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.

BMJ public health Pub Date : 2025-03-04 eCollection Date: 2025-01-01 DOI:10.1136/bmjph-2024-001836

Paul Moulaire, Gilles Hejblum, Nathanaël Lapidus

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Abstract

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.

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法国2020年至2023年的超额死亡率和寿命损失：一项关于COVID-19大流行对死亡率总体影响的队列研究

在世界范围内，经常使用超额死亡率来总结与COVID-19大流行相关的负担。不同的报告对法国2020-2022年的预测差异很大，而2023年的数据也很少。本研究评估了2020年至2023年期间法国发生的超额死亡率水平以及相应的生命损失年数，以便对这一流行病的总体影响提供可靠、详细和全面的描述。方法：这项针对全法国人口的开放式队列研究分析了2010-2023年报告的8 451 372例死亡病例。使用2010-2019年的泊松回归模型进行训练，以确定大流行时期前死亡率的年龄特异性和性别特异性演变趋势。然后将这些趋势用于估计大流行期间（2020-2023年）的超额死亡率。使用超额死亡率人群的预期寿命来估计相应的YLL。结果：从2020年到2023年，超额死亡人数(平均（95% CI）（变化百分比与预期死亡率）分别为49 541人(48 467人；50 616) (+8.0%), 42 667 (41 410；43 909) (+6.9%), 53 129 (51 696；54 551)（+8.5%）和17 355 (15 760；18917)（+2.8%）。相应的YLL为512 753 (496 029；529 633), 583 580 (564 137；602 747), 663 588 (641 863；685 723)和312 133 (288 051；335 929)。2020年，60岁以下的个人占YLL的17%，2021年为26%，2022年为32%，2023年为50%。男性比女性更容易受到超额死亡率和YLL的影响。结论：这项研究突出了疫情对法国死亡率的长期影响，连续四年死亡率过高，对60岁以下人群（尤其是男性）的影响越来越大，这表明对医疗保健系统造成了持久而深刻的破坏。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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BMJ public health

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