The unequal impact of the COVID-19 pandemic on life expectancy across Chile

Objectives

To quantify the effect of the COVID-19 pandemic on life expectancy in Chile categorized by rural and urban, and to correlate life expectancy changes with socioeconomic factors at the municipal level.

Design

Retrospective cross-sectional demographic analysis using aggregated data.

Setting

Vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health.

Participants

Aggregated national all-cause death data stratified by year (2000-2020), sex, and municipality.

Main Outcome measures

Stratified mortality rates using a Bayesian methodology. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for men and women and analyzed previous mortality trends since 2010.

Results

Life expectancy declined for both men and women in 2020. Urban areas were the most affected, with males losing 1.89 and females 1.33 in 2020. The strength of the decline in life expectancy correlated with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities.

Conclusions

Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.

Strengths and limitations

• First study to analyze changes in life expectancy in Chile with small-area resolution.

• We applied a hierarchical Bayesian methodology to estimate life expectancies in the past 20 years.

• We show that COVID-19 led to declines in life expectancy in Chile greater than a year in magnitude. These declines correlated with poverty levels, indicating that socially deprived populations were hit the hardest.

• We also show that inequality in life expectancy between municipalities increased due to excess mortality among the working-age population in socially disadvantaged municipalities.

• The main limitation is that our estimates depend on accurate small-area stratified population estimates. We implemented several estimates and showed that our findings are robust to the choice of them.