National life expectancies fluctuated over the course of the pandemic and a new international study has examined the ongoing impacts of COVID on mortality.
The research, published 17 October 2022 in Nature Human Behaviour, showed that following a global decline in life expectancy (LE) in 2020, seven countries in Western Europe saw an incomplete but significant increase in 2021, while in the US, Chile, and most of Eastern Europe, the decline continued.
Only Australia and New Zealand avoided declines in LE across their populations in 2020, with Norway, Denmark, and Finland reporting no decline amongst women during this time.
The results also demonstrated that female advantage in LE significantly increased in 16 of the 29 countries during the pandemic, with the biggest growth in the sex gap observed in the US, increasing by nearly 12 months, from 5.72 to 6.69 years.
Lead author, Dr Jonas Schöley and his colleagues from Germany’s Max Planck Institute for Demographic Research, used all-cause mortality data from Short-Term Mortality Fluctuations Database, collected from 29 countries between 2015 and 2021, to estimate changes in life expectancy.
Dr Scholey explained that LE is a useful indicator of overall population health, and these diverging trends illustrate how some countries’ populations were more severely affected by the pandemic than others.
“At the turn of the twenty-first century, the rate of improvement in LE slowed in many high-income countries prior to the COVID pandemic, such as the US, England, Wales, and Scotland, among others. The COVID crisis triggered a mortality shock resulting in LE declines in 2020 of a magnitude not observed in the recent history of high-income countries,” Dr Scholey said.
“LE dropped in 28 of the 29 countries analysed from 2019 to 2021, with only Norway exceeding the 2019 levels, and excess mortality in ages 60+ was the main or sole contributor to these losses in 19 of 28 countries, with the US being the prominent exception.
“Throughout 2021, the impact of the pandemic became more heterogeneous across populations with differences in prior infection, non-pharmaceutical interventions, and vaccination uptake, all influencing the pandemic’s course.
“[However], COVID was still the largest contributor to the 2021 LE deficit in all analysed countries except the Netherlands – this is despite different reporting standards and thus provides additional strong evidence for the direct effect of COVID on increases in mortality.”
When they analysed mortality by age group the team found that deaths from COVID, in 11 of the 16 countries with LE losses in 2021, occurred significantly more in younger age groups (under the age of 60), compared to 2020, most notably in the US, where mortality increases among people under 60 contributed LE losses of −7.2 months.
“By 1 July, when vaccines were already available in the United States, only 66.9% of 50- to 64-year-olds were fully vaccinated compared with 82.3% of 65- to 74-year-olds (as per the CDCP’s COVID Data Tracker), meaning that older age groups may have been better protected during the large Delta wave in the United States in the summer/autumn of 2021 than during previous waves,” the authors noted.
They highlighted that the study also analysed the proportion of the population that was fully vaccinated as of October 2021 and found that reduced LE was associated with lower vaccination uptake.
Among the 13 countries that partially or completely bounced back from their LE losses in 2020, 10 achieved this primarily or solely due to normalizing mortality among the older population – but by 2021, countries that bounced back were able to do so by avoiding mortality increases in those under 60.
Long-term, emerging estimates of LE losses based on excess deaths suggest that most western European countries are expected to partly recover from their losses, with France, Belgium, Switzerland, and Sweden already returned to pre-pandemic levels by the end of 2021.
However, other countries -including the US and Russia – will suffer further LE declines.
“The inconsistent registration of deaths due to COVID across countries complicates any cause-of-death attribution analysis, including ours,” the authors concluded.
“[Yet] given that several countries have seen continued declines in life expectancy that are unprecedented over the past 70 years, there remains the possibility that some countries will experience a longer-term health crisis.”