COVID-19–related deaths lowered life expectancy at birth in Brazil by an estimated 1.3 years in 2020 and by 1.8 years in early 2021, reversing 19% of gains achieved since 2000, according to a study today in Nature Medicine.
Harvard University researchers led the study, which used data on total deaths in 2020 and January to April 2021 to assess and compare the COVID-19 death tally in each Brazilian state.
They found that life expectancy in Brazil declined by 1.3 years, reversing overall gains observed since 2014. People 65 years old in 2020 lost 0.9 years of life expectancy, a number not seen since 2012.
From January to April 2021, coronavirus deaths were at 107% of the total deaths in 2020. Under the assumption that death rates would have been on par with 2019 all-cause death rates if it hadn't been for the pandemic, 2021 COVID-19 deaths have already cut life expectancy by 1.8 years. For those 65 years old, the 2021 reduction is 1.05 years.
The decrease in life expectancy was more pronounced for males (1.57 years) than for females (0.95), broadening the gap between them by 0.6 years (9.1%). In Amapa state, in the country's north, the gap between the sexes increased by an estimated 2.1 years, the most among all states.
Among those 65 years old in 2020, the gap between the sexes widened 16.3% in 2020 in the country as a whole and 107% in Amapa. Among males, the northern states Amazonas and Para lost all gains since 2000.
Northern states take biggest hit
The largest declines in overall life expectancy were seen in northern states, where Amazonas saw the loss of 3.46 years, representing 60.4% of improvements in life expectancy made since 2000 (-68% for males, -29% for those age 65). Other states with large life expectancy reductions included Amapa (3.18 years) and Para (2.71).
Northern and northeastern states have the highest levels of income disparities and poverty and poor access to infrastructure, doctors, and hospital beds. But the estimated 2020 declines in life expectancy were smaller in the northeast than in the north, which could be at least partially due to the more stringent physical distancing mandates in the northeast, the researchers said.
Southern states experienced a surge of COVID-19 later than other states, which could explain their relatively small reduction in life expectancy. However, southern states are expected to have a much larger loss in 2021 than in 2020.
The life expectancy reduction for Brazilians aged 65 from 2019 to 2020 was 0.94 years (0.66 years for women, 1.17 years for men). Again, the biggest reductions during that period occurred in Amazonas (3.14 years), Amapa (2.46), and Para (2.44), with the steepest drops in men (-20%).
Serious threat to global health
The authors noted that Brazil and the United States represent 28% of all COVID-19 global deaths and 59% of those in the Americas.
In Brazil, April 2021 was the deadliest month of the pandemic, with deaths outpacing births in nine capital cities; by Apr 25, COVID-19 deaths had already passed the number reported in all of 2020. In the United States, life expectancy dropped 1.13 years, reversing gains made since 2003.
Yet the true coronavirus death tally is likely higher than reported because of a lack of robust surveillance, limited testing, and poor compliance with protocols for reporting COVID-19 deaths, the researchers said.
From 1945 to 2020, Brazil's life expectancy had risen from 45.5 years to 76.7 years, representing, on average, nearly 5 months per year.
The researchers said they expect life expectancies to rebound in Brazil, but not this year, and not as quickly as gains accumulated in recent years. This is because coronavirus cases and deaths remain very high (roughly 2,000 deaths a day) and because of low vaccine availability, intensive care unit occupancy above 80%, and the emergence of more transmissible virus variants. As of May 29, this year's COVID-19 deaths in Brazil were 137% higher than those recorded in 2020.
Other issues likely to compromise life expectancy in Brazil, the authors said, include disrupted primary care services, long-term COVID-19 complications, economic crises contributing to poverty and inequality, health budget cuts, and changes in the health financing model.
"Brazil does not lack a universal healthcare system, a network of community health agents to target vulnerable communities, sufficient data and a capable cadre of researchers tirelessly advancing knowledge and informing policy," the researchers wrote. "What it lacks is leadership commitment to save lives."
Brazil lags other countries in pandemic response, they said: "Without a change in coordination of pandemic response, expansion of testing and a rapid increase in vaccination, Brazil will soon become a serious threat to national and global health security."
Jun 25 CIDRAP News story "COVID cuts US life expectancy, with minorities hit hardest"