All the data with which it has been measured the coronavirus pandemic They give an account of the enormous impact it has had in Spain, one of the hardest hit countries in the world, but there is one that illustrates this in a particularly graphic way. Several researchers in demography and epidemiology have calculated how mortality translates into life expectancy. Their estimates show that COVID-19 has reduced it by 0.8 years in Spain, that is, a little more than nine months, for both men and women. The results have been grouped into a study that has not yet been peer-reviewed and published by a scientific journal, but which can be accessed in the MedRxiv repository.
It is common to hear that life expectancy increases year after year, but it is likely that in this 2020 it will not only slow down, but will decrease considerably. At the moment, and according to these researchers, during the worst of the epidemic (it has been calculated from June 14, 2019 to the same date in 2020), life expectancy at birth in Spain was 79.60 years for men. and 85.21 for women; compared to 80.45 and 85.99 in 2019 (from January 1 to December 31). These latest figures, those of 2019, have also been obtained by the study authors, they are not the provisional data published by the National Statistics Institute (INE). You would have to go back to 2012 to find similar life expectancy data. In March alone, the impact of the coronavirus left almost 50,000 dead, the month with the most deaths since the beginning of democracy.
“It is a huge setback. The coronavirus has been visualized in many ways and this what it shows us is how many years of life we have lost on average. What we do is put the mortality crisis in years, which we thought was an easy way of transmitting gravity “, sums up Usaba Bilal, professor of Epidemiology and Biostatistics at Drexel University (Philadelphia) and one of those responsible for the study.
To reach this result, they have used the INE population estimate as of July 1, 2019 and the deaths recorded by the Mortality Monitoring System (MoMo), of the Carlos III Health Institute (ISCIII), which feeds on civil registries and that estimates an excess of 44,000 deaths during the pandemic. Keep in mind that only computerized records are included, which reach 93% of the population.
Differences between communities
The study, led by Sergi Trias-Llimos, demographer and epidemiologist at the Center for Demographic Studies and the London School of Hygiene and Tropical Medicine and also signed by Tim Riffe of the Max Planck Institute for Demographic Research in Germany, analyzes how modified life expectancy in the different autonomous communities and found marked differences. Those most affected by the pandemic recorded much larger declines than those in which the virus has had a shorter journey, which shows that “the impact of the pandemic in Spain has been severe and highly heterogeneous.” “First we did a study only in Madrid – which has already been published in the magazine Journal of Public Health–, but we were impressed by the result and we wanted to extend it to the rest. Life expectancy is something that is commonly used and understood by people, and which also progressively tends to rise, “says Trias-Llimos.
The differences are palpable. While in some territories this indicator does not vary, in others, such as the Community of Madrid, they reach falls of 2.7 years (about 2 years and slightly more than 8 months) in the case of men and 2 years in the case Women’s. It is the region that registers the most decline, followed by Castilla-La Mancha: 2.1 for men and 1.8 for women, and Catalonia, where a decrease in life expectancy of 1.4 is observed for them. and 1.2 for them. Navarra and Castilla y León are also at the top of the table, with a reduction of 1.1 years and 0.9 in the first case; and also 1.1 for both sexes in the second.
These are several of the communities hardest hit by the outbreak of COVID-19 in Spain, both in the number of confirmed infections and in fatalities, and the most hit by the focus on residences, of which Health admits that it does not have reliable data on deaths to publish. In addition, as revealed by the ENE-COVID seroprevalence study developed by the Carlos III Health Institute (ISCIII), that has already ended, are the territories with the highest presence of antibodies in their populations. Many of the provinces of Catalonia, Castilla y León and Castilla-La Mancha and the Community of Madrid reach infection rates that exceed 5%, the Spanish average, and progressively approach 10% and even exceed it.
However, in other territories the pandemic has had a much smaller impact, something that is also demonstrated by the figures found in the study. In some such as La Rioja, Aragón, Extremadura or the Basque Country, life expectancy has been shortened by a range of between five and ten months, for both men and women. And in places where the virus has had the least impact, such as in the Canary Islands, Balearic Islands or Cantabria, life expectancy was hardly affected. For men, for example, the calculation gives sums of one month in these places, but rounding and the confidence interval (95%) must be taken into account. In the case of women, the same thing happens: it decreases one month in the Canary Islands, adds one in Cantabria and increases to three in Murcia.
In addition to the annual estimates, the research tries to shed light on the worst moments of the mortality crisis and projects how life expectancy declined in specific weeks when peaks of infection and deaths were reached. A “much more volatile” indicator, but one that crudely reflects the effect of the pandemic. Thus, in the weeks between March 23 and April 5, when the MoMo registered the highest number of deaths, there was a decrease in the total for Spain that varied between 6.1 years and 7.6, but from again, with great differences between communities. As can be read in the investigation, Madrid suffered the most important fall, which ranged from 11.2 to 14.8 years. Others like Galicia, Asturias or the Canary Islands “did not experience major interruptions in weekly life expectancy”.
A 2020 of “notable” declines
As of the end of May, the observed life expectancy, explain the authors, has been close to 2019 levels because after the confinement decreed on March 15, the curve began to gradually decrease. Now, the biggest challenge is the outbreaks declared in specific places such as Lleida or A Mariña (Galicia), which have forced the health authorities to take new restrictions. In the whole of Spain, infections have increased in the last week, in which nine people have died with COVID-19. The Ministry of Health counts today 28,396 deaths since the start of the pandemic, but these balances only include the figures of confirmed deaths, that is, of people who had been tested and had tested positive.
This number of deaths does not represent the totality of the coronavirus mortality crisis, as evidenced by MoMo reports, which determine a difference of 15,000 deaths with official statistics, but neither can the totality of this excess be directly associated with deaths from people with COVID-19 (in this case, with compatible but unconfirmed symptoms), as experts have explained on multiple occasions. In part, this will be the case, but it is likely that there will also be deaths caused indirectly by the pandemic in the form of delays in care or delays in consultations that could later be complicated.
At the same time, the researchers explain, it must be borne in mind that the pandemic has been able to bring forward the death of fragile people, most of them elderly or with underlying diseases, who may have died in the following months, which could lead to reductions. of mortality in the second part of 2020. But it is not only these people who have died, so it will not be compensated, they agree. In this scenario, and taking into account that the coronavirus has not yet passed, as demonstrated by the 118 outbreaks recorded by Health since May, when the de-escalation began, the authors of the study predict that the 2020 life expectancy data , no longer from estimates, but from real ones, will show “notable decreases”, says Bilal. “We will have to do careful monitoring that will ultimately give us answers about the overall impact of COVID-19,” he concludes.
To obtain the calculations, the study authors used the daily data on deaths by age and sex from the Daily Mortality Monitoring System (MoMo), which gives groups of people under 65, 65 to 75 and over 75 years of age. . In total, 385,931 deaths in 2019 and 425,233 from June 14, 2019 to the same date in 2020.
Subsequently, they have grouped the daily death counts into weeks and redistributed them by age groups of five years using the INE mortality patterns of 2018. After have estimated the mortality rates by age for each group, necessary to calculate life expectancy, using the population as of July 1, 2019 as the denominator. Life expectancy “was estimated using conventional life table techniques”, clarify in the methodology.
The National Statistics Institute has recently published provisional data on life expectancy for 2019. These are not those used in the study for that period, but the authors have made their own calculation. It must be taken into account that the MoMo does not have all the deaths because it covers computerized records (93% of the population).