2025-03-12 インペリアル・カレッジ・ロンドン(ICL)
<関連情報>
- https://www.imperial.ac.uk/news/261935/almost-17-million-years-life-were/
- https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004541
COVID-19パンデミックが平均余命と障害の有無にかかわらず失われた生命年数に与えた直接的・間接的影響: 欧州18カ国を対象とした系統的分析、2020-2022年 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
Sara Ahmadi-Abhari ,Piotr Bandosz,Martin J. Shipley,Joni V. Lindbohm,Abbas Dehghan ,Paul Elliott
PLOS Medicine Published: March 11, 2025
DOI:https://doi.org/10.1371/journal.pmed.1004541
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.
Author summary
Why was this study done
- Estimating the person-years of life lost (PYLL) due to the pandemic broken down by cause of death and disability status is informative for policy setting and resource allocation in healthcare, but not thoroughly investigated
What did the researchers do and find
- Many people who died during the pandemic would likely have lived longer if the pandemic had not happened. To quantify these lost years, we tracked incidence of disease, disability and mortality, and integrated data from multiple sources in a statistical model
- In 18 European countries constituting a population of 289 million, 16.8 million person-years of life were lost due to the pandemic in 2020–2022. About 60% of the PYLL would have been lived without disability if the pandemic had been avoided.
- In 18 European countries constituting a population of 289 million, 16.8 million person-years of life were lost due to the pandemic in 2020–2022. About 60% of the PYLL would have been lived without disability if the pandemic had been avoided.
- PYLL varied considerably between the studied countries, ranging between 20 and 109 per 1,000 population. Countries with lower gross domestic product had higher PYLL per capita, a disproportionately higher disability-free PYLL, and a higher proportion of PYLL related to the pandemic’s indirect impacts.
What do these findings mean?
- The considerable proportion and increase over time in PYLL due to non-COVID deaths, point to the potential long-term impacts of the pandemic. The substantial proportion of PYLL without disability bring to light an instinctive underestimation of the pandemic’s impact, especially on the older population.
- Findings suggest the pandemic worsened socioeconomic inequalities in premature mortality between countries and widened sex differences in life expectancy.
- Main limitations of the study were the lack of observed data on mortality rates by disability status during the pandemic necessitating reliance on data modeling strategies, and between-country differences in policies to ascertain COVID-19 as cause of death. Uncertainties in data modeling are reflected in the 95% uncertainty intervals accompanying all findings.
