The COVID-19 pandemic has carried a heavy burden of mortality, and not just for the people widely considered at highest risk.
A team from the USC Schaeffer Center undertook a full assessment of the first year of the pandemic’s mortality burden by measuring years of life lost and accounting for quality-of-life differences, factoring in age, sex, race/ethnicity and comorbidities.
They found that life-years lost from premature mortality were distributed almost equally across elderly and younger adult populations. In addition, Black and Hispanic populations have experienced a disproportionate number of life-years lost and were significantly burdened by the pandemic.
“The focus on older people passing away from COVID misses the substantial burden COVID has imposed on younger people with chronic conditions like obesity,” says Darius N. Lakdawalla, director of research at the USC Schaeffer Center and one of the study’s co-investigators. “Many people have emphasized that protections like lockdowns and vaccinations ought to focus on the old and the vulnerable. However, our findings contradict the belief that this is a pandemic primarily of the elderly.”
The study was published in Annals of Internal Medicine.
A Deeper Dive into Pandemic Data
The study team used data from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services to examine excess deaths during the first full year of the pandemic, from March 2020 to March 2021. With this data, they leveraged the Future Elderly Model and Future Adult Model, two economic microsimulation models housed at the Schaeffer Center that estimate future trends in a broad array of indicators including health, functional status, and mortality.
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They found that the 740,247 “excess deaths” caused by the pandemic in that year resulted in 9.08 million years of life lost, or 6.62 million quality-adjusted life years (QALYs) lost.
Some 3.6 million (54%) of these QALYs were lost by people ages 25 to 64. The toll on Black and Hispanic communities was the greatest, especially among men over age 65.
“Our results show that—for both younger and older age groups—the Black and Hispanic communities bore a disproportionately large mortality burden,” said Julian Reif, associate professor of Finance and Economics at Gies College of Business, University of Illinois Urbana-Champaign. “The racial disparities in the amount of life lost were largest among those living in nursing homes and those living with dementia.”
Several factors put adults of any age at higher risk, including obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke and dementia. Living in a nursing home and having a dementia diagnosis were also significant risk factors. But absent the pandemic, more than one-third of those who died would have been expected to have an average or above average life expectancy for their age, sex or race/ethnicity.
Measuring this mortality burden is critical for identifying vulnerable populations and evaluating pandemic mitigation measures.
“The burden of premature mortality, measured as total life years lost, reveals much narrower gaps between the old and the young,” says Lakdawalla, who is also the Quintiles Professor of Pharmaceutical Development and Regulatory Innovation at the USC School of Pharmacy. “Vaccinations and precaution are more important for younger age groups than one might think.”
The study was funded by the National Institute on Aging. In addition to Lakdawalla and Reif, the study was conducted by Hanke Heun-Johnson, PhD, senior quantitative analyst at the Schaeffer Center and Bryan Tysinger, PhD, director of Health Policy Microsimulation at the Schaeffer Center.