Bounce backs amid continued losses: Life expectancy changes since COVID-19

Abstract

AbstractThe COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020, including most of Europe, the US and Chile, attribute them to mortality changes by age group, and compare them to historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in Western Europe experienced bounce-backs from life expectancy losses of 2020, Eastern Europe and the US witnessed sustained and substantial life expectancy deficits. Life expectancy deficits among ages 60+ were strongly correlated with measures of vaccination uptake. In contrast to 2020, the age profile of excess mortality in 2021 was younger with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.Research in contextEvidence before this studyThe COVID-19 pandemic disrupted mortality trends around the world. Most high-income countries experienced life expectancy declines in 2020, and emerging evidence from low-to-middle income shows substantial losses in life expectancy with large regional variation. These analyses emphasise the impact of COVID-19 deaths and also highlight the effect of excess mortality at older ages as the main contributor to life expectancy losses, although in some countries working-age mortality also contributed substantially to life expectancy reductions. Among those countries with publicly available data on deaths, only a few, including Denmark, Norway, Finland, Australia, South Korea, Iceland and New Zealand did not experience life expectancy losses.Added value of this studyWe estimate life expectancy for 29 countries in 2020-21 and assess bounce-backs versus mounting losses. We determine which age groups contributed most to life expectancy changes in 2021, and analyze how age patterns of excess mortality changed between 2020 and 2021. By projecting pre-pandemic mortality trends into 2020-21 we calculate the life expectancy deficit induced by the pandemic. We compare age-specific life expectancy deficits during fall/winter 2021 against age-specific vaccination uptake by October 1st and further decompose the deficit into contributions from COVID-19 versus non-COVID mortality. To contextualize the magnitude of life expectancy loss, we compare the 2020-21 COVID-19 pandemic with historic mortality shocks over the 20th century. We report results for females, males and the total population.Implications of all the available evidenceLife expectancy is an important summary measure of population health. Over the past decade, improvements in life expectancy have slowed in several countries. The COVID-19 pandemic has compounded these trends and disrupted life expectancy improvements across the globe. The pandemic increased life expectancy inequalities between the 29 low-mortality countries that we analyze, as life expectancy losses were higher among countries with lower pre-pandemic life expectancy. COVID-19 may be a short-term mortality shock, but it is unclear whether countries will bounce back to increasing life expectancy trends in the short- or medium-term. New variants continue the spread of SARS-CoV-2 globally. Variation in preventive measures and vaccine uptake has led to disparate mortality burdens across countries. The long-term mortality impacts of social and economic stressors due to the pandemic are not known, neither are the mortality implications of regular re-infection or Long-COVID. Going forward, it is crucial to understand how and why death rates vary across and within countries.