"Countries where the decline in life expectancy slowed down, or where life expectancy began to slowly rise again, prevented high mortality rates in older age groups in 2021," Hannaliis Jaadla, a researcher at the Estonian Center for Demography, explained.

Jaadla collaborated on a study that looked at how the Covid-19 pandemic affected life expectancy in 27 European countries, the United States and Chile.

The authors examined how life expectancy changed between 2019 and 2021 in these countries. They analyzed the correlation between the change in life expectancy and mortality rate in various age groups, and compared the impact of the Covid-19 pandemic with the impact of other mortality shocks over the past 120 years.

"The study reveals that life expectancy in Estonia did not fall significantly between 2019 and 2020. Our excess mortality, for example, was not much higher when compared to Italy and Bulgaria," Jaadla said.

"The events of 2020, the first year of the pandemic, have been the subject of extensive research and international comparisons. Even before vaccines were available, the situation varied greatly from county to county," the researcher continued.

In the first pandemic year, life expectancy fell the highest in the United States, lowering by 25.5 months. Bulgaria and Lithuania both had their life expectancy lowered by 17.8 months. In Norway and Denmark life expectancy, however, increased by 2 and 1.1 months, respectively, in 2020.

During the same time period, life expectancy for Estonians decreased by 1.8 months.

"In its first year of the pandemic, Estonia resembled the Nordic countries, which experienced almost no decline. Unfortunately, Estonia's life expectancy lowered in 2021. We ranked third among 29 countries in terms of the extent of the decline," Jaadla said.

In 2021, the life expectancy in Bulgaria, Slovakia and Estonia lowered by 25,1 months, 23,9 months, and 21,5 months, respectively.

The two line segments indicate the annual changes in LE in 2020 and 2021. Red segments to the left indicate an LE drop, while grey arrows to the right indicate a rise in LE. The position of the arrowhead indicates the total change in LE from 2019 through 2021. The grey dots and lines indicate the average annual LE changes over the years 2015 through 2019 along with 95 percent CIs. Δe0 marks the change in period LE over the designated period.

"In the first year, the excess mortality rate was particularly high among seniors, i.e. those over 60," she said.

In the absence of vaccines, the decrease in life expectancy was mostly due to the mortality among the elderly who were most severely affected.

"In some countries life expectancy continued to decline also in the second year of the pandemic, which was often due to the pandemic death toll shifting to younger age groups," Jaadla explained.

Despite the trend towards a greater contribution of excess mortality from younger age groups in 2021, increasing death among the elderly remained the most significant factor of life expectancy decreases relative to levels before the pandemic.

Jaadla said that protecting the elderly should be one of the measures for reducing the climbing mortality rate.

"In our study, we tried to assess what influence immunizations may have played," she explains. The authors analyzed immunization rates using data through October 2021.

They determined the life expectancy deficit using statistics. "We compared the current life expectancy to what it would have been had the coronavirus pandemic not occurred and previous patterns continued," she continued.

Jaadla said that when the researchers compared the resulting deficits and the vaccination coverage rates of countries, they discovered a correlation. "The decline in life expectancy was much more pronounced in countries with lower vaccination coverage," she said.

The correlation was even more apparent when the researchers examined the vaccination rates in people aged 60 and older in detail. Jaadla said that the differences between countries widened.

For instance, while vaccination rates among the elderly were comparable in the Netherlands and Poland at the time of the study, the drop in life expectancy in the Netherlands was much smaller than in Poland, she explained.

"This requires taking into account not just the vaccination level, but also any possible variations. What vaccines were administered? Which age groups were targeted? What is the capacity of the health system?"

Jaadla was mostly involved in the historical aspect of the research. "My background involves examining long-term trends across hundreds of years, not just the past two," she explains.

The authors also wanted to look at comparative data for all of the mortality crises that occurred in the 29 countries studied over the past 120 years.

In some countries, the First World War and the 1918 flu pandemic were believed to have reduced life expectancy across more than 20 consecutive years. "However, recovery was usually very quick: it took one to two years," she explained. "In other words, a 20-year long decline in life expectancy could be bounced back in one or two years."

Comparing the Covid-19 pandemic to the major flu epidemics of the 20th century revealed that the comparison is invalid, as the losses during these flu epidemics were substantially smaller than the decline in life expectancy during the Covid-19 pandemic.

"The decline in life expectancy was only a matter of months," Jaadla explained. "In comparison, the Covid-19 pandemic shortened people's lives by up to two years."

Countries recover differently from mortality crises such as pandemics, Jaadla continued, because public health systems, preexisting health and other factors come into play.

During and after the collapse of the Soviet Union, for example, life expectancy in post-Soviet countries experienced an extended period of stagnation. "It took a very long time for life expectancy growth to recover then," Jaadla said.

The researcher sees a continuation in 2022 of the 2021 mortality trend in Estonia. Jaadla said that this may be due to the low immunization rate among the elderly.

In Denmark and England, 99 percent of those over the age of 80 are vaccinated, whereas in Estonia and many other Eastern European countries, the rate hovers around 80 percent, she explained.

However, she said, more precise study on the causes of death would be necessary. "Unfortunately, we were unable to use them for Estonia in this research piece, but future studies should examine this topic in greater depth. What causes high mortality rates? How big a role do different factors play, such as COVID-19 mortality, summer heatwaves and cardiovascular diseases?" the researcher concluded.

The article by Hannaliis Jaadla and colleagues was published in Nature Human Behaviour.

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