Different approaches to quantify years of life lost from COVID-19

  1. Tamás Ferenci

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Abstract

The burden of an epidemic is often characterized by death counts, but this can be misleading as it fails to acknowledge the age of the deceased patients. Years of life lost is therefore widely used as a more relevant metric, however, such calculations in the context of COVID-19 are all biased upwards: patients dying from COVID-19 are typically multimorbid, having far worse life expectation than the general population. These questions are quantitatively investigated using a unique Hungarian dataset that contains individual patient level data on comorbidities for all COVID-19 deaths in the country. To account for the comorbidities of the patients, a parametric survival model using 11 important long-term conditions was used to estimate a more realistic years of life lost. As of 12 May, 2021, Hungary reported a total of 27,837 deaths from COVID-19 in patients above 50 years of age. The usual calculation indicates 10.5 years of life lost for each death, which decreases to 9.2 years per death after adjusting for 11 comorbidities. The expected number of years lost implied by the life table, reflecting the mortality of a developed country just before the pandemic is 11.1 years. The years of life lost due to COVID-19x in Hungary is therefore 12% or 1.3 years per death lower when accounting for the comorbidities and is below its expected value, but how this should be interpreted is still a matter of debate. Further research is warranted on how to optimally integrate this information into epidemiologic risk assessments during a pandemic.

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  1. Version published to 10.1101/2021.05.13.21257193v2 on medRxiv
  2. Version published to 10.1007/s10654-021-00774-0
  3. ScreenIT

    SciScore for 10.1101/2021.05.13.21257193: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The major limitation of the present study is the application of an external survival model to calculate the potential life expectancy for the patients who died. A logical and important research step would be the calculation and application of a survival model for the comorbidities from the same Hungarian population. Administrative/financial data has been extracted and successfully applied from the Hungarian healthcare system’s databases for biomedical research [37–39], so this endeavour seems to be feasible in the future. Perhaps the most important strength of the present is study is the application of the detailed, individual-level comorbidity database (available for more than 27,000 deaths). However, the data quality is poor, comorbid diseases are entered without any form of standardization, with many typographical errors, arbitrary usage of Latin and Hungarian terminologies, arbitrary usage of abbreviations etc. We tried to overcome these limitations by using carefully selected search expressions to identify the comorbidities, but no formal analysis on the sensitivity or specificity was carried out. We also have no systematic validation on the correctness of the recorded comorbidity data. A third limitation is that only 11 comorbidities were used and no information was available on the severity of the comorbidity. A final limitation is the application of YLL itself. A recent paper of Rubo et al argues that the application of YLL is incorrect when there is no clear, causal ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

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    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  4. Version published to 10.1101/2021.05.13.21257193v1 on medRxiv