COVID: “The most severe global mortality shock since the Second World War”

Two new studies reveal the profound impact of the COVID-19 pandemic on global life expectancy (LE), one showing substantial and sustained LE losses in the United States and Eastern Europe, and the other finding a link between LE at age 60 before the pandemic and excess deaths amid COVID-19 only in countries with older populations.

Life expectancy fell further in 2021 in 12 countries

In the first study, a team led by researchers from the Max Planck Institute for Demographic Research in Germany and the University of Oxford used the Short-Term Mortality Fluctuations Database to examine mortality all-cause and LE changes in 29 countries, including the United States. , most of Europe and Chile, since 2019. The research was published this week in Nature Human behavior.

Eight of the 29 countries saw substantial rebounds from 2020 LE losses, including Belgium (+10.8 months), Switzerland (+7.7), Spain (+7.6), France (+5.0), England and Wales (+2.1), Italy (+5.1), Sweden (+7.5) and Slovenia (+3.1).

But on top of the 2020 losses, LE fell further in 2021 in 12 countries: Bulgaria (−25.1 months), Chile (−8.0), Czech Republic (−10.4), Germany (−3.1 ), Estonia (−21.5), Greece (−12.4), Croatia (−11.6), Hungary (−16.4), Lithuania (−7.9), Poland (−12.1), Slovakia (−23.9) and United States (−2.7). In Scotland and Northern Ireland in 2021, LE showed no rebound from 2020.

In 2021, France, Belgium, Switzerland and Sweden all fully rebounded from substantial losses in 2020. Three countries, Denmark, Norway and Finland, had no LE loss in 2020, but only Norway had a significantly higher LE in 2021 than in 2019.

All countries experienced lower than expected LE in 2021 as pre-pandemic trends continued. Bulgaria, Chile, Croatia, Czech Republic, Estonia, Germany, Greece, Hungary, Lithuania, Poland and Slovakia all experienced much higher LE deficits in 2021 than in 2020.

Older people have become less vulnerable

In 2021, pandemic deaths have shifted to younger age groups, with U.S. mortality for ages 80 and older returning to pre-pandemic levels, possibly due to greater use of vaccination against COVID-19 in this group, but LE losses worsen at age 60 and younger. An increase in deaths in the younger age group contributed to LE losses of 7.2 months in 2021 compared to 2020, reversing LE rebounds in the older age group and resulting in a net decline in 2.7 months in 2021.

Excess deaths among Americans under 60 accounted for 58.9% of LE losses since the start of the pandemic. Losses in this age group, especially for men, were much higher in the United States than in most other countries in 2020.

Women had higher LE in all countries amid the pandemic, with a difference ranging from 3.17 years in Norway to 9.65 years in Lithuania, and the female advantage increased significantly in 16 out of 29 country. The largest increase in the gender gap occurred in the United States, where it rose from 5.72 to 6.69 years.

Deaths from COVID-19 explained most LE losses in 2021 in all countries except the Netherlands, where other causes accounted for 51.7% of LE deficit. Higher vaccination coverage by October 2021 was linked to lower LE deficits in the last 3 months of 2021 in all countries and in all age groups.

“Human populations faced multiple mortality crises during the 20th century, but LE continued to increase globally in the medium to long term, particularly in the second half of the 20th century” , the researchers wrote. “While COVID-19 has been the most severe global mortality shock since World War II, we will have to wait and see if and how longer-term LE trends are altered by the pandemic.”

In a press release from the University of Oxford, co-author Jose Manuel Aburto, PhD, said Brazil and Mexico [not included in the study] saw even worse LE losses in 2020 than the United States. “It is therefore likely that these countries have continued to experience mortality impacts in 2021, potentially even exceeding the 43 months that we estimated for Bulgaria,” he said.

Aging and excess mortality

In a research letter today in Open JAMA Networkresearchers from Jikei University in Tokyo describe their analysis of EL at age 60 before the pandemic and excess mortality from January 2020 to December 2021 in 158 countries.

Across countries, the median proportion of the population aged 60 or over was 9.7% (range 2.8% to 34.0%). After adjustment in 40 countries with aging populations, three factors were linked to excess mortality, including LE at age 60, gross domestic product per capita, and proportion of residents fully immunized. But in a multiple linear regression analysis, only LE at age 60 remained significant.

The likelihood of dying from cardiovascular disease, cancer, diabetes or chronic respiratory disease between the ages of 30 and 70 was most strongly associated with excess mortality. Mortality rates among people aged 15 to 60 and children aged 5 to 14, however, had weaker associations with excess mortality, and mortality rate among those aged 5 and under was not associated.

“The results suggest that long life expectancy at older ages in aging countries can be seen as a proxy variable associated with high-quality health care systems and resilience to health care crises, including health care crises. pandemics,” the authors concluded.

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