The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in western Europe experienced bounce backs from life expectancy losses of 2020, eastern Europe and the United States witnessed sustained and substantial life expectancy deficits. Life expectancy deficits during fall/winter 2021 among people ages 60+ and <60 were negatively correlated with measures of vaccination uptake across countries (r60+ = −0.86; two-tailed P < 0.001; 95% confidence interval, −0.94 to −0.69; r<60 = −0.74; two-tailed P < 0.001; 95% confidence interval, −0.88 to −0.46). In contrast to 2020, the age profile of excess mortality in 2021 was younger, with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.

Background The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. In 2021, life expectancy trends globally diverged more due to the unequal impact of the pandemic across countries, variation in the age-patterns of mortality, and differences in vaccination. We estimate life expectancy changes in 29 countries since 2020, attribute them to mortality changes by age group, and compare them to historic life expectancy shocks. Data Total death counts by age and sex came from the Short-term Mortality Fluctuations and Human Mortality databases. Registered COVID-19 deaths and vaccination counts by age and sex were sourced from the COVerAGE-DB database. Midyear population counts were extracted from the UN World Population Prospects database. Methods Life expectancy for females, males, and the total population were calculated for 29 countries for 2020 and 2021. Additionally, we calculated life expectancy deficits for 2020 and 2021 based on pre-pandemic Lee-Carter forecasts of short-term life expectancy trends. Using demographic decomposition techniques, age- and COVID-19 specific contributions to changes and deficits in life expectancy were calculated. Deficits in life expectancy in 2021 across countries were compared to country vaccination rates. 95% uncertainty intervals were derived from Poisson replications of death counts. Findings Out of 29 countries, 14 countries lost life expectancy in both 2020 and 2021, 12 recovered losses in 2020 but not all of them back to 2019 levels, 2 exceeded pre-pandemic life expectancy, and 1 dropped below 2019 levels only in 2021. All 29 countries had lower life expectancy in 2021 than expected had pre-pandemic trends continued. The female life expectancy advantage increased for most countries, consistent with hypotheses that females are more resilient to mortality crises than men. Life expectancy losses were moderately correlated with measures of vaccination uptake. One notable change from 2020 was that mortality at younger ages contributed more to life expectancy losses in 2021. Registered COVID-19 deaths accounted for most losses of life expectancy. Interpretation In 2021 we saw divergence in the impact of the pandemic on population health. While some countries saw bounce-backs from stark life expectancy losses, others experienced sustained and substantial life expectancy deficits. While COVID-19 has been the most severe global mortality shock since the Second World War, this observed heterogeneity in 2021 indicates that pathways to long-term recovery of life expectancy trends remain unclear.

As in many other countries affected by the COVID-19 pandemic, the German federal and state governments responded to increasing numbers of cases of COVID-19 and deaths by taking drastic public health measures intended to slow down the rate of transmission of the SARS-CoV-2 virus. During the pandemic's first wave, large parts of public life were shut down from March 22, 2020, for the next 3 months. To keep intensive care beds available, the German government ordered hospitals to postpone non-emergency procedures and surgeries. First comparisons of hospitalizations during the pandemic (March 16 to April 5, 2020) and pre-pandemic (corresponding dates in 2019) periods, based on data from one of the largest insurance companies in Germany, indicate a decrease of 16% in pregnancies, births, or postpartum-related hospitalizations and a decrease of 14% in hospitalizations related to diseases of the fetus or the newborn. 1 Scholars expressed concerns from the early stages of the pandemic that the COVID-19 measures might disrupt the delivery of

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