Hajdu, Tamás and Krekó, Judit and Tóth, G. Csaba (2023) Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe. Working Paper. KRTK KTI, Budapest.
|
PDF
- Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
1MB |
Abstract
Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021. This was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.
| Item Type: | Monograph (Working Paper) |
|---|---|
| Series Name: | KRTK-KTI Working Papers / KRTK-KTI Műhelytanulmányok |
| Series Number / Identification Number: | KRTK-KTI WP – 2023/16 |
| Uncontrolled Keywords: | COVID-19, excess mortality, life expectancy, inequality |
| JEL classification: | I10 - Health: General I14 - Health and Inequality I18 - Health: Government Policy; Regulation; Public Health |
| Divisions: | Regional Centre for Energy Policy Research |
| Subjects: | Social welfare, insurance, health care |
| Funders: | Hungarian Academy of Sciences’ “Lendület” program |
| Projects: | LP2018-2/2018 |
| References: | 1. Aburto, J. M. et al. Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries. International Journal of Epidemiology 51, 63–74 (2022).
2. Stang, A. et al. Excess mortality due to COVID-19 in Germany. Journal of Infection 81, 797801 (2020).
3. Andrasfay, T. & Goldman, N. Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations. Proceedings of the National Academy of Sciences 118, e2014746118 (2021).
4. Castro, M. C. et al. Reduction in life expectancy in Brazil after COVID-19. Nat Med 27, 16291635 (2021).
5. Heuveline, P. Global and National Declines in Life Expectancy: An End-of-2021 Assessment. Population and Development Review 48, 31–50 (2022).
6. Islam, N. et al. Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries. BMJ 375, e066768 (2021).
7. Islam, N. et al. Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries. BMJ 373, n1137 (2021).
8. Konstantinoudis, G. et al. Regional excess mortality during the 2020 COVID-19 pandemic in five European countries. Nat Commun 13, 482 (2022).
9. Modig, K., Ahlbom, A. & Ebeling, M. Excess mortality from COVID-19: weekly excess death rates by age and sex for Sweden and its most affected region. European Journal of Public Health 31, 17–22 (2021).
10. Rossen, L. M. et al. Excess all-cause mortality in the USA and Europe during the COVID-19 pandemic, 2020 and 2021. Sci Rep 12, 18559 (2022).
11. Schöley, J. et al. Life expectancy changes since COVID-19. Nat Hum Behav 6, 1649–1659 (2022).
12. Wang, H. et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. The Lancet 399, 1513–1536 (2022).
13. Huang, G. et al. The effect of the COVID-19 pandemic on life expectancy in 27 countries. Sci Rep 13, 8911 (2023).
14. Msemburi, W. et al. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature 613, 130–137 (2023).
15. Silva, S., Goosby, E. & Reid, M. J. A. Assessing the impact of one million COVID-19 deaths in America: economic and life expectancy losses. Sci Rep 13, 3065 (2023).
16. Aburto, J. M., Tilstra, A. M., Floridi, G. & Dowd, J. B. Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality. Proceedings of the National Academy of Sciences 119, e2205813119 (2022).
17. Alsan, M., Chandra, A. & Simon, K. The Great Unequalizer: Initial Health Effects of COVID19 in the United States. Journal of Economic Perspectives 35, 25–46 (2021).
18. McGowan, V. J. & Bambra, C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. The Lancet Public Health 7, e966–e975 (2022).
19. Oroszi, B. et al. Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic. BMJ Global Health 6, e006427 (2021).
20. Schwandt, H. et al. Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021. JAMA 328, 360–366 (2022).
21. Grossman, M. On the Concept of Health Capital and the Demand for Health. Journal of Political Economy 80, 223–255 (1972).
22. Roffia, P., Bucciol, A. & Hashlamoun, S. Determinants of life expectancy at birth: a longitudinal study on OECD countries. Int J Health Econ Manag. 23, 189–212 (2023).
23. Zheng, X. Y. et al. Progress in research of nutrition and life expectancy. Biomed Environ Sci 27, 155–161 (2014).
24. Mondal, M. N. I. & Shitan, M. Relative Importance of Demographic, Socioeconomic and Health Factors on Life Expectancy in Low- and Lower-Middle-Income Countries. Journal of Epidemiology 24, 117–124 (2014).
25. Gracia-de-Rentería, P., Ferrer-Pérez, H., Sanjuán, A. I. & Philippidis, G. Live and let live: understanding the temporal drivers and spillovers of life expectancy in Europe for public planning. Eur J Health Econ 24, 335–347 (2023).
26. Chiang, C. L. Introduction to Stochastic Processes in Biostatistics. (John Wiley & Sons, 1968).
27. Haldane, V. et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med 27, 964–980 (2021).
28. Berawi, M. A. Empowering Healthcare, Economic, and Social Resilience during Global Pandemic Covid-19. International Journal of Technology 11, 291–319 (2020).
29. Bittmann, F. How Trust Makes a Difference: The Impact of the First Wave of the COVID-19 Pandemic on Life Satisfaction in Germany. Applied Research Quality Life 17, 1389–1405 (2022).
30. Santana, A., Rama, J. & Bértoa, F. C. The Coronavirus Pandemic and Voter Turnout: Addressing the Impact of Covid-19 on Electoral Participation. Preprint at https://doi.org/10.31235/osf.io/3d4ny (2020).
31. Ascani, A., Faggian, A. & Montresor, S. The geography of COVID-19 and the structure of local economies: The case of Italy. Journal of Regional Science 61, 407–441 (2021).
32. Bontempi, E. & Coccia, M. International trade as critical parameter of COVID-19 spread that outclasses demographic, economic, environmental, and pollution factors. Environmental Research 201, 111514 (2021).
33. Alfano, V. & Ercolano, S. The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis. Appl Health Econ Health Policy 18, 509–517 (2020).
34. Plümper, T. & Neumayer, E. Lockdown policies and the dynamics of the first wave of the Sars-CoV-2 pandemic in Europe. Journal of European Public Policy 29, 321–341 (2022).
35. Antonietti, R., Falbo, P. & Fontini, F. The Wealth of Nations and the First Wave of COVID19 Diffusion. Ital Econ J 9, 61–83 (2023).
36. Sharma, M. et al. Understanding the effectiveness of government interventions against the resurgence of COVID-19 in Europe. Nat Commun 12, 5820 (2021).
37. Chung, H. W. et al. Effects of government policies on the spread of COVID-19 worldwide. Sci Rep 11, 20495 (2021).
38. Nyberg, T. et al. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. The Lancet 399, 1303–1312 (2022).
39. Jassat, W. et al. Trends in Cases, Hospitalizations, and Mortality Related to the Omicron BA.4/BA.5 Subvariants in South Africa. Clinical Infectious Diseases 76, 1468–1475 (2023).
40. Coma, E. et al. Impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia: a time-series analysis of primary care electronic health records covering about five million people. BMJ Open 11, e047567 (2021).
41. Elek, P. et al. Effects of lower screening activity during the COVID-19 pandemic on breast cancer patient pathways: Evidence from the age cut-off of organized screening. Health Policy 126, 763–769 (2022).
42. Xu, Z., FitzGerald, G., Guo, Y., Jalaludin, B. & Tong, S. Impact of heatwave on mortality under different heatwave definitions: A systematic review and meta-analysis. Environment International 89–90, 193–203 (2016). 43. Paget, J. et al. Estimates of mortality associated with seasonal influenza for the European Union from the GLaMOR project. Vaccine 40, 1361–1369 (2022). |
| ID Code: | 11352 |
| Deposited By: | Erzsó Nyitrai |
| Deposited On: | 05 Jun 2025 09:07 |
| Last Modified: | 05 Jun 2025 09:07 |
Repository Staff Only: item control page


Download Statistics
Download Statistics