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. 2022:30:33-80.
Epub 2022 Feb 17.

The Effect of the COVID-19 Pandemic on the Elderly: Population Fatality Rates, COVID Mortality Percentage, and Life Expectancy Loss

Paula Natalia Barreto Parra  1 , Vladimir Atanasov  2 , Jeff Whittle  3 , John Meurer  3 , Qian Eric Luo  4 , Ruohao Zhang  5 , Bernard Black  6
Affiliations

The Effect of the COVID-19 Pandemic on the Elderly: Population Fatality Rates, COVID Mortality Percentage, and Life Expectancy Loss

Paula Natalia Barreto Parra et al. Elder Law J. 2022.

Abstract

The COVID-19 pandemic has disproportionately affected the elderly. This Article provides a detailed analysis of those effects, drawing primarily on individual-level mortality data covering almost three million persons aged 65+ in three Midwest states (Indiana, Illinois, and Wisconsin). We report sometimes surprising findings on population fatality rates ("PFR"), the ratio of COVID to non-COVID deaths, reported as a percentage, which we call the "Covid Mortality Percentage," and mean life expectancy loss ("LEL"). We examine how these COVID-19 outcomes vary with age, gender, race/ethnicity, socio-economic status, and time period during the pandemic. For all persons in the three Midwest areas, COVID PFR through year-end 2021 was 0.22%, mean years of life lost ("YLL") was 13.0 years, the COVID Mortality Percentage was 12.4%, and LEL was 0.028 years (eleven days). In contrast, for the elderly, PFR was 1.03%; YLL was 8.8 years, the COVID Mortality Percentage was 13.2%, and LEL was 0.091 years (thirty-four days). Controlling for gender, PFR and LEL were substantially higher for Blacks and Hispanics than for Whites at all ages. Racial/ethnic disparities for the elderly were large early in the pandemic but diminished later. Although COVID-19 mortality was much higher for the elderly, the COVID Mortality Percentage over the full pandemic period was only modestly higher for the elderly, at 13.2%, than for non-elderly adults aged 25-64, at 11.1%. Indeed, in 2021, this ratio was lower for the elderly than for the middle-aged, reflecting higher elderly vaccination rates.

Keywords: COVID mortality rates; COVID-19; life expectancy.

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Conflict of interest statement

Competing Interest Statement: The authors have no competing interests.

Figures

FIGURE 1:
FIGURE 1:. The COVID Waves
Panel A shows monthly COVID-19 deaths in the three Midwest areas for indicated age ranges over March 1, 2020 through December 31, 2021. Panel B shows monthly COVID PFR (per 100,000 people) for these age ranges over the same period.
FIGURE 2:
FIGURE 2:. PFR by Age, Gender, and Race/Ethnicity, Three Midwest Areas, Ages 65–95
Figure shows estimated COVID PFRs, modeled using eqn. (2), by age and race/ethnicity, pooled across the three Midwest areas and across zip-SES quintiles, separately for women (top graph) and men (bottom graph). PFR by race/ethnicity is estimated within the appropriate subsamples. For Hispanics and Asians, data for ages 90+ is two-year average (data point for age 90 covers ages 90–91, and so on).
FIGURE 3:
FIGURE 3:. Ratios of Black, Hispanic, and Asian to White PFR by Age, Three Midwest Areas, Ages 65+
Figure shows ratio of COVID PFRs for Blacks, Hispanics, and Asians relative to Whites, pooled across the three Midwest areas, for women (top graph) and men (bottom graph), for ages 65–95.
FIGURE 4:
FIGURE 4:. Ratios of Black, Hispanic, and Asian to White PFR by Calendar Quarter, Three Midwest Areas, Ages 65+
Figure shows, by calendar quarter, ratio of COVID PFRs for Blacks, Hispanics, and Asians relative to Whites, pooled across the three Midwest areas, for women (top graph) and men (bottom graph). Data points for 2Q 2020 covers March-June.
FIGURE 5:
FIGURE 5:. COVID Mortality Percentage by Age and Gender: Three Midwest Areas
Figure shows COVID mortality percentage (ratio of COVID/non-COVID deaths) for the three Midwest areas, by age range and gender for indicated time periods. Panel A. Full pandemic period from March 1, 2020 through December 31, 2021. Panel B. 2020 (March 1–December 31). Panel C. All of 2021. Panel D. Second half of 2021.
FIGURE 5:
FIGURE 5:. COVID Mortality Percentage by Age and Gender: Three Midwest Areas
Figure shows COVID mortality percentage (ratio of COVID/non-COVID deaths) for the three Midwest areas, by age range and gender for indicated time periods. Panel A. Full pandemic period from March 1, 2020 through December 31, 2021. Panel B. 2020 (March 1–December 31). Panel C. All of 2021. Panel D. Second half of 2021.
FIGURE 5:
FIGURE 5:. COVID Mortality Percentage by Age and Gender: Three Midwest Areas
Figure shows COVID mortality percentage (ratio of COVID/non-COVID deaths) for the three Midwest areas, by age range and gender for indicated time periods. Panel A. Full pandemic period from March 1, 2020 through December 31, 2021. Panel B. 2020 (March 1–December 31). Panel C. All of 2021. Panel D. Second half of 2021.
FIGURE 6:
FIGURE 6:. National Vaccination Rates by Age and Time (Jan. 1, 2021 through Mar. 25, 2022)
Source: CDC. Panel A. National estimates of vaccination rates by age group, from Jan. 1, 2021, through Mar. 25, 2022. Vaccination is two doses for the Pfizer and Moderna vaccines; one dose for the Johnson & Johnson vaccine. Panel B. National estimates of vaccine booster rates by age group, from Oct. 1, 2021 through Apr. 4, 2022. Both panels. The age ranges are those available from the CDC and are different for booster doses than for primary vaccination.
FIGURE 7.
FIGURE 7.. Elderly/Nonelderly PFR Ratios: Three Midwest Areas
Figure shows the monthly ratios of PFR in the three Midwest areas for (i) ages 85+, and (ii) ages 65–84, in each case relative to PFR for adults aged 45–64, by month during the pandemic period, using national from April 1, 2020, through Dec. 31, 2021.
FIGURE 8:
FIGURE 8:. National PFR Over Pandemic Period for Nursing Home Residents
FIGURE 9:
FIGURE 9:. Three Midwest Areas: Mean Age at Death and YLL by Calendar Quarter
Figure shows, by calendar quarter, mean age at death (Panel A) and mean years of life lost (Panel B) for elderly COVID-19 decedents by race/ethnicity, separately for women (left hand side) and men (right hand side), from March 1, 2020 through Dec. 31, 2021. Data points for 2Q 2020 cover March-June.
FIGURE 10:
FIGURE 10:. Three Midwest Areas: Life Expectancy Loss (LEL) Due to COVID
Panel A: LEL in weeks due to COVID-19 by race/ethnicity for the elderly (ages 65+), from March 1, 2020 through Dec. 31, 2021, for three Midwest areas. Individual lines show population-weighted estimates for all persons, Whites, Blacks, Hispanics, and Asians. Panel B: Uses same data as Panel A, but shows LEL ratios (Black, Hispanic, and Asian relative to White) by calendar quarter. Both panels: Separate figures for women (left hand figures) and men (right hand figures). LEL by race/ethnicity is estimated within the appropriate subsamples for Whites, Blacks, and Hispanics.
FIGURE 11:
FIGURE 11:. Three Midwest Areas: Cumulative Life Expectancy Loss
Panel A. Cumulative LEL for all elderly (thick line), Blacks, Hispanics, Whites, and Asians, separately for women (left-hand graph) and men (right-hand graph. Panel B. similar to Panel A, but limited to ages 65–84. Panel C. Similar to Panel A, but limited to ages 85+.
FIGURE 11:
FIGURE 11:. Three Midwest Areas: Cumulative Life Expectancy Loss
Panel A. Cumulative LEL for all elderly (thick line), Blacks, Hispanics, Whites, and Asians, separately for women (left-hand graph) and men (right-hand graph. Panel B. similar to Panel A, but limited to ages 65–84. Panel C. Similar to Panel A, but limited to ages 85+.
FIGURE 12:
FIGURE 12:. Three Midwest Areas: Cohort vs. Period Estimates of Life Expectancy Loss
Panel A. Figure shows elderly LEL due to COVID, over March 1, 2020 through December 31, 2021, by age and race/ethnicity for the three Midwest areas using the cohort-based approach (left-hand graph); and compares this to LEL computed using the period life expectancy approach using data for 2020 (right-hand graph). Individual lines show population-weighted estimates for all elderly (thick line) and for Whites, Blacks, Hispanics, and Asians. Asian estimates are only available for the cohort-based approach because the National Center for Health Statistics does not report Asian life expectancy tables. Panel B. Ratio of period-based to cohort-based estimate of LEL. Both panels: LEL by race/ethnicity is estimated within the appropriate subsamples.
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