Data: COVID shaved 2.6 years from life expectancy—much more in some groups—in India

COVID-19
COVID burial in India

Ninian Reid / Flickr cc

COVID-19 dealt an outsized blow to India during the first year of the pandemic, reveals an analysis of survey data from 765,180 residents that fills a gap left by the incomplete vital statistics and disease surveillance often seen in low- and middle-income countries (LMICs).

The study, led by researchers from the University of Oxford and the Research Institute for Compassionate Economics in Connecticut, estimates a 2.6-year lower life expectancy at birth and a 17% higher death rate, with the greatest losses among females, the youngest and oldest people, and marginalized groups.

The investigators compared high-quality empirical data on death rates and socioeconomic characteristics from India’s National Family Health Survey-5 from 2019 to 2021 with official estimates from the United Nations and the Indian government. Prepandemic rates and characteristics from the two data sources matched closely.

The team used a subsample of households from 14 states and territories (representative of roughly a quarter of India's population) interviewed in 2021 to compare death rates in 2020 with those in previous years.

The research was published late last week in Science Advances.

17% higher death rate in 2020

Life expectancy fell 2.6 years from 2019 to 2020, a decline larger than that in modeled life-expectancy estimates in India and in any high-income country (HIC) during the same period. While drops in life expectancy in HICs were mainly driven by rising death rates among people aged 60 or older, nearly all Indian age-groups—especially the youngest and oldest—contributed to lower life expectancy.

The death rate was 17% higher in 2020 than in 2019 in India, implying an estimated 1.19 million excess deaths—eight times higher than the official number, 1.5 times higher than World Health Organization (WHO) estimates, and more than 2.5 times higher than US deaths. 

Higher death rates among children were likely due to other causes in addition to COVID-19 (eg, worse economic conditions, public health service disruptions), but excess deaths in 2020 among older people was higher than expected based on age-specific infection deaths in HICs and the SARS-CoV-2 seroprevalence seen in India, the authors said. 

"Greater observed than expected excess mortality for older age groups could have been due to higher age-specific infection fatality rates in India as well as due to indirect effects of the pandemic," they wrote.

Pandemic exacerbated existing disadvantages

Unlike other countries, Indian women lost 3.1 years in life expectancy—1 year more than males, which the authors said could be attributed to healthcare inequalities and uneven allocation of resources in households. And Muslims and Scheduled Tribes lost 5.4 and 4.1 years, respectively, compared with 1.3 years among high-cast Hindu groups.

Our findings challenge the view that 2020 was not significant in terms of the mortality impacts and severity of the COVID-19 pandemic in India.

Ridhi Kashyap

"Indian society is one of the most stratified in the world," the researchers noted, with Scheduled Castes, Scheduled Tribes, and Muslims facing discrimination based on caste, indigenous identity, and religion, respectively.

"Our findings challenge the view that 2020 was not significant in terms of the mortality impacts and severity of the COVID-19 pandemic in India," coauthor Ridhi Kashyap, of the University of Oxford, said in a university news release. "While a mortality surge caused by the Delta variant in 2021 received more attention, our study reveals significant and unequal mortality increases even earlier on in the pandemic."

The study also underscores the importance of considering inequality when calculating death rates and the need for policies to address social determinants of health, she added: "This was particularly noticeable on the role that COVID-19 had in further exacerbating the health impacts of pre-pandemic gender disparities."

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