Different approaches to quantify years of life lost from COVID-19

Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality

Introduction

Excess mortality has been frequently used worldwide for summarising the COVID-19 pandemic-related burden. Estimates for France for the years 2020-2022 vary substantially from one report to another, and the year 2023 is poorly documented. The present study assessed the level of excess mortality that occurred in France between 2020 and 2023 together with the corresponding years of life lost (YLL), in order to provide a reliable, detailed and comprehensive description of the overall impact of the pandemic.

Method

This open cohort study of the whole French population analysed the 8 451 372 death occurrences reported for the years 2010-2023. A Poisson regression model was trained with years 2010-2019 for determining the age-specific and sex-specific evolution trends of mortality before the pandemic period. These trends were then used for estimating the excess mortality during the pandemic period (years 2020-2023). The life expectancies of the persons in excess mortality were used for estimating the corresponding YLL.

Results

From 2020 to 2023, the number of excess deaths (mean (95% CI) (percentage of change versus expected mortality)) was, respectively, 49 541 (48 467; 50 616) (+8.0%), 42 667 (41 410; 43 909) (+6.9%), 53 129 (51 696; 54 551) (+8.5%), and 17 355 (15 760; 18 917) (+2.8%). Corresponding YLL were 512 753 (496 029; 529 633), 583 580 (564 137; 602 747), 663 588 (641 863; 685 723), and 312 133 (288 051; 335 929). Individuals younger than 60 years old accounted for 17% of the YLL in 2020, 26% in 2021, 32% in 2022 and 50% in 2023. Men were more affected than women by both excess mortality and YLL.

Conclusion

This study highlights the long-lasting impact of the pandemic on mortality in France, with four consecutive years of excess mortality and a growing impact on people under 60, particularly men, suggesting lasting and profound disruption to the healthcare system.

Using Potential Years of Life Lost (PYLL) to Compare Premature Mortality between Romanian Counties to Confirmed COVID-19 Cases in 2020 and 2021

This article examines the impact of the COVID-19 pandemic on potential years of life lost (PYLL) in Romania's counties in 2020 and 2021. PYLL highlights the burden of premature deaths in a community and is a useful tool for prioritizing community health issues. The study compares the PYLL variation between different counties, identifying disparities in premature mortality rates and highlighting areas that require specific public health interventions. The results indicate that COVID-19 has had a significant impact on potential years of life lost across the country. For the year 2020, the total number of deaths from confirmed COVID-19 cases was 19,455, of which 14,152 premature deaths caused 193,489 PYLL, with a crude rate of 1053.28 PYLL per 100,000 inhabitants. In 2021, there were 39,966 deaths from confirmed COVID-19 cases, with 28,777 premature deaths, 386,061 PYLL, and a crude rate of 2116.63 PYLL per 100,000 population. This study reveals significant variations only in some counties, based on BYLL rates, and in the two years analyzed. The proportion of premature deaths (<80 years) varied by county and gender. PYLL's analysis by gender shows that men experienced a higher number of premature deaths than women in most counties, and this trend persisted in both years. The results are presented in the form of thematic maps, highlighting standardized PYLL rates for both genders in each county, facilitating a visual understanding of regional disparities. The identified variations can serve as a basis for developing and implementing more effective public health policies, based on the specifics of each county.

Premature Mortality Excess Rates Before and During the COVID-19 Pandemic: A Comparative Analysis Conducted in Bihor County, Romania

BACKGROUND

Estimating the excess of premature deaths (before the age of 75 years) and Potential Years of Life Lost allows ranking causes of death as an expression of the burden of disease in a population. We statistically analysed the impact of the coronavirus disease 2019 (COVID-19) pandemic on excess premature mortality in the total population and specifically, by sexes, compared to the pre-pandemic period, through Potential Years of Life Lost.

MATERIAL AND METHOD

In this retrospective descriptive observational study, we counted excess of premature mortality in the years 2020, 2021, and 2022 by cause of death (cardiovascular diseases, cancer, digestive diseases, injury, COVID-19, and other causes) and by sexes compared to the period average from 2017-2019, based on the deaths registered in Bihor County (48,948 people).

RESULTS

Premature deaths due to COVID-19 (1,745 people of both sexes) contributed 71.3% to excess mortality, the population being similar for both sexes (71.4% in men and 71.2% in women). The Potential Years of Life Lost/death due to COVID-19 was 11.84 years for both sexes (11.76 years in men and 12.02 years in women). Potential Years of Life Lost/all-cause heath was lower during the pandemic (13.42 years for both sexes, 14.06 years for men and 12.32 years for women) compared to the pre-pandemic period (14.6 years for both sexes, 15.1 years for men and 13.5 years for women).

CONCLUSIONS

The excess of premature mortality and decreased Potential Years of Life Lost/death during the pandemic, shows an increase in the proportion of deaths at ages closer to the established limit for premature mortality (75 years) compared to the pre-pandemic period.

Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data

BACKGROUND

Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+.

METHODS

Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy.

RESULTS

Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile.

CONCLUSIONS

Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.

Towards closing socio-economic status disparities in COVID-19 premature mortality: a nationwide and trend analysis in Chile

BACKGROUND

Socio-economic status (SES) disparities in coronavirus disease 2019 (COVID-19) mortality have been reported but complete information and time trends are scarce. In this study, we analysed the years of life lost (YLL) due to COVID-19 premature mortality during the pandemic in Chile and its evolution according to SES and sex compared with a counterfactual scenario [cerebrovascular accidents (stroke)].

METHOD

We used Chile's national mortality databases from 2020 to 2022. YLL and age-standardized YLL and mortality rates by sex and by epidemic waves were determined. The 346 communes were stratified into SES groups according to their poverty index quintile. Negative binomial regression models were used to test trends.

RESULTS

In >2 years of the pandemic, the COVID-19 YLL was 975 937, corresponding to 61 174 deaths. The YLL rate per 100 000 inhabitants was 1027 for males and 594 for females. There was a heterogeneous distribution of YLL rates and the regional level. Communes in the most advantaged SES quintile (Q5) had the highest YLL during the first wave compared with those in the lowest SES quintile (Q1) (P < 0.001) but the opposite was true during the second wave. COVID-19 YLL trends declined and differences between Q1 and Q2 vs Q5 converged from the second to the fourth waves (0.33 and 0.15, Ptrend < 0.001 and Ptrend = 0.024). YLL declined but differences persisted in stroke (-0.002, Ptrend = 0.979).

CONCLUSIONS

COVID-19 deaths resulted in a higher impact on premature death in Chile, especially in men, with a heterogeneous geographic distribution along the territory. SES and sex disparities in COVID-19 premature mortality had narrowed by the end of the pandemic.

Effectiveness of and Inequalities in COVID-19 Epidemic Control Strategies in Hungary: A Nationwide Cross-Sectional Study

INTRODUCTION

Before the mass vaccination, epidemiological control measures were the only means of containing the COVID-19 epidemic. Their effectiveness determined the consequences of the COVID-19 epidemic. Our study evaluated the impact of sociodemographic, lifestyle, and clinical factors on patient-reported epidemiological control measures.

METHODS

A nationwide representative sample of 1008 randomly selected adults were interviewed in person between 15 March and 30 May 2021. The prevalence of test-confirmed SARS-CoV-2 infection was 12.1%, of testing was 33.7%, and of contact tracing among test-confirmed infected subjects was 67.9%. The vaccination coverage was 52.4%.

RESULTS

According to the multivariable logistic regression models, the occurrence of infection was not influenced by sociodemographic and lifestyle factors or by the presence of chronic disease. Testing was more frequent among middle-aged adults (aOR = 1.53, 95% CI 1.10-2.13) and employed adults (aOR = 2.06, 95% CI 1.42-3.00), and was more frequent among adults with a higher education (aOR_secondary = 1.93, 95% CI 1.20-3.13; aOR_tertiary = 3.19, 95% CI 1.81-5.63). Contact tracing was more frequently implemented among middle-aged (aOR41-7y = 3.33, 95% CI 1.17-9.45) and employed (aOR = 4.58, 95% CI 1.38-15.22), and those with chronic diseases (aOR = 5.92, 95% CI 1.56-22.47). Positive correlation was observed between age groups and vaccination frequency (aOR41-70y = 2.94, 95% CI 2.09-4.15; aOR71+y = 14.52, 95% CI 7.33-28.77). Higher than primary education (aOR_secondary = 1.69, 95% CI 1.08-2.63; aOR_tertiary = 4.36, 95% CI 2.46-7.73) and the presence of a chronic disease (aOR = 2.58, 95% CI 1.75-3.80) positively impacted vaccination. Regular smoking was inversely correlated with vaccination (aOR = 0.60; 95% CI 0.44-0.83).

CONCLUSIONS

The survey indicated that testing, contact tracing, and vaccination were seriously influenced by socioeconomic position; less so by chronic disease prevalence and very minimally by lifestyle. The etiological role of socioeconomic inequalities in epidemic measure implementation likely generated socioeconomic inequality in COVID-19-related complication and death rates.

Early-death weeks associated with COVID-19: a comparison among France, the UK and the USA

BACKGROUND

Years of life lost (YLL) is recently used as a more insightful indicator to assess the mortality impact of COVID-19. However, this indicator still has methodological limits. This study aims to propose an alternative approach and new index, early-death weeks.

METHODS

The natural mortality and social mortality laws were employed to support two essential assumptions: the sequential and translational early-mortality patterns of COVID-19. This approach was then used with the data related to COVID-19 to calculate early-death weeks associated with COVID-19 in France, the UK and the USA.

RESULTS

As of week 20 of 2021, the rate of the total number of early-death weeks per the population of the USA is nearly two times compared to that of France and the UK, with 0.004% to 0.0021 and 0.0023%, respectively. The average numbers of early-death weeks after converting to units of years are 1.2, 1.0 and 1.3 years in France, the UK and the USA, respectively.

CONCLUSIONS

The new approach is significantly different from death counts, excess deaths and YLL. The early-death week index provides more insights into COVID-19 and can be applied promptly at any time as well as anywhere once excess deaths have occurred.

The Impact of Comorbidities and Obesity on the Severity and Outcome of COVID-19 in Hospitalized Patients-A Retrospective Study in a Hungarian Hospital

Patients with comorbidities and obesity are more likely to be hospitalized with coronavirus disease 2019 (COVID-19), to have a higher incidence of severe pneumonia and to also show higher mortality rates. Between 15 March 2020 and 31 December 2021, a retrospective, single-center, observational study was conducted among patients requiring hospitalization for COVID-19 infection. Our aim was to investigate the impact of comorbidities and lifestyle risk factors on mortality, the need for intensive care unit (ICU) admission and the severity of the disease among these patients. Our results demonstrated that comorbidities and obesity increased the risk for all investigated endpoints. Age over 65 years and male sex were identified as independent risk factors, and cardiovascular diseases, cancer, endocrine and metabolic diseases, chronic kidney disease and obesity were identified as significant risk factors. Obesity was found to be the most significant risk factor, associated with considerable odds of COVID-19 mortality and the need for ICU admission in the under-65 age group (aOR: 2.95; p < 0.001 and aOR: 3.49, p < 0.001). In our study, risk factors that increased mortality and morbidity among hospitalized patients were identified. Detailed information on such factors may support therapeutic decision making, the proper targeting of vaccination campaigns and the effective overall management of the COVID-19 epidemic, hence reducing the burden on the healthcare system.

[Factors Influencing Results of Mortality Measurement in the Corona Pandemic: Analyses of Mortality in Germany in 2020]

INTRODUCTION

(Excess) mortality and years of life lost are important measures of health risks from the Corona pandemic. The aim of this paper was to identify methodological factors that affect the calculation of mortality and further to point out possible misinterpretations of years of life lost.

METHODOLOGY

Standardized mortality ratios (SMRs) can be used to compare mortalities (e. g., an SMR of 1.015 means excess mortality of 1.5%, an SMR of 0.990 means that mortality is reduced by 1.0%). In this study, SMRs as a measure of association for mortality in Germany were calculated for 2020 using different methods. In particular, the influence of different data sources and reference periods was examined. Furthermore, its influence on the calculated mortality was also examined to take into account increasing life expectancy. In addition, published results on years of life lost were critically analyzed.

RESULTS

Using January 2022 data from the Federal Statistical Office on mortality for 5-year age groups resulted in higher SMR values than using preliminary data from February 2021 with 20-year age groups (SMR=0.997, 95% confidence interval (CI): 0.995-0.999 versus SMR=0.976 (95% CI: 0.974-0.978)). The choice of the reference period had a large impact on calculated mortality (for men, SMR=1.024 (95% CI: 1.022-1.027) with 2019 as the reference year versus SMR=0.998 (95% CI: 0.996-1.001) with 2016 to 2019 as the reference period). Analyses in which declining mortality in 2016 to 2019 was carried forward into 2020 when calculating expected deaths resulted in significantly higher SMR values (for men SMR=1.024 (95% CI: 1.021-1.026) with, and SMR=0.998 (95% CI: 0.996-1.001) without carrying forward declining mortality). Figures for pandemic-related years of life lost per person who died from COVID-19 should be interpreted with caution: Calculation from remaining life reported in mortality tables can lead to misleading results.

CONCLUSION

When calculating mortality and years of life lost during the pandemic, a number of methodological assumptions must be made that have a significant impact on the results and must be considered when interpreting the results.

Time-varying risk of death after SARS-CoV-2 infection in Swedish long-term care facility residents: a matched cohort study

OBJECTIVES

To evaluate whether SARS-CoV-2 infection in residents of long-term care (LTC) facilities is associated with higher mortality after the acute phase of infection, and to estimate survival in uninfected residents.

DESIGN

Extended follow-up of a previous, propensity score-matched, retrospective cohort study based on the Swedish Senior Alert register.

SETTING

LTC facilities in Sweden.

PARTICIPANTS

n=3604 LTC residents with documented SARS-CoV-2 until 15 September 2020 matched to 3604 uninfected controls using time-dependent propensity scores on age, sex, health status, comorbidities, prescription medications, geographical region and Senior Alert registration time. In a secondary analysis (n=3731 in each group), geographical region and Senior Alert registration time were not matched for in order to increase the follow-up time in controls and allow for an estimation of median survival.

PRIMARY OUTCOME MEASURES

All-cause mortality until 24 October 2020, tracked using the National Cause of Death Register.

RESULTS

Median age was 87 years and 65% were women. Excess mortality peaked at 5 days after documented SARS-CoV-2-infection (HR 21.5, 95% CI 15.9 to 29.2), after which excess mortality decreased. From the second month onwards, mortality rate became lower in infected residents than controls. The HR for death during days 61-210 of follow-up was 0.76 (95% CI 0.62 to 0.93). The median survival of uninfected controls was 1.6 years, which was much lower than the national life expectancy in Sweden at age 87 (5.05 years in men, 6.07 years in women).

CONCLUSIONS

The risk of death after SARS-CoV-2 infection in LTC residents peaked after 5 days and decreased after 2 months, probably because the frailest residents died during the acute phase, leaving healthier residents remaining. The limited life expectancy in this population suggests that LTC resident status should be accounted for when estimating years of life lost due to COVID-19.

Time-varying risk of death after SARS-CoV-2 infection in Swedish long-term care facility residents: a matched cohort study

OBJECTIVES

To evaluate whether SARS-CoV-2 infection in residents of long-term care (LTC) facilities is associated with higher mortality after the acute phase of infection, and to estimate survival in uninfected residents.

DESIGN

Extended follow-up of a previous, propensity score-matched, retrospective cohort study based on the Swedish Senior Alert register.

SETTING

LTC facilities in Sweden.

PARTICIPANTS

n=3604 LTC residents with documented SARS-CoV-2 until 15 September 2020 matched to 3604 uninfected controls using time-dependent propensity scores on age, sex, health status, comorbidities, prescription medications, geographical region and Senior Alert registration time. In a secondary analysis (n=3731 in each group), geographical region and Senior Alert registration time were not matched for in order to increase the follow-up time in controls and allow for an estimation of median survival.

PRIMARY OUTCOME MEASURES

All-cause mortality until 24 October 2020, tracked using the National Cause of Death Register.

RESULTS

Median age was 87 years and 65% were women. Excess mortality peaked at 5 days after documented SARS-CoV-2-infection (HR 21.5, 95% CI 15.9 to 29.2), after which excess mortality decreased. From the second month onwards, mortality rate became lower in infected residents than controls. The HR for death during days 61-210 of follow-up was 0.76 (95% CI 0.62 to 0.93). The median survival of uninfected controls was 1.6 years, which was much lower than the national life expectancy in Sweden at age 87 (5.05 years in men, 6.07 years in women).

CONCLUSIONS

The risk of death after SARS-CoV-2 infection in LTC residents peaked after 5 days and decreased after 2 months, probably because the frailest residents died during the acute phase, leaving healthier residents remaining. The limited life expectancy in this population suggests that LTC resident status should be accounted for when estimating years of life lost due to COVID-19.

The estimated disease burden of acute COVID-19 in the Netherlands in 2020, in disability-adjusted life-years

The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700-290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620-1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions.

Years of life lost during the Covid-19 pandemic in Sweden considering variation in life expectancy by level of geriatric care

The Covid-19 pandemic has not affected the population evenly. This must be acknowledged when it comes to understanding the Covid-19 death toll and answering the question of how many life years have been lost. We use level of geriatric care to account for variation in remaining life expectancy among individuals that died during 2020. Based on a linkage of administrative registers, we estimate remaining life expectancy stratified by age, sex, and care status using an incidence-based multistate model and analyze the number of years of life lost (YLL) during 2020 in Sweden. Our results show that remaining life expectancy between individuals with and without care differs substantially. More than half of all Covid-19 deaths had a remaining life expectancy lower than 4 years. Yet, in a 1-year perspective, Covid-19 did not seem to replace other causes of death. Not considering the differences in remaining life expectancy in the affected populations overestimated YLL by 40% for women and 30% for men, or around 2 years per death. While the unadjusted YLL from Covid-19 amounted to an average of 7.5 years for women and 8.6 years for men, the corresponding YLL adjusted for care status were 5.4 and 6.6, respectively. The total number of YLL to Covid-19 in 2020 is comparable to YLL from ischemic heart disease in 2019 and 2020. Our results urge the use of subgroup specific mortality when counting the burden of Covid-19. YLL are considerably reduced when the varying susceptibility for death is considered, but even if most lifespans were cut in the last years of life, the YLL are still substantial.

The Impact of Education and Lifestyle Factors on Disability-Free Life Expectancy From Mid-Life to Older Age: A Multi-Cohort Study

Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE).

Methods: Data (n = 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE.

Results: Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years).

Conclusion: Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.

Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU

The ability of healthcare workers to learn proper hand hygiene has been an understudied area of research. Generally, hand hygiene skills are regarded as a key contributor to reduce critical infections and healthcare-associated infections. In a clinical setup, at a Neonatal Intensive Care Unit (NICU), the outcome of a multi-modal training initiative was recorded, where objective feedback was provided to the staff. It was hypothesized that staff at the NICU are more sensitive towards applying increased patient safety measures. Outcomes were recorded as the ability to cover all hand surfaces with Alcohol-Based Handrub (ABHR), modelled as a time-series of measurements. The learning ability to rub in with 1.5 mL and with 3 mL was also assessed. As a secondary outcome, handrub consumption and infection numbers were recorded. It has been observed that some staff members were able to quickly learn the proper hand hygiene, even with the limited 1.5 mL, while others were not capable of acquiring the technique even with 3 mL. When analyzing the 1.5 mL group, it was deemed an insufficient ABHR amount, while with 3 mL, the critical necessity of skill training to achieve complete coverage was documented. Identifying these individuals helps the infection control staff to better focus their training efforts. The training led to a 157% increase in handrub consumption. The setting of the study did not allow to show a measurable reduction in the number of hospital infections. It has been concluded that the training method chosen by the staff greatly affects the quality of the outcomes.

Weeks of life lost to COVID-19, the case of the United States

BACKGROUND

Years of life lost (YLL) is a preferable indicator to assess the mortality impact of COVID-19. This indicator still has limits, however. Therefore, a new approach and its early-death weeks (eDW) index has been recently proposed to alter YLL. This study aims to add a new approach, the moving excess-deficit mortality model, and its method, the weeks of life lost (WLL) index. The new method was then used to measure WLL associated with COVID-19 in the United States (US).

METHODS

The natural mortality law and the random pattern of spreading COVID-19 were employed to support calculating WLL. The natural mortality law implied that under the same living conditions and the weaker would die earlier. The random spreading of COVID-19 assumed that COVID-19 causes the weekly number of early deaths in equal proportions from all of those who would have died eventually distributed through the pandemic.

RESULTS

From Week 02 of 2020 to Week 44 of 2021, we found that the US population has lost 56,270,300 weeks to COVID-19; the average WLL per COVID-19-related death is 74 or 1.4 in the unit of years.

CONCLUSIONS

The results do not depend on the high heterogeneity of deaths (e.g., age, gender, health status) and on whether COVID-19 is the main cause of death. The moving excess-deficit mortality model and WLL index can be applied promptly at any time and anywhere once excess deaths occurred during the pandemic. The index also provides critical insights into COVID-19, which can support making public health policies and decisions.

Burden of COVID-19 Mortality and Morbidity in Poland in 2020

In 2020 COVID-19 caused 41,442 deaths in Poland. We aimed to estimate the burden of COVID-19 using years of potential life lost (YPLL) and quality-adjusted years of life lost (QALYL). YPLL were calculated by multiplying the number of deaths due to COVID-19 in the analyzed age/sex group by the residual life expectancy for that group. Standard and country-specific (local) life tables were used to calculate SPYLL and LPYLL, respectively. QALYL were calculated adjusting LPYLL due to COVID-19 death by age/sex specific utility values. Deaths from COVID-19 in Poland in 2020 caused loss of 630,027 SPYLL, 436,361 LPYLL, and 270,572 QALYL. The loss was greater among men and rose with age reaching the maximum among men aged 65–69 and among women aged 70–74. Burden of COVID-19 in terms of YPLL is proportionate to external-cause deaths and was higher than the burden of disease in the respiratory system. Differential effects by sex and age indicate important heterogeneities in the mortality effects of COVID-19 and justifies policies based not only on age, but also on sex. Comparison with YPLL due to other diseases showed that mortality from COVID-19 represents a substantial burden on both society and on individuals in Poland.

Is Mandatory Vaccination in Population over 60 Adequate to Control the COVID-19 Pandemic in E.U.?

Vaccine hesitancy, which potentially leads to the refusal or delayed acceptance of COVID-19 vaccines, is considered a key driver of the increasing death toll from the pandemic in the EU. The European Commission and several member states’ governments are either planning or have already directly or indirectly announced mandatory vaccination for individuals aged over 60, the group which has repeatedly proved to be the most vulnerable. In this paper, an assessment of this strategy’s benefits is attempted by deriving a metric for the potential gains of vaccination mandates that can be used to compare EU member states. This is completed by examining the reduction in Standard Expected Years of Life Lost (SEYLL) per person for the EU population over 60 as a function of the member states’ vaccination percentage in these ages. The publicly available data and results of the second iteration of the SHARE COVID-19 survey on the acceptance of COVID-19 vaccines, conducted during the summer of 2021, are used as inputs.

The Effect of the COVID-19 Pandemic on the Elderly: Population Fatality Rates, COVID Mortality Percentage, and Life Expectancy Loss

The COVID-19 pandemic has disproportionately affected the elderly. This Article provides a detailed analysis of those effects, drawing primarily on individual-level mortality data covering almost three million persons aged 65+ in three Midwest states (Indiana, Illinois, and Wisconsin). We report sometimes surprising findings on population fatality rates ("PFR"), the ratio of COVID to non-COVID deaths, reported as a percentage, which we call the "Covid Mortality Percentage," and mean life expectancy loss ("LEL"). We examine how these COVID-19 outcomes vary with age, gender, race/ethnicity, socio-economic status, and time period during the pandemic. For all persons in the three Midwest areas, COVID PFR through year-end 2021 was 0.22%, mean years of life lost ("YLL") was 13.0 years, the COVID Mortality Percentage was 12.4%, and LEL was 0.028 years (eleven days). In contrast, for the elderly, PFR was 1.03%; YLL was 8.8 years, the COVID Mortality Percentage was 13.2%, and LEL was 0.091 years (thirty-four days). Controlling for gender, PFR and LEL were substantially higher for Blacks and Hispanics than for Whites at all ages. Racial/ethnic disparities for the elderly were large early in the pandemic but diminished later. Although COVID-19 mortality was much higher for the elderly, the COVID Mortality Percentage over the full pandemic period was only modestly higher for the elderly, at 13.2%, than for non-elderly adults aged 25-64, at 11.1%. Indeed, in 2021, this ratio was lower for the elderly than for the middle-aged, reflecting higher elderly vaccination rates.

Comparison of years of life lost to 1,565 suicides versus 10,650 COVID-19 deaths in 2020 in Sweden: four times more years of life lost per suicide than per COVID-19 death

BACKGROUND

The burden of disease from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is large; however, suicide affects the population year after year. From a public health perspective, it is important to not neglect contributors to the total burden of disease. The aim of this paper is to compare years of life lost (YLL) to suicide with those lost to coronavirus disease 2019 (COVID-19).

METHODS

A nationwide cohort study in 2020, in Sweden. YLL was measured as the sex- and age-specific remaining life expectancy at the time of the person's death based on the death risks that pertained to the Swedish population in 2019. YLL to suicide was compared to YLL to COVID-19 and presented by sex and age groups. Suicide deaths in 2020 were estimated as the annual average of suicides in 2015-2019.

RESULTS

Annual average of suicide was 1,565, whereof 1,076 (68.8%) men and 489 (31.2%) women. In 2020, 10,650 persons died of COVID-19, whereof 5,681 (53.3%) men and 4,969 (46.7%) women. Estimated total YLL to suicide and COVID-19 in 2020 was 53,237 and 90,116, respectively. The COVID-19 YLL to suicide YLL ratio in 2020 was 1.69 (90,116/53,237). Men accounted for 67.1% of suicide YLL and of 56.4% of COVID-19 YLL. Those 44 years or younger accounted for 60.3% of suicide YLL and 3.9% of COVID-19 YLL. Those 75 years and older accounted for 2.9% of suicide YLL and 60.9% of COVID-19 YLL. On average, each suicide generates 34 YLL (53,237/1,565), and each COVID-19 death generates 8.5 YLL (90,116/10,650).

CONCLUSIONS

YLL to suicide affects Sweden year after year, foremost attributable to the younger age groups, whereas YLL to COVID-19 is foremost attributable to the elderly. On average, each suicide generates four times more YLL than a COVID-19 death. Enormous efforts and resources have been put on tackling the pandemic, and without these, the burden would probably have been much larger. However, from a public health perspective, it is important to not neglect other contributors to the total burden of disease where national efforts also may have an impact.