New research uncovers the hidden cost of the pandemic: millions of years of healthy life lost, with poorer countries and older adults hit hardest.

Study: 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. Image Credit: Hyejin Kang / Shutterstock

Emerging research indicates that the coronavirus disease 2019 (COVID-19) pandemic shortened lives in more ways than we thought. A recent study published in the journal PLOS Medicine reveals that COVID-19 not only caused mortality in the millions but also reduced the years people could have lived without disability. The researchers analyzed data from 18 European countries using multi-state Markov models to track health transitions, uncovering a lasting impact on life expectancy beyond the virus itself.

The aftermath of COVID-19

Life expectancy has steadily increased over the past century, driven by medical advancements, improved public health, and better living conditions. However, global crises, such as pandemics, can reverse such progress. While many studies have quantified the mortality rates associated directly with COVID-19, less is known about its indirect effects.

Factors such as delayed healthcare, mental health struggles, and economic instability may have led to additional premature deaths. Moreover, distinguishing deaths due to COVID-19 from those indirectly linked to pandemic-related disruptions —including potential misclassification of COVID-19 as the cause of death for individuals with terminal illnesses— remains challenging.

Another critical gap in research is understanding how many of these lost years were disability-free, as older individuals and those with preexisting conditions were at greater risk. Using data from the English Longitudinal Study of Ageing (ELSA) and the Survey for Health, Ageing, and Retirement in Europe (SHARE), this study aimed to fill that gap by examining person-years of life lost (PYLL) due to the pandemic’s direct and indirect effects.

Person-years of life lost (PYLL) per capita in the population aged 35 and over by year and country, sorted by descending gross domestic product per capita.

Assessing disability due to COVID-19

To assess the impact of COVID-19 on life expectancy and disability-free years, the team of researchers analyzed data from 289 million adults in 18 European countries between 2020 and 2022. Using a statistical model that accounted for pre-pandemic trends in disease and mortality, they tracked the health transitions of individuals aged 35 and older.

The model categorized individuals into eight health states, starting from disease-free individuals and spanning various combinations of cognitive impairment, cardiovascular disease, disability, dementia, and, lastly, death.

The study integrated mortality data from multiple sources, including national statistics, while differentiating between COVID-19 deaths and non-COVID excess mortality using two scenarios to address potential misclassification. One scenario assumed a genuine reduction in non-COVID deaths, while the other considered a possible substitution of expected non-COVID deaths with COVID-19 on death certificates. To ensure accuracy, they conducted statistical simulations to generate 95% uncertainty intervals (e.g., 16.8 million PYLL [12.0–21.8 million]), reflecting variability in the data.

Major findings

The study found that between 2020 and 2022, 16.8 million person-years of life (95% uncertainty interval: 12.0–21.8 million) were lost across the 18 studied countries. Of these, 11.6–13.2 million years were due to registered COVID-19 deaths, while 3.6–5.3 million were linked to non-COVID excess deaths attributed to healthcare disruptions or unintended consequences of containment measures.

Surprisingly, nearly 60% of these lost years would have been disability-free, meaning that many individuals who died prematurely were in good health before the pandemic. Men lost 1.5 times more PYLL than women, deepening preexisting gender disparities in life expectancy.

The burden of lost life years was highest among older adults, with 60% of PYLL occurring in individuals over 80 and 30% in those between the ages of 65 and 80 years. Moreover, almost half of the life-years lost among people over 80 would have been lived without disability, challenging assumptions that the pandemic primarily affected frail individuals.

The study also found striking disparities between countries. Nations with lower GDP per capita (e.g., Estonia, Poland) experienced higher PYLL per capita, with disproportionately more disability-free years lost, while Sweden and Switzerland fared the best. Importantly, lower-income countries not only lost more total life years but also a higher share of healthy, disability-free years.

Additionally, life expectancy at age 35 declined by up to 2.8 years in 2021, with over two-thirds of this loss involving disability-free years. Only Sweden showed a near-full recovery to pre-pandemic life expectancy levels by 2022, standing out among the 18 nations studied.

Beyond COVID-19 deaths, the increasing trend in non-COVID mortality from 2020 to 2022 suggested that pandemic-related healthcare disruptions had a lasting effect. While COVID-related PYLL declined as vaccination coverage expanded, non-COVID deaths continued to rise, especially among older adults.

Higher vaccination coverage and GDP per capita were independently associated with lower PYLL. Both factors helped mitigate life-years lost from direct COVID-19 deaths and indirect non-COVID excess mortality. These findings highlighted the pandemic’s broader impact and underscored the need for more resilient healthcare systems and better preparedness for future public health crises.

Conclusions

In summary, the findings brought attention to the fact that the COVID-19 pandemic caused profound losses in life expectancy across Europe, not only through direct infections but also due to healthcare disruptions. While vaccines helped reduce COVID-related deaths, non-COVID excess deaths continued to rise after the pandemic.

Alarmingly, most of the years lost were disability-free, indicating a greater toll than previously assumed. Older individuals, especially those over 80, bore the largest burden, but many were healthy before the pandemic.

The study also revealed widened socioeconomic inequalities between countries and gender gaps in mortality. Countries with lower GDP not only lost more years but also more years of healthy life, exacerbating inequality.

These findings emphasize the urgent need for strengthened healthcare systems, policies addressing socioeconomic and gender disparities, and proactive measures to mitigate future health-related crises. Protecting healthy older adults and investing in healthcare resilience emerge as critical priorities for future pandemic preparedness.