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Journal ArticleDOI

Reduction in life expectancy in Brazil after COVID-19.

TL;DR: In this article, the authors used data on reported total deaths in 2020 and in January-April 2021 to measure and compare the death toll across states in Brazil and found that COVID-19 deaths represented 107% of the total 2020 figures.
Abstract: Brazil has been heavily affected by coronavirus disease 2019 (COVID-19). In this study, we used data on reported total deaths in 2020 and in January–April 2021 to measure and compare the death toll across states. We estimate a decline in 2020 life expectancy at birth (e0) of 1.3 years, a mortality level not seen since 2014. The reduction in life expectancy at age 65 (e65) in 2020 was 0.9 years, setting Brazil back to 2012 levels. The decline was larger for males, widening by 9.1% the female–male gap in e0. Among states, Amazonas lost 60.4% of the improvements in e0 since 2000. In the first 4 months of 2021, COVID-19 deaths represented 107% of the total 2020 figures. Assuming that death rates would have been equal to 2019 all-cause rates in the absence of COVID-19, COVID-19 deaths in 2021 have already reduced e0 in 2021 by 1.8 years, which is slightly larger than the reduction estimated for 2020 under similar assumptions. New estimates of life expectancy at birth and at age 65 years in Brazil reveal substantial declines as a result of COVID-19, bringing mortality back to levels observed 20 or more years ago.

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Journal ArticleDOI
TL;DR: In this article , the authors estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks.
Abstract: Abstract The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in western Europe experienced bounce backs from life expectancy losses of 2020, eastern Europe and the United States witnessed sustained and substantial life expectancy deficits. Life expectancy deficits during fall/winter 2021 among people ages 60+ and <60 were negatively correlated with measures of vaccination uptake across countries ( r 60+ = −0.86; two-tailed P < 0.001; 95% confidence interval, −0.94 to −0.69; r <60 = −0.74; two-tailed P < 0.001; 95% confidence interval, −0.88 to −0.46). In contrast to 2020, the age profile of excess mortality in 2021 was younger, with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.

54 citations

Journal ArticleDOI
01 Jan 2021-Genus
TL;DR: In this paper, the authors measured the effect of the 2020 COVID-19 pandemic wave at the national and subnational levels in selected Latin American countries that were most affected: Brazil, Chile, Ecuador, Guatemala, Mexico, and Peru.
Abstract: In this paper, we measure the effect of the 2020 COVID-19 pandemic wave at the national and subnational levels in selected Latin American countries that were most affected: Brazil, Chile, Ecuador, Guatemala, Mexico, and Peru. We used publicly available monthly mortality data to measure the impacts of the pandemic using excess mortality for each country and its regions. We compare the mortality, at national and regional levels, in 2020 to the mortality levels of recent trends and provide estimates of the impact of mortality on life expectancy at birth. Our findings indicate that from April 2020 on, mortality exceeded its usual monthly levels in multiple areas of each country. In Mexico and Peru, excess mortality was spreading through many areas by the end of the second half of 2020. To a lesser extent, we observed a similar pattern in Brazil, Chile, and Ecuador. We also found that as the pandemic progressed, excess mortality became more visible in areas with poorer socioeconomic and sanitary conditions. This excess mortality has reduced life expectancy across these countries by 2–10 years. Despite the lack of reliable information on COVID-19 mortality, excess mortality is a useful indicator for measuring the effects of the coronavirus pandemic, especially in the context of Latin American countries, where there is still a lack of good information on causes of death in their vital registration systems.

37 citations

Journal ArticleDOI
TL;DR: The global life expectancy appears to have declined by .92 years between 2019 and 2020 and by another .72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021.
Abstract: Timely, high-quality mortality data have allowed for assessments of the impact of Covid-19 on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by .92 years between 2019 and 2020 and by another .72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed in rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the HIV/AIDS pandemic.

22 citations

Journal ArticleDOI
TL;DR: In this article , the authors used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died.
Abstract: Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil’s COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.

17 citations

Posted ContentDOI
24 Feb 2022-medRxiv
TL;DR: While COVID-19 has been the most severe global mortality shock since the Second World War, this observed heterogeneity in 2021 indicates that pathways to long-term recovery of life expectancy trends remain unclear.
Abstract: Background The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. In 2021, life expectancy trends globally diverged more due to the unequal impact of the pandemic across countries, variation in the age-patterns of mortality, and differences in vaccination. We estimate life expectancy changes in 29 countries since 2020, attribute them to mortality changes by age group, and compare them to historic life expectancy shocks. Data Total death counts by age and sex came from the Short-term Mortality Fluctuations and Human Mortality databases. Registered COVID-19 deaths and vaccination counts by age and sex were sourced from the COVerAGE-DB database. Midyear population counts were extracted from the UN World Population Prospects database. Methods Life expectancy for females, males, and the total population were calculated for 29 countries for 2020 and 2021. Additionally, we calculated life expectancy deficits for 2020 and 2021 based on pre-pandemic Lee-Carter forecasts of short-term life expectancy trends. Using demographic decomposition techniques, age- and COVID-19 specific contributions to changes and deficits in life expectancy were calculated. Deficits in life expectancy in 2021 across countries were compared to country vaccination rates. 95% uncertainty intervals were derived from Poisson replications of death counts. Findings Out of 29 countries, 14 countries lost life expectancy in both 2020 and 2021, 12 recovered losses in 2020 but not all of them back to 2019 levels, 2 exceeded pre-pandemic life expectancy, and 1 dropped below 2019 levels only in 2021. All 29 countries had lower life expectancy in 2021 than expected had pre-pandemic trends continued. The female life expectancy advantage increased for most countries, consistent with hypotheses that females are more resilient to mortality crises than men. Life expectancy losses were moderately correlated with measures of vaccination uptake. One notable change from 2020 was that mortality at younger ages contributed more to life expectancy losses in 2021. Registered COVID-19 deaths accounted for most losses of life expectancy. Interpretation In 2021 we saw divergence in the impact of the pandemic on population health. While some countries saw bounce-backs from stark life expectancy losses, others experienced sustained and substantial life expectancy deficits. While COVID-19 has been the most severe global mortality shock since the Second World War, this observed heterogeneity in 2021 indicates that pathways to long-term recovery of life expectancy trends remain unclear.

15 citations

References
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Journal ArticleDOI
TL;DR: In this article, the authors describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.

2,933 citations

Journal ArticleDOI
Nuno R. Faria, Thomas A. Mellan1, Charles Whittaker1, Ingra Morales Claro2, Darlan da Silva Candido2, Darlan da Silva Candido3, Swapnil Mishra1, Myuki A E Crispim, Flavia C. S. Sales2, Iwona Hawryluk1, John T. McCrone4, Ruben J.G. Hulswit3, Lucas A M Franco2, Mariana S. Ramundo2, Jaqueline Goes de Jesus2, Pamela S Andrade2, Thais M. Coletti2, Giulia M. Ferreira5, Camila A. M. Silva2, Erika R. Manuli2, Rafael Henrique Moraes Pereira, Pedro S. Peixoto2, Moritz U. G. Kraemer3, Nelson Gaburo, Cecilia da C. Camilo, Henrique Hoeltgebaum1, William Marciel de Souza2, Esmenia C. Rocha2, Leandro Marques de Souza2, Mariana C. Pinho2, Leonardo José Tadeu de Araújo6, Frederico S V Malta, Aline B. de Lima, Joice do P. Silva, Danielle A G Zauli, Alessandro C. S. Ferreira, Ricardo P Schnekenberg3, Daniel J Laydon1, Patrick G T Walker1, Hannah M. Schlüter1, Ana L. P. dos Santos, Maria S. Vidal, Valentina S. Del Caro, Rosinaldo M. F. Filho, Helem M. dos Santos, Renato Santana Aguiar7, José Luiz Proença-Módena8, Bruce Walker Nelson9, James A. Hay10, Melodie Monod1, Xenia Miscouridou1, Helen Coupland1, Raphael Sonabend1, Michaela A. C. Vollmer1, Axel Gandy1, Carlos A. Prete2, Vitor H. Nascimento2, Marc A. Suchard11, Thomas A. Bowden3, Sergei L Kosakovsky Pond12, Chieh-Hsi Wu13, Oliver Ratmann1, Neil M. Ferguson1, Christopher Dye3, Nicholas J. Loman14, Philippe Lemey15, Andrew Rambaut4, Nelson Abrahim Fraiji, Maria Perpétuo Socorro Sampaio Carvalho, Oliver G. Pybus16, Oliver G. Pybus3, Seth Flaxman1, Samir Bhatt17, Samir Bhatt1, Ester Cerdeira Sabino2 
21 May 2021-Science
TL;DR: In this article, the authors used a two-category dynamical model that integrates genomic and mortality data to estimate that P.1 may be 1.7-to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.
Abstract: Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.

985 citations

Journal ArticleDOI
22 Apr 2021-Nature
TL;DR: In this paper, the authors used the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae, including diagnoses, medication use and laboratory abnormalities, in patients with COVID-19 who survived for at least 30 days after diagnosis.
Abstract: The acute clinical manifestations of COVID-19 have been well characterized1,2, but the post-acute sequelae of this disease have not been comprehensively described. Here we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6-month incident sequelae—including diagnoses, medication use and laboratory abnormalities—in patients with COVID-19 who survived for at least 30 days after diagnosis. We show that beyond the first 30 days of illness, people with COVID-19 exhibit a higher risk of death and use of health resources. Our high-dimensional approach identifies incident sequelae in the respiratory system, as well as several other sequelae that include nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We show increased incident use of several therapeutic agents—including pain medications (opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive and oral hypoglycaemic agents—as well as evidence of laboratory abnormalities in several organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient that increases according to the severity of the acute COVID-19 infection (that is, whether patients were not hospitalized, hospitalized or admitted to intensive care). Our findings show that a substantial burden of health loss that spans pulmonary and several extrapulmonary organ systems is experienced by patients who survive after the acute phase of COVID-19. These results will help to inform health system planning and the development of multidisciplinary care strategies to reduce chronic health loss among individuals with COVID-19. Healthcare data from the US Department of Veterans Affairs are used to characterize the six-month incident sequelae of individuals who survive for at least thirty days after developing COVID-19.

725 citations

Journal ArticleDOI
TL;DR: The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades, but analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration.

460 citations

Journal ArticleDOI
04 Aug 2020-JAMA
TL;DR: This study uses data from the National Center for Health Statistics to estimate excess deaths in the US and the District of Columbia in the early weeks of the COVID-19 pandemic.
Abstract: This study updates a previous report of the estimated number of excess deaths in the US during the coronavirus disease 2019 (COVID-19) pandemic through August 1, 2020, and describes causes of those deaths and temporal relationships with state lifting of coronavirus restrictions.

454 citations