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Disclosures: Healio Primary Care could not confirm relevant financial disclosures at the time of publication.
September 20, 2021
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COVID-19 pandemic shortens aggregate US life expectancy by more than 9 million years

Disclosures: Healio Primary Care could not confirm relevant financial disclosures at the time of publication.
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Researchers estimated that the COVID-19 pandemic shortened aggregate U.S. life expectancy by more than 9 million years, and Black and Hispanic individuals lost more than twice as many quality-adjusted life years per capita than white individuals.

To better understand the mortality burden of the COVID-19 pandemic, Julian Reif, PhD, an associate professor of finance and economics at the Gies College of Business at the University of Illinois, and colleagues culled data from the Health and Retirement Study, Panel Study of Income Dynamics, CDC and nursing home death counts from CMS. They then used an established microsimulation model to estimate “what life expectancy would have been for a nationally representative cohort of Americans aged 25 years or older if the COVID-19 pandemic had never happened.”

An infographic with a person in a hospital bed. Text that reads: Absent the pandemic, 38% of decedents would have otherwise had average or above-average life expectancies.
Reference: Reif J, et al. Ann Intern Med. 2021;doi:10.7326/M21-2239.

The results, published in Annals of Internal Medicine, indicated that the COVID-19 pandemic led to an estimated 6.62 million quality-adjusted life years lost (about 9.08 million years of life lost) from March 22, 2020, through March 13, 2021, and that 54% of those years were lost among adults aged 25 to 64 years. The impact was the greatest on Black and Hispanic men aged 65 years and older, who lost 1,138 and 1,371 quality-adjusted life years, respectively, for every 10,000 individuals.

“Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex and race/ethnicity,” the researchers wrote.

In addition, dementia, the most influential risk factor (OR = 3.62), was present in only 2.5% of the population and trended toward the oldest age groups, Reif and colleagues reported. Conversely, moderate risk factors such as former smoking (OR = 1.26), diabetes (OR = 1.41) and obesity (BMI of 30 kg/m2 to 35 kg/m2, OR = 1.07; BMI of 35 kg/m2 to 40 kg/m2, OR = 1.44; BMI 40 kg/m2 or higher, OR = 2.11) “are significantly more prevalent overall and among younger adults,” according to the researchers. Nearly 73% of the U.S. population in 2020 and 67.9% of the adult population aged 25 to 64 years had one or more risk factors that were positively associated with death from COVID-19.

“Some have emphasized that COVID-19 — especially before the delta variant — created a pandemic of the old, the sick, and the vulnerable,” Darius Lakdawalla, PhD, study co-author and director of research at the University of Southern California’s Schaeffer Center for Health Policy & Economics, told Healio Primary Care.

Darius Lakdawalla

“We find this not to be true,” Lakdawalla continued. “While deaths were more likely among older and more vulnerable groups, young and middle-aged adults lost roughly the same number of years of life. Remarkably, during the first year of the pandemic, COVID-19 caused 90% as much premature mortality among adults aged 25 to 64 years as all cardiovascular diseases combined.”

Ashish K. Jha, MD, MPH, a physician, health policy researcher and dean of the Brown University School of Public Health, wrote in a related editorial that the new effort by Reif and colleagues “yields crucial findings that deepen our understanding of the pandemic” in areas such as age group most affected and risk factors associated with the disease.

“Furthermore, Reif and colleagues found that the effect of COVID-19 is by no means limited to people with comorbidities,” Jha wrote. “In other words, although the pandemic certainly exploited the vulnerabilities of frail Americans with comorbidities, Americans fell prey to the worst disease outbreak in a century without regard to their prior health status.”

Reif and colleagues’ findings are also the latest to show the catastrophic toll that lifestyle and the COVID-19 pandemic are taking on all Americans. A January paper in the Proceedings of the National Academy of Sciences stated that the COVID-19 pandemic may wipe out life expectancy gains that took more than a dozen years for the United States to achieve. One month later, the CDC announced that in the first half of 2020, life expectancy for the total U.S. population dropped an entire year to 77.8 years.

In the Annals of Internal Medicine paper, Reif, Lakdawalla and colleagues acknowledged that their model did not consider “the effects of possible morbidity caused by COVID-19 in survivors or for other morbidity effects that may have resulted from the pandemic response.”

Regardless, Lakdawalla told Healio Primary Care that efforts to curb the pandemic should continue, with an emphasis on Black and Hispanic individuals and not confined to “the old or the sick.”

References

Jha A. Ann Intern Med. 2021;doi:10.7326/M21-3725.

Reif J, et al. Ann Intern Med. 2021;doi:10.7326/M21-2239.