In 2020, there were more than 28 million excess years of life lost (YLL) in 31 countries found to be associated the COVID-19 pandemic, according to results of a study published in BMJ.

Annual data on all-cause mortality was obtained from 37 upper-middle- and high-income countries between 2005 and 2020 from the Human Mortality Database maintained by the University of California, Berkeley, and the Max Planck Institute. Using these data, the investigators performed a time series analysis to assess the effect of the COVID-19 pandemic on mortality.

All countries included in the study showed an increasing trend in life expectancy at birth between 2005 and 2019. In 2020, however, most countries had a decrease in life expectancy at birth.

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The greatest decreases in life expectancy at birth were observed in Russia (-2.32 years), Bulgaria (-1.75 years), Lithuania (-1.61 years), and Poland (-1.36 years). Only 2 countries, New Zealand (0.66 years) and Taiwan (0.35 years), reported an increase in life expectancy.

Among all countries included in the study, with the exception of Luxembourg, men had a greater decrease in life expectancy at birth compared with women. For men, the greatest decreases occurred in Russia, the United States, Bulgaria, Lithuania, and Chile. For women, the greatest decreases occurred in Russia, the US, Bulgaria, Lithuania, and Spain.

The investigators found years of life lost (YLL) decreased between 2005 and 2019 in all countries with the exception of Canada, Greece, Scotland, Taiwan, and the US. In addition, the increase in YLL was greater than expected in 2020 for all countries with the exception of New Zealand, Taiwan, Iceland, South Korea, Denmark, and Norway.

For the remaining 31 countries included in the study, there were a total of 222 million YLL in 2020, which comprised 130 million YLL among men and 92.6 million YLL among women. The investigators noted that these rates represented a total of 28.1 million excess YLL (95% CI, 26.8-29.5).

Among both men and women, the greatest increases in excess YLL per 100,000 occurred in Russia (5810), followed by Bulgaria (5440), Lithuania (3940), the US (3380), and Poland (2800).

Although excess YLL was increased in most countries among individuals 65 years and older, the investigators found that excess YLL were also increased among individuals younger than 65 years in Russia, Bulgaria, Lithuania, and the US.

Compared with the influenza epidemic in 2015, the rate of excess YLL was 5.5 times greater in 2020 during the COVID-19 pandemic (2510 vs 458 per 100,000, respectively), with an absolute difference of 2050 YLL per 100,000.

This study was limited by its exclusion of most countries in Asia, Africa, and Latin America due to the unreliability of data. In addition, there was a lack of data on socioeconomic status and race/ethnicity.

According to the investigators, “as many of the effects of the [COVID-19] pandemic might take a longer time frame to have a measurable effect on human lives, continuous and timely monitoring of excess YLL would help identify the sources of excess mortality and excess YLL in population subgroups.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.


Islam N, Jdanov DA, Shkolnikov VM, et al. Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries. BMJ. 2021;375:e066768. doi:10.1136/bmj-2021-066768