Direct and indirect impacts of the COVID-19 pandemic on life expectancy and person-years of life lost with and without disability: A systematic analysis for 18 European countries, 2020-2022.

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2025-03-11 eCollection Date: 2025-03-01 DOI:10.1371/journal.pmed.1004541
Sara Ahmadi-Abhari, Piotr Bandosz, Martin J Shipley, Joni V Lindbohm, Abbas Dehghan, Paul Elliott, Mika Kivimaki
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引用次数: 0

Abstract

Background: The direct and indirect impacts of the COVID-19 pandemic on life expectancy (LE) and years of life lost with and without disability remain unclear. Accounting for pre-pandemic trends in morbidity and mortality, we assessed these impacts in 18 European countries, for the years 2020-2022.

Methods and findings: We used multi-state Markov modeling based on several data sources to track transitions of the population aged 35 or older between eight health states from disease-free, combinations of cardiovascular disease, cognitive impairment, dementia, and disability, through to death. We quantified separately numbers and rates of deaths attributable to COVID-19 from those related to mortality from other causes during 2020-2022, and estimated the proportion of loss of life expectancy and years of life with and without disability that could have been avoided if the pandemic had not occurred. Estimates were disaggregated by COVID-19 versus non-COVID causes of deaths, calendar year, age, sex, disability status, and country. We generated the 95% uncertainty intervals (UIs) using Monte Carlo simulations with 500 iterations. Among the 289 million adult population in the 18 countries, person-years of life lost (PYLL) in millions were 4.7 (95% UI 3.4-6.0) in 2020, 7.1 (95% UI 6.6-7.9) in 2021, and 5.0 (95% UI 4.1-6.2) in 2022, totaling 16.8 (95% UI 12.0-21.8) million. PYLL per capita varied considerably between the 18 countries ranging between 20 and 109 per 1,000 population. About 60% of the total PYLL occurred among persons aged over 80, and 30% in those aged 65-80. If the pandemic were avoided, over half (9.8 million (95% UI 4.7-15.1)) of the 16.8 million PYLL were estimated to have been lived without disability. Of the total PYLL, 11.6-13.2 million were due to registered COVID-19 deaths and 3.6-5.3 million due to non-COVID mortality. Despite a decrease in PYLL attributable to COVID-19 after 2021, PYLL associated with other causes of death continued to increase from 2020 to 2022 in most countries. Lower income countries had higher PYLL per capita as well as a greater proportion of disability-free PYLL during 2020-2022. Similar patterns were observed for life expectancy. In 2021, LE at age 35 (LE-35) declined by up to 2.8 (95% UI 2.3-3.3) years, with over two-thirds being disability-free. With the exception of Sweden, LE-35 in the studied countries did not recover to 2019 levels by 2022.

Conclusions: The considerable loss of life without disability and the rise in premature mortality not directly linked to COVID-19 deaths during 2020-2022 suggest a potential broader, longer-term and partially indirect impact of the pandemic, possibly resulting from disruptions in healthcare delivery and services for non-COVID conditions and unintended consequences of COVID-19 containment measures. These findings highlight a need for better pandemic preparedness in Europe, ideally, as part of a more comprehensive global public health agenda.

2019冠状病毒病大流行对预期寿命和有残疾和无残疾人均寿命损失的直接和间接影响:对18个欧洲国家2020-2022年的系统分析
背景:COVID-19大流行对预期寿命(LE)以及有残疾和无残疾的寿命损失年数的直接和间接影响尚不清楚。考虑到大流行前的发病率和死亡率趋势,我们评估了18个欧洲国家2020-2022年的这些影响。方法和发现:我们使用基于多个数据源的多状态马尔可夫模型来跟踪35岁或以上人群从无疾病、心血管疾病组合、认知障碍、痴呆和残疾到死亡的八种健康状态之间的转变。我们分别量化了2020-2022年期间因COVID-19导致的死亡人数和死亡率与其他原因导致的死亡人数和死亡率,并估计了如果没有发生大流行,预期寿命损失的比例以及有残疾和没有残疾的寿命损失的比例。估计数按COVID-19与非COVID-19死亡原因、日历年、年龄、性别、残疾状况和国家分列。我们使用500次迭代的蒙特卡罗模拟生成了95%的不确定性区间(ui)。在18个国家的2.89亿成年人口中,以百万计的人年生命损失(PYLL)在2020年为4.7 (95% UI 3.4-6.0), 2021年为7.1 (95% UI 6.6-7.9), 2022年为5.0 (95% UI 4.1-6.2),总计16.8 (95% UI 1.2 - 2180)万。18个国家的人均死亡人数差别很大,从每1 000人20至109人不等。大约60%的PYLL发生在80岁以上的人群,30%发生在65-80岁的人群。如果大流行得以避免,估计1680万PYLL患者中有一半以上(980万(95% UI 4.7-15.1))没有残疾。在死亡总人数中,1160万至1320万人死于已登记的COVID-19死亡,360万至530万人死于非COVID-19死亡。尽管2021年后归因于COVID-19的PYLL减少,但在大多数国家,与其他死亡原因相关的PYLL在2020年至2022年期间继续增加。在2020-2022年期间,低收入国家的人均PYLL较高,无残疾PYLL比例也较高。在预期寿命方面也观察到类似的模式。2021年,35岁时的生活质量(LE-35)下降了2.8年(95%为2.3-3.3年),其中超过三分之二的人没有残疾。除瑞典外,研究国家的LE-35到2022年都没有恢复到2019年的水平。结论:2020-2022年期间,大量无残疾的生命损失和与COVID-19死亡无直接关系的过早死亡率上升表明,大流行可能产生更广泛、更长期和部分间接的影响,可能是由于对非COVID-19病症的医疗保健提供和服务中断以及COVID-19遏制措施的意外后果造成的。这些发现突出表明,欧洲需要更好地做好大流行防范工作,最好将其作为更全面的全球公共卫生议程的一部分。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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