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The 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 contextO_ST_ABSEvidence before this studyC_ST_ABSThe 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.
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IntroductionThe infection-fatality rate (IFR) of COVID-19 has been carefully measured and analyzed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries. MethodsWe systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using population representative samples collected by early 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analyzed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible. ResultsSeroprevalence in many developing country locations was markedly higher than in high-income countries. In most locations, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups. Age-specific IFRs were roughly 2x higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure. ConclusionThe burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to accelerate the provision of vaccine doses to populations in developing countries. Key Points- Age-stratified infection fatality rates (IFRs) of COVID-19 in developing countries are about twice those of high-income countries. - Seroprevalence (as measured by antibodies against SARS-CoV-2) is broadly similar across age cohorts, underscoring the challenges of protecting older age groups in developing countries. - Population IFR in developing countries is similar to that of high-income countries, because differences in population age structure are roughly offset by disparities in healthcare access as well as elevated infection rates among older age cohorts. - These results underscore the urgency of disseminating vaccines throughout the developing world.
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Variations in the age patterns and magnitudes of excess deaths, as well as differences in population sizes and age structures make cross-national comparisons of the cumulative mortality impacts of the COVID-19 pandemic challenging. Life expectancy is a widely-used indicator that provides a clear and cross-nationally comparable picture of the population-level impacts of the pandemic on mortality. Life tables by sex were calculated for 29 countries, including most European countries, Chile, and the USA for 2015-2020. Life expectancy at birth and at age 60 for 2020 were contextualised against recent trends between 2015-19. Using decomposition techniques, we examined which specific age groups contributed to reductions in life expectancy in 2020 and to what extent reductions were attributable to official COVID-19 deaths. Life expectancy at birth declined from 2019 to 2020 in 27 out of 29 countries. Males in the USA and Lithuania experienced the largest losses in life expectancy at birth during 2020 (2.2 and 1.7 years respectively), but reductions of more than an entire year were documented in eleven countries for males, and eight among females. Reductions were mostly attributable to increased mortality above age 60 and to official COVID-19 deaths. The COVID-19 pandemic triggered significant mortality increases in 2020 of a magnitude not witnessed since WW-II in Western Europe or the breakup of the Soviet Union in Eastern Europe. Females from 15 countries and males from 10 ended up with lower life expectancy at birth in 2020 than in 2015.
