Background Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+. Methods Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy. Results Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile. Conclusions Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.

中文翻译：

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量化因 COVID-19 而损失的生命年数中的收入不平等：使用荷兰行政数据的预测模型方法


背景 较低的社会经济地位和基础健康状况会增加因 COVID-19 导致致命后果的风险，导致穷人的寿命损失 (YLL) 更长。然而，使用标准预期寿命高估了 COVID-19 的 YLL。我们的目的是按性别和收入四分位数量化与 COVID-19 死亡相关的 YLL，同时考虑个人水平的既往健康状况对所有 50 岁以上荷兰成年人剩余预期寿命的影响。方法 使用大量行政数据对 2019 年所有 50 岁以上人口的年内死亡概率进行建模，考虑年龄、性别、可支配收入和医疗保健使用情况 (n = 6 885 958)。该模型用于预测 2020 年死于 COVID-19 的人（如果他们没有死亡）的死亡率概率。结合生命表中的这些概率，我们按性别和收入四分位估计了 YLL。这些估计值是根据标准预期寿命和收入分层预期寿命与 YLL 进行比较的。结果 使用标准预期寿命结果为 167 315 岁寿命年（每名死亡 8.4 岁寿命年），这与使用收入分层寿命表的估计值相当（167 916 岁寿命年，每人死亡 8.2 岁寿命年）。考虑到先前存在的健康和收入，YLL 下降至 100 743，最贫困收入四分位数损失了 40% 的年数（每人死亡 5.0 YLL）。尽管最贫困四分之一群体中的个体死亡年龄较轻，但与最富有四分之一群体相比，每例 COVID-19 死亡的平均 YLL 差异很小。结论 考虑既往健康状况会显着影响因 COVID-19 造成的 YLL 估计。然而，人口层面的 YLL 不平等主要是由穷人中的 COVID-19 死亡人数增加造成的。 为了减少未来流行病造成的健康负担中的收入不平等，政策应侧重于限制低收入群体的基本健康和暴露程度的结构性差异。