BMJ: 2020年新冠大流行对多国预期寿命和死亡率的影响

近期,《英国医学杂志》发表的文章评估了2020年与新冠大流行相关的预期寿命和寿命损失年的变化。


确定37个中上收入和高收入国家或地区的可靠和完整的死亡率数据。2005-20年人类死亡率数据库的所有死因死亡率年度数据,按年龄和性别统一分类。


使用Lee-Carter模型,预期寿命的减少被估计为2020年观察到的预期寿命和预期寿命之间的差异。使用世界卫生组织的标准寿命表,根据2020年观察到的和预期损失的寿命之间的差值估计了额外损失的寿命。


除新西兰、台湾和挪威外,所有研究国家的男性和女性预期寿命均有所下降,2020年这些国家的预期寿命有所增加。没有证据表明丹麦、冰岛和韩国的预期寿命发生了变化。俄罗斯的预期寿命下降幅度最大(男性:-2.33,95%置信区间-2.50至-2.17;女性:−2.14,−2.25至−2.03,美国(男性:−2.27,−2.39至−2.15;女性:−1.61,−1.70至−1.51),保加利亚(男性:−1.96,−2.11至−1.81;女性:−1.37,−1.74至−1.01),立陶宛(男性:−1.83,−2.07至−1.59;女人:−1.21−1.36−1.05),智利(男人:−1.64−1.97−1.32;女性:−0.88,−1.28至−0.50,西班牙(男性:−1.35,−1.53至−1.18;女性:−1.13、−1.37~−0.90)。


除台湾、新西兰、挪威、冰岛、丹麦和韩国外,所有国家在2020年失去的寿命都高于预期。在剩下的31个国家中,超过2.22亿年的寿命在2020年消失,这意味着2810万(95%置信区间2680万至2950万)的寿命损失超过预期(男性1730万(1680万至1780万)和女性1080万(1040万至1130万))。每10万人口中寿命损失最高的是保加利亚(男性:7260,95%置信区间6820至7710;女性:3730,2740至4730),俄罗斯(男性:7020,6550至7480;女性:4760、4530至4990)、立陶宛(男性:5430、4750至6070;女性:2640,2310 - 2980),美国(男性:4350,4170 - 4530;女性:2430,2320 - 2550),波兰(男性:3830,3540 - 4120;女性:1830年、1630年至2040年),匈牙利(男性:2770年、2490年至3040年;女性:1920年、1590年至2240年)。除了俄罗斯、保加利亚、立陶宛和美国以外,65岁以下人群的额外寿命损失相对较低,这些国家的额外寿命损失为>2000/10万人。


结论:2020年,31个国家的寿命减少了2800多万年,其中男性的比例高于女性。2020年新冠大流行导致的额外寿命损失是2015年季节性流感大流行导致的额外寿命损失的5倍以上。


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原文摘要:


Objective 

To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic.


Design 

Time series analysis.


Setting

37 upper-middle and high income countries or regions with reliable and complete mortality data.


Participants 

Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex.


Main outcome measures 

Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table.


Results 

Reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia (men: −2.33, 95% confidence interval −2.50 to −2.17; women: −2.14, −2.25 to −2.03), the United States (men: −2.27, −2.39 to −2.15; women: −1.61, −1.70 to −1.51), Bulgaria (men: −1.96, −2.11 to −1.81; women: −1.37, −1.74 to −1.01), Lithuania (men: −1.83, −2.07 to −1.59; women: −1.21, −1.36 to −1.05), Chile (men: −1.64, −1.97 to −1.32; women: −0.88, −1.28 to −0.50), and Spain (men: −1.35, −1.53 to −1.18; women: −1.13, −1.37 to −0.90). Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730), Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990), Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980), the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550), Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040), and Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240). The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000.


Conclusion 

More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.


参考文献:


Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries  BMJ 2021;375:e066768

           


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