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The Impact of COVID-19 on Years of Life Lost

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Summary: Since April, 1.9 million excess years of life have been lost, 13% above historical average. Over the course of the pandemic, we found age and sex contributions to excess YLL have shifted. Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. Since April, working age adults 20-64 have accounted for 47% of excess YLL, and males 20 to 64 have contributed 34%.

To date, more than 200,000 Americans have died from COVID-19 (CDC). Nearly 80% of those deaths were people 65 and older. Policymakers and journalists have concentrated on that demographic, at times portraying COVID-19 as only a serious risk for older adults. However, with a death toll that is both high and continually rising, deaths of those under the age of 65 also merit the attention of anyone concerned about the broad societal impact of COVID-19.

While most COVID deaths are individuals over the age of 65, COVID is also responsible for a significant share of deaths in other age groups. According to the Centers for Disease Control, about 10% of all deaths among older adults from February 2020 to August 2020 have been due to COVID-19. In that same period, COVID also caused about 9% of deaths among those ages 45-64 and 5% of deaths among those 25-44 (CDC).

The personal, social, and economic impacts of premature death can be difficult to quantify. Excess death rates provide a measure of the current burden of disease but cannot capture the long-term impact that, say, the death of a 40-year old married person with 3 children will have. Years of Life Lost (YLL) is a measure that captures both the immediate tragedy while also providing insight into the longer-term impacts of premature death on families, communities, and the economy. The calculation determines the number of forgone years that could have been spent contributing to society in roles such as spouses, parents, community members, and employees. For example, if a person dies at age 50, and life expectancy at age 50 is more 25 years, then the YLL is 25. In contrast, if a person dies at age 80 and life expectancy at 80 is 2 more years, then YLL is 2.

The Health Care Cost Institute, in collaboration with researchers at the Berkeley Research Group, has been analyzing real-time death data collected using obituary data sourced from online newspapers, funeral homes, online memorials, and direct submissions made available through the Datavant ecosystem since the onset of the pandemic, and have found substantially more deaths nationally in April through August of 2020 compared to previous years. State and national level data are available on the Health Care Cost Institute website, and are updated on a weekly basis. 

We combined these death data with 5-year abridged life tables for the United States published by the Human Mortality Database. We calculated the overall deaths and YLL per 100,000 people and compared deaths and YLL by month and since April 2020. We also compared YLL by age and sex to the average number of deaths reported in each month over a 5-year historical average to determine excess YLL.

The Datavant death data does not provide cause of death. Our measures of deaths and YLL include deaths from all causes, not just COVID-19 related deaths. Compared to other studies of deaths in 2020, overall mortality is somewhat lower using Datavant counts of death suggesting that these estimates are likely a lowerbound estimate of potential deaths and YLL. We use Datavant deaths because these data could be aggregated in 5-year age-sex groups appropriate for linking to standard life tables. 

Years of Life Lost are Higher so Far in 2020

Using these data, we found that deaths from April to August 2020 are 12% above our historical averages, and total YLL are 13% above average. From April to August, there were 1.9 million excess YLL (see Figure 1).

While deaths were 14% above the historical average in April, YLL were only 10% greater in than the historical average. This tracks with the known course of the pandemic, as excess deaths in April were heavily concentrated among older adults who are not weighted as highly by the YLL methodology. In contrast, YLL calculations later in the pandemic reflect larger numbers of deaths among younger adults. In August, deaths were 15% above the historical average but YLL were 17% above average.

Higher YLL Has Been Driven by Deaths of Working Age Adults, With Variations in Age-Sex Contribution

Over the course of the pandemic, age and sex contributions to excess YLL have shifted (see Figure 2). Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. In August, deaths among older adults accounted for just over half of excess YLL (51%).

In August, working age adults accounted for 48% of excess YLL: adults 20-44 accounted for 25% (19% males, 5% females) and adults 45-64 accounted for 23% (13% males and 25% females). The largest overall contributors to excess YLL were males 65+ (27%), females 65+ (25%), and males 20-44 (19%). 

Analysis of YLL Points to COVID-19s Long Term Impact

Since April, 1.9 million excess years of life have been lost, 13% above historical average. Our analysis finds that excess deaths among older adults explain only about half of excess YLL. Working age males 20 to 64 account for one-third of the excess YLL between April and August. In August, deaths among working age adults accounted for about half of excess YLL reflecting more deaths among younger adults.

The high number of deaths among the elderly has underscored the vulnerabilities of older adults to COVID-19, especially those living in nursing homes and those with multiple chronic conditions. However premature death among working age adults raises an additional set of policy implications including its impacts on children, families, and employers. For example, individuals in their fifties are often at the peak of their earning potential; the loss of income can be disastrous for families, and the loss of productivity can be disastrous for the economy.

During the summer months, new COVID-19 infections were more frequently observed in younger populations. Many states have seen people in their 20s and 30s account for a larger share of positive COVID-19 tests. Large increases in infections in young adults and the corresponding increase in deaths will have a notable impact on YLL. To reduce the burden of YLL, states and the Federal government should revisit policies including stay at home orders and universal masks. If the latter months of 2020 and early 2021 brings even higher COVID-19 deaths, as some experts forecast, then the long-term impact on our society may be felt for years to come.

The Health Care Cost Institute will continue to update this analysis monthly, reporting the YLL and the changes in death rates by age and sex. 

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions, position, or policy of Berkeley Research Group, LLC or its other employees and affiliates.

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