Pandemic marked by premature deaths, lost years of life

Father and daughter at graveside
Father and daughter at graveside

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More than 28 million extra years of life were lost among 31 high- and upper-middle–income countries, and 33 nations saw declines in life expectancy, amid the COVID-19 pandemic in 2020, concludes a study yesterday in BMJ.

A team led by University of Oxford investigators conducted a time-series analysis of all-cause death data from the Human Mortality Database for 2005 to 2020 to estimate excess years of life lost and changes in life expectancy associated with the pandemic among 37 countries with reliable death data.

Decreases in life expectancy were estimated as the difference between expected and observed life expectancy using the Lee-Carter model, and excess years of life lost were estimated using the difference between the observed and expected years of life lost using the World Health Organization's standard life table.

The authors noted that years of life lost had fallen among both men and women in most countries, except Canada, Greece, Scotland, Taiwan, and the United States, from 2005 to 2019.

More men than women died prematurely

All countries except New Zealand, Taiwan, and Norway, which observed gains in life expectancy in 2020, saw declines in life expectancy among both men and women. Denmark, Iceland, and South Korea experienced no change in life expectancy.

The most marked declines in life expectancy were seen in Russia (men, -2.33; women: -2.14), the United States (men, -2.27; women, -1.61), Bulgaria (men, -1.96; women, -1.37), Lithuania (men, -1.83; women, -1.21), Chile (men, -1.64; women, -0.88), and Spain (men, -1.35; women, -1.13).

Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea were the only countries that didn't experience years of life lost in 2020. The remaining 31 countries observed more than 222 million years of life lost, equaling 28.1 million more than were expected (men, -17.3 million; women, -10.8 million).

The most lost years of life per 100,000 people were seen in Bulgaria (men, -7,260; women, -3730), Russia (men, -7,020; women, -4,760), Lithuania (men, -5,430; women, -2,640), the United States (men, -4,350; women, -2,430), Poland (men, -3,830; women, -1,830), and Hungary (men, -2,770; women, -1,920).

Excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the United States, where excess years lost were more than 2,000 per 100,000 people. The ratio of years of life lost between people younger and older than 65 years was at least 0.2 in Estonia, Canada, Scotland, the United States, Lithuania, and Chile.

More years lost than during 2015 flu epidemic

The study authors noted that all-cause death data are better measures of the true impact of the pandemic than reported COVID-19 deaths because they are less sensitive to coding errors, competing risks, and possible misclassifications in the cause of death; as such, they facilitate comparisons between countries.

"Excess years of life lost associated with the COVID-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015," they wrote. "Our findings of a comparable or lower than expected YLL [years of life lost] in Taiwan, New Zealand, Denmark, Iceland, Norway, and South Korea underscore the importance of successful viral suppression and elimination policies, including targeted and population based public health policy interventions."

Quantification of the effects of different policy interventions on the reduction of premature deaths can inform the creation of future policies, the researchers said.

"As many of the effects of the pandemic might take a longer time frame to have a measurable effect on human lives, continuous and timely monitoring of excess YLL would help identify the sources of excess mortality and excess YLL in population subgroups," they concluded.

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