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-19 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.
Highlights
Quantifying the burden of the COVID-19—or any other infectious disease—is not a straightforward undertaking, primarily due to the multifaceted nature of the problem: “burden” can be measured along several dimensions
The present study aims to quantitatively explore these issues for the COVID-19 pandemic using data from
As of 12 May, 2021, Hungary reported a total of 28,970 deaths from COVID-19, of which 27,837 occurred in patients above 50 years of age (13,667 females and 14,170 males)
Summary
Quantifying the burden of the COVID-19—or any other infectious disease—is not a straightforward undertaking, primarily due to the multifaceted nature of the problem: “burden” can be measured along several dimensions. Perhaps the most widely used indicator of burden is the mortality associated with the epidemic [7] This can be directly measured, it is considered to be very relevant and calculating the number of deaths due to COVID19 to measure the burden is associated with two inherent problems [9, 10]. The first is the definition of dying from the disease: how deaths are attributed in a multimorbid patient is not necessarily unambiguously defined, procedures might be different between countries or change over time. In addition to this uncertainty, deaths may be undercounted if patients are not tested for COVID-19 even post mortem. Excess death calculation cannot discern the— positive or negative—indirect effects from the direct effects of the epidemic.) These problems will not be addressed in the present paper
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