• Ann. Intern. Med. · Dec 2021

    Measuring the COVID-19 Mortality Burden in the United States : A Microsimulation Study.

    • Julian Reif, Hanke Heun-Johnson, Bryan Tysinger, and Darius Lakdawalla.
    • University of Illinois, Champaign, Illinois, and National Bureau of Economic Research, Cambridge, Massachusetts (J.R.).
    • Ann. Intern. Med. 2021 Dec 1; 174 (12): 170017091700-1709.

    BackgroundFully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences.ObjectiveTo measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity.DesignState-transition microsimulation model.Data SourcesHealth and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare & Medicaid Services.Target PopulationU.S. population aged 25 years and older.Time HorizonLifetime.PerspectiveIndividual.InterventionCOVID-19 pandemic through 13 March 2021.Outcome MeasuresYLLs and QALYs lost per 10 000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence.Results Of Base Case AnalysisThe COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10 000 persons. Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity.Results Of Sensitivity AnalysisAccounting for uncertainty in risk factors for death from COVID-19 yielded similar results.LimitationEstimates may vary depending on assumptions about mortality and quality-of-life projections.ConclusionBeyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities.Primary Funding SourceNational Institute on Aging.

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