 101762. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Johns Hopkins University. Mortality Analyses. Available online: https://coronavirus.jhu.edu/data/mortality (accessed on 4 August 2026).
- Mathieu, E.; Ritchie, H.; Rodés-Guirao, L.; Appel, C.; Giattino, C.; Hasell, J.; Macdonald, B.; Dattani, S.; Beltekian, D.; Ortiz-Ospina, E.; et al. COVID-19 Pandemic. Our World in Data. 2020. Available online: https://ourworldindata.org/coronavirus (accessed on 4 August 2026).
- Karlinsky, A.; Kobak, D. Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset. eLife 2021, 10, e69336. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- World Health Organization. Clinical Management of COVID-19: Living Guideline, 13 January 2023; World Health Organization: Geneva, Switzerland, 2023. [Google Scholar]
- Karlatiras, T. Coronavirus: This Is How Deaths Are Recorded in Greece. ProtoThema. 2021. Available online: https://www.protothema.gr/greece/article/1183058/etsi-ginetai-i-katagrafi-ton-thanaton-apo-koronoio-stin-ellada/ (accessed on 21 February 2023).
- Statens Serum Institut. Surveillance of Mortality Related to the COVID-19 Epidemic in Denmark; Statens Serum Institut: Copenhagen, Denmark, 2022. [Google Scholar]
- UK Health Security Agency. Changes to the Way We Report on COVID-19 Deaths. 27 January 2023. Available online: https://ukhsa.blog.gov.uk/2023/01/27/changes-to-the-way-we-report-on-covid-19-deaths/ (accessed on 4 August 2026).
- World Health Organization. International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- World Health Organization. Guidance for After Action Review (AAR); World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]

| Age Group (Years) | 0–19 | 20–34 | 35–44 | 45–54 | 55–69 | 70+ | Total (n = 33,740) |
|---|---|---|---|---|---|---|---|
| Not vaccinated (n, %) | 8 (100.0) | 63 (87.5) | 208 (86.3) | 822 (87.4) | 4031 (80.8) | 18,474 (67.2) | 23,606 (70.0) |
| Two doses (n, %) | 0 (0.0) | 9 (12.5) | 21 (8.7) | 69 (7.3) | 491 (9.8) | 4131 (15.0) | 4721 (14.0) |
| Three or more doses (n, %) | 0 (0.0) | 0 (0.0) | 12 (5.0) | 50 (5.3) | 467 (9.4) | 4884 (17.8) | 5413 (16.0) |
| Age Group (Years) | 0–19 | 20–34 | 35–44 | 45–54 | 55–69 | 70+ | Total |
|---|---|---|---|---|---|---|---|
| Number of deaths per age group | 8 | 72 | 241 | 941 | 4989 | 27,489 | 33,740 |
| Hypertension (n, %) | 0 (0) | 9 (12.7) | 34 (14.2) | 243 (25.8) | 2383 (47.8) | 19,985 (72.7) | 22,654 (67.1) |
| Dyslipidaemia (n, %) | 0 (0) | 6 (8.5) | 30 (12.5) | 256 (27.2) | 2604 (52.2) | 18,261 (66.4) | 21,157 (62.7) |
| Diabetes mellitus—type 2 (n, %) | 0 (0) | 7 (9.7) | 18 (7.5) | 139 (14.8) | 1360 (27.3) | 10,332 (37.6) | 11,856 (35.1) |
| Coronary artery disease (n, %) | 0 (0) | 0 (0) | 4 (1.7) | 29 (3.1) | 701 (14.1) | 6944 (25.3) | 7678 (22.8) |
| Atrial fibrillation (n, %) | 0 (0) | 0 (0) | 5 (2.1) | 10 (1.1) | 235 (4.7) | 5391 (19.6) | 5641 (16.7) |
| COPD (n, %) | 1 (12.5) | 0 (0) | 10 (4.2) | 30 (3.2) | 442 (8.9) | 3561 (13%) | 4044 (12.0) |
| Cardiac failure (n, %) | 0 (0) | 0 (0) | 6 (2.5) | 11 (1.2) | 186 (3.7) | 2297 (8.4) | 2500 (7.4) |
| Age Group 70+ | Number of Vaccine Doses Against COVID-19 | Total Number of Deaths | ||
|---|---|---|---|---|
| Number of Comorbidities | Not Vaccinated | Two Doses | Three or More Doses | |
| 0 (n, %) | 1821 (6.6) | 280 (1.0) | 277 (1.0) | 2378 (8.7) |
| 1 (n, %) | 3125 (11.4) | 615 (2.2) | 625 (2.3) | 4365 (15.9) |
| 2 (n, %) | 4842 (17.6) | 974 (3.5) | 1128 (4.1) | 6944 (25.3) |
| 3 (n, %) | 4587 (16.7) | 1099 (4.0) | 1307 (4.8) | 6993 (25.4) |
| 4 (n, %) | 2723 (9.9) | 696 (2.5) | 927 (3.4) | 4346 (15.8) |
| 5 (n, %) | 1021 (3.7) | 317 (1.2) | 454 (1.7) | 1792 (6.5) |
| 6 (n, %) | 289 (1.1) | 120 (0.4) | 127 (0.5) | 536 (1.9) |
| 7+ (n, %) | 66 (0.2) | 30 (0.1) | 39 (0.1) | 135 (0.5) |
| Number of deaths | 18,474 (67.2) | 4131 (15.0) | 4884 (17.8) | 27,489 |
| Age Group 55–69 Years | Number of Vaccine Doses Against COVID-19 | Total Number of Deaths | ||
|---|---|---|---|---|
| Number of Comorbidities | Not Vaccinated | Two Doses | Three or More Doses | |
| 0 (n, %) | 1144 (22.9) | 113 (2.3) | 92 (1.8) | 1349 (27.1) |
| 1 (n, %) | 955 (19.1) | 90 (1.8) | 113 (2.3) | 1158 (23.2) |
| 2 (n, %) | 921 (18.5) | 130 (2.6) | 98 (2.0) | 1149 (23.0) |
| 3 (n, %) | 607 (12.2) | 75 (1.5) | 80 (1.6) | 762 (15.3) |
| 4 (n, %) | 284 (5.7) | 57 (1.1) | 56 (1.1) | 397 (7.9) |
| 5 (n, %) | 90 (1.8) | 21 (0.4) | 22 (0.4) | 133 (2.7) |
| 6 (n, %) | 27 (0.5) | 5 (0.1) | 5 (0.1) | 37 (0.7) |
| 7+ (n, %) | 3 (0.1) | 0 (0.0) | 1 (0.0) | 4 (0.1) |
| Number of deaths | 4031 (80.8) | 491 (9.8) | 467 (9.4) | 4989 |
| Variable | OR | 95% CI | p Value |
|---|---|---|---|
| Male vs. female | 1.72 | 1.68–1.77 | <0.001 |
| Two COVID-19 vaccine doses vs. no recorded doses | 0.35 | 0.33–0.36 | <0.001 |
| First additional vaccination vs. no recorded doses | 0.16 | 0.15–0.17 | <0.001 |
| Second additional vaccination vs. no recorded doses | 0.09 | 0.09–0.10 | <0.001 |
| Previous infection | 0.42 | 0.38–0.46 | <0.001 |
| One comorbidity or more | 1.10 | 1.09–1.11 | <0.001 |
| Original/Alpha vs. Delta wave | 0.97 | 0.94–1.01 | 0.125 |
| Omicron vs. Delta wave | 0.28 | 0.27–0.29 | <0.001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.
Share and Cite
Rakovac, I.; Triantafyllou, C.; Psiakis, V.; Galinovic, A.; Domingues, A.M.; Myrianthefs, P.; Breda, J. The Impact of the COVID-19 Pandemic in Greece, 2020–January 2023: An Analysis Based on National Digital COVID-19 and Vaccination Registries. Epidemiologia 2026, 7, 129. https://doi.org/10.3390/epidemiologia7050129
Rakovac I, Triantafyllou C, Psiakis V, Galinovic A, Domingues AM, Myrianthefs P, Breda J. The Impact of the COVID-19 Pandemic in Greece, 2020–January 2023: An Analysis Based on National Digital COVID-19 and Vaccination Registries. Epidemiologia. 2026; 7(5):129. https://doi.org/10.3390/epidemiologia7050129
Chicago/Turabian StyleRakovac, Ivo, Christos Triantafyllou, Vion Psiakis, Adela Galinovic, Ana Marques Domingues, Pavlos Myrianthefs, and Joao Breda. 2026. "The Impact of the COVID-19 Pandemic in Greece, 2020–January 2023: An Analysis Based on National Digital COVID-19 and Vaccination Registries" Epidemiologia 7, no. 5: 129. https://doi.org/10.3390/epidemiologia7050129
APA StyleRakovac, I., Triantafyllou, C., Psiakis, V., Galinovic, A., Domingues, A. M., Myrianthefs, P., & Breda, J. (2026). The Impact of the COVID-19 Pandemic in Greece, 2020–January 2023: An Analysis Based on National Digital COVID-19 and Vaccination Registries. Epidemiologia, 7(5), 129. https://doi.org/10.3390/epidemiologia7050129

