By 2022, COVID pandemic had shaved 1.6 years from global life expectancy, research reveals

Pandemic death

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In a stunning reversal of decades of progress, global life expectancy at birth fell 1.6 years from 2019 to 2021, with 16 million of 131 million total deaths in 2020 and 2021 directly or indirectly attributable to COVID-19, reveals one of the most comprehensive studies of its kind published yesterday in The Lancet.

The Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021 Collaborators analyzed trends in death rates and life expectancy in 204 countries and territories and 811 subnational locations from 1950 to 2021, with a focus on the 2020-2021 COVID-19 pandemic period. The data, obtained from registries, surveys, censuses, and other sources, include more than 607 billion estimates of 371 diseases and injuries and 88 risk factors.

An ongoing effort, the GBD is the largest and most comprehensive study measuring health losses in global locations over time. More than 11,000 collaborators in 160 countries contribute to the research, which is coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Child death rates continued to fall

About 131 million people around the world died from any cause in 2020-2021 combined, with 15.9 million more deaths than expected due to COVID-19 infection or pandemic-related social, economic, or behavioral factors, such as delays in seeking healthcare.

Age-standardized death rates decreased 62.8% from 1950 to 2019 and then rose 5.1% in 2020-2021, but death rates among children younger than 5 years continued to fall, albeit more slowly (4.7 million in 2021, down from 5.2 million in 2019). Regional differences in child death rates, however, were stark, with one of four child pandemic deaths occurring in South Asia, and two of every four deaths occurring in sub-Saharan Africa.

All-cause death rates were higher among males than females aged 15 years and older (21.9% vs 16.6%) in 2020-2021 than in 2019. In 2020 or 2021, excess death rates surpassed 150 deaths per 100,000 people in 80 countries and territories, while 20 countries saw negative excess death rates.

After adjustment for population age, countries such as Jordan and Nicaragua had high excess COVID-related death rates. In analyzing subnational locations not previously investigated, the South African provinces of KwaZulu-Natal and Limpopo had among the highest excess death rates and largest life expectancy decreases, while some of the lowest excess death rates were seen in countries such as Barbados, New Zealand, Antigua, and Barbuda.

Global life expectancy climbed 22.7 years from 1950 to 2021, from 49.0 to 71.7 years, but from 2019 to 2021, it dropped 1.6 years, reversing historical trends. Thirty-two countries (15.7%) saw increased life expectancy.

The worldwide population was 7.89 billion in 2021, when populations in 56 countries had peaked and began to decrease, with continued rapid population growth in many lower-income countries. Countries in sub-Saharan Africa and South Asia experienced the greatest population growth from 2020 to 2021, at 39.5% and 26.3%, respectively. The ratio of people aged 65 years and older to those younger than 15 years rose in 188 countries (92.2%) from 2000 to 2021.

Despite losses, substantial progress in past 72 years

"For adults worldwide, the COVID-19 pandemic has had a more profound impact than any event seen in half a century, including conflicts and natural disasters," co-first author Austin Schumacher, PhD, of the IHME, said in an IHME press release. "Life expectancy declined in 84% of countries and territories during this pandemic, demonstrating the devastating potential impacts of novel pathogens."

Declining population growth, aging populations, and the shifting of growth to lower-income countries with worse health outcomes will have social, economic, and political consequences, such as workforce shortages in areas with shrinking younger populations and resource scarcity in those with growing populations. "This is worth restating, as these issues will require significant policy forethought to address in the affected regions," Schumacher added.

Life expectancy declined in 84% of countries and territories during this pandemic, demonstrating the devastating potential impacts of novel pathogens.

Austin Schumacher, PhD

But the study authors also noted substantial overall progress—including lower death rates and greater life expectancy—worldwide over the past 72 years. "Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages," they wrote.

"The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic," they added.

'Decolonizing' global public health

In a related commentary, Kathleen Strong, PhD, of the World Health Organization (WHO), and colleagues from the WHO and UNICEF said that, as the GBD collaborators acknowledge, all estimation methods are limited by the quality of data sources, data gaps, and model limitations.

"Many countries could benefit from knowing which of their data sources get used in estimation efforts and why," they wrote. "Such information and relevant explanations should be provided to countries so that they can better use estimates to direct future country-level interventions, needed health research, and priorities for donor funding."

Ultimately, Strong and colleagues said, more accurate worldwide estimates of death rates, life expectancy, and population projections will be possible only by improving country-level data and statistical systems, including household surveys, health management information systems, and civil registration and vital statistics systems.

"Greater transparency and involvement of countries in the development of global estimates will help improve ownership and use of the data, and will contribute to the decolonisation of global public health," they concluded.

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