Decomposing life expectancy changes in Spain in the COVID-19 pandemic and post-pandemic periods

Abstract

Background: COVID-19 pandemic produced an important decrease in life expectancy at birth (LE) in 2020 in Western European countries, which has only been recovered in 2023. Spain has the highest LE in the European Union in spite of being one of the European countries more affected by the pandemic. The main goal in this study is to decompose the LE changes in Spain over the 2019-2023 period into age-specific and cause-of-death-specific contributions, and to compare them with those occurred in the pre-pandemic period 2010-2019. Methods: Data on LE and mortality rates by age and for each main group of causes was obtained from the Spanish National Institute for Statistics (INE) for years 2010, 2019, 2020, 2021, 2022 and 2023. We estimated age-specific contribution to changes in LE using the Arriaga decomposition method. Age-specific contributions were proportionally attributed to each main cause of death. Results: Age groups higher than 20 years old had negative contribution to LE in 2020 and, most of them, positive contribution in each year from then. Paradoxically, the most affected groups in 2020 have positive contribution to LE changes in the whole 2019/2023 period, while age groups under 45 years old have still negative contributions to LE. Infectious diseases were the main contributor to the sharp drop in life expectancy in 2020, accounting for - 1.33 years in the total population, with a more severe impact in men (- 1.43 years) than in women (- 1.16 years). From 2021 onwards, their contribution became positive, with a net effect close to zero by 2023 (- 0.11 in men; -0.20 in women). Neoplasms showed no signs of pandemic-related excess mortality. On the contrary, they maintained a positive contribution throughout the period, particularly in men (+ 0.25 years, compared to + 0.05 in women). Circulatory diseases also made a positive contribution to LE in the whole period (+ 0.09 years in men, + 0.16 years in women), although almost of it happened in 2023. Conclusion: Four years after the beginning of the pandemic, age groups under 45 years old have still negative contributions to LE. Tumours and cardiovascular diseases have the more positive contribution to LE changes in 2019/2023. Nevertheless, while tumours contributed positively each single year, cardiovascular diseases only made a relevant positive contribution in the post-pandemic 2023.