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BACKGROUNDIn 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent to which non-COVID deaths contributed to excess mortality, its regional characterization, and the association between municipal-and individual-level sociodemographic inequality has not been characterized. METHODSWe conducted a retrospective municipal an individual-level study using death certificate data in Mexico from 2016-2020. We analyzed mortality related to COVID-19 and to non-COVID-19 causes using ICD-10 codes to identify cause-specific mortality. Excess mortality was estimated as the increase in deaths in 2020 compared to the average of 2016-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. We evaluated correlates of non-COVID-19 mortality at the individual level using mixed effects logistic regression and correlates of non-COVID-19 excess mortality in 2020 at the municipal level using negative binomial regression. RESULTSWe identified 1,069,174 deaths in 2020 (833.5 per 100,000 inhabitants), which was 49% higher compared to the 2016-2019 average (557.38 per 100,000 inhabitants). Overall excess mortality (276.11 deaths per 100,000 inhabitants) was attributable in 76.1% to COVID-19; however, non-COVID-19 causes comprised one-fifth of excess deaths. COVID-19 deaths occurred primarily in-hospital, while excess non-COVID-19 deaths decreased in this setting and increased out-of-hospital. Excess non-COVID-19 mortality displayed geographical heterogeneity linked to sociodemographic inequalities with clustering in states in southern Mexico. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization, and social marginalization. At the individual level, lower educational attainment, blue collar workers, and lack of medical care assistance were associated with non-COVID-19 mortality during 2020. CONCLUSIONNon-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual-and municipal-level sociodemographic inequalities. These findings should prompt an urgent call to action to improve healthcare coverage and access to reduce health and sociodemographic inequalities in Mexico to reduce preventable mortality in situations which increase the stress of healthcare systems, including the ongoing COVID-19 pandemic.
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The COVID-19 pandemic triggered declines in life expectancy at birth around the world. The United States of America (USA) was hit particularly hard among high income countries. Early data from the USA showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared to white people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life expectancy disparities in the USA from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 years and 3.6 years, respectively) compared to white males (1.5 years). These drops nearly eliminated the previous life expectancy advantage for the Hispanic compared to white population, while dramatically increasing the already large gap in life expectancy between Black and white people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans additionally saw increases in cardiovascular disease and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and white populations, but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the USA, underscoring the importance of the social determinants of health during a public health crisis. Significance statementPublic interest in social and health inequalities is increasing. We examine the impact of COVID-19 on mortality in the USA across racial/ethnic groups and present four key findings. First, all groups suffered sizable life-expectancy losses and increases in years of life lost. Mortality from cardiovascular diseases, "deaths of despair", and COVID-19 explained most of these losses. Second, working-age mortality accounted for substantial life-expectancy losses, especially among Hispanic males. Third, lifespan inequality increased for Hispanic and white people, but decreased slightly for Black people. Fourth, the pandemic shifted racial/ethnic mortality differentials in favor of white people: narrowing the Hispanic advantage and widening the Black disadvantage. Our results provide a comprehensive assessment of mortality trends to inform policies targeting inequalities.
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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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ObjectivesTo quantify the effect of the COVID-19 pandemic on life expectancy in Chile categorized by rural and urban, and to correlate life expectancy changes with socioeconomic factors at the municipal level. DesignRetrospective cross-sectional demographic analysis using aggregated data. SettingVital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. ParticipantsAggregated national all-cause death data stratified by year (2000-2020), sex, and municipality. Main Outcome measuresStratified mortality rates using a Bayesian methodology. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for men and women and analyzed previous mortality trends since 2010. ResultsLife expectancy declined for both men and women in 2020. Urban areas were the most affected, with males losing 1.89 and females 1.33 in 2020. The strength of the decline in life expectancy correlated with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities. ConclusionsNot only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll. Strengths and limitationsO_LIFirst study to analyze changes in life expectancy in Chile with small-area resolution. C_LIO_LIWe applied a hierarchical Bayesian methodology to estimate life expectancies in the past 20 years. C_LIO_LIWe show that COVID-19 led to declines in life expectancy in Chile greater than a year in magnitude. These declines correlated with poverty levels, indicating that socially deprived populations were hit the hardest. C_LIO_LIWe also show that inequality in life expectancy between municipalities increased due to excess mortality among the working-age population in socially disadvantaged municipalities. C_LIO_LIThe main limitation is that our estimates depend on accurate small-area stratified population estimates. We implemented several estimates and showed that our findings are robust to the choice of them. C_LI
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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.
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COVerAGE-DB is an open-access database including cumulative counts of confirmed COVID-19 cases, deaths, and tests by age and sex. The main goal of COVerAGE-DB is to provide a centralized, standardized, age-harmonized, and fully reproducible database of COVID-19 data. Original data and sources are provided alongside data and measures in age-harmonized formats. An international team, composed of more than 60 researchers, contributed to the collection of data and metadata in COVerAGE-DB from governmental institutions, as well as to the design and implementation of the data processing and validation pipeline. The database is still in development, and at this writing, it includes 89 countries, and 237 subnational areas. Cumulative counts of COVID-19 cases, deaths, and tests are recorded daily (when possible) since January 2020. Many time series thus fully capture the first pandemic wave and the beginning of later waves. Since collection efforts began for COVerAGE-DB several studies have used the data.
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ObjectiveTo determine the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in the first half of 2020 (from week 1 to week 26 starting June 22) in England and Wales. DesignDemographic analysis of all-cause mortality from week 1 through week 26 of 2020 using publicly available death registration data from the Office for National Statistics. Setting and populationEngland and Wales population by age and sex in 2020. Main outcome measureAge and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality in the first half of 2020. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the standard deviation in age at death. ResultsWe estimate that there have been 53,937 (95% Prediction Interval: 53,092, 54,746) excess deaths in the first half of 2020, 54% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 1.7 and 1.9 years for females and males relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period. ConclusionsQuantifying excess deaths and their impact on life expectancy at birth provides a more comprehensive picture of the full COVID-19 burden on mortality. Whether mortality will return to - or even fall below - the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place. Summary boxesO_ST_ABSWhat is already known on this topicC_ST_ABSCOVID-19 related deaths may be misclassified as other causes of death thereby underestimating the full impact of the pandemic on mortality. Excess mortality, the difference between observed deaths and what would have been expected in the absence of the pandemic, is a useful metric to quantify the overall impact of the pandemic on mortality and population health. Life expectancy at birth and lifespan inequality assess the cumulative impact of the pandemic on population health. What this study addsWe examine death registration data from the Office for National Statistics from 2015 to week 26 (mid-year) in 2020 to quantify the impact of the COVID-19 pandemic on mortality in England and Wales thus far. We estimate excess mortality risk by age and sex, and quantify the impact of excess mortality risk on excess deaths, life expectancy and lifespan inequality. During weeks 10 through 26 of 2020, elevated mortality rates resulted in 53,937 additional deaths compared with baseline mortality. Life expectancy at birth for males and females in the first half of 2020 was 78 and 81.8 years, which represent a decline of 1.9 and 1.7 years of life lost relative to the year 2019. Lifespan inequality, a measure of the spread or variation in ages at death, declined due to the increase of mortality at older ages.
