Nearly 17 million years of life were lost among 289 million adults aged 35 and older in 18 European countries from 2020 through 2022 due to the COVID-19 pandemic, an Imperial College London-led research team [estimates](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004541) in _PLOS Medicine._
To inform policy-setting and resource allocation, the investigators used modeling and several data sources to estimate rates of disease-free states and combinations of cardiovascular disease, cognitive impairment, dementia, disability, and death.
They quantified numbers and rates of deaths related to COVID-19 and deaths from other causes and estimated the proportion of loss of life expectancy and years lived with and without disability that could have been avoided if the pandemic had not happened.
### **60% of years of life lost was in adults older than 80**
A total of 4.7 million person-years of life (PYLL) were lost among adults in 2020, 7.1 million in 2021, and 5.0 million in 2022, for a total of 16.8 million. PYLL per capita varied considerably among the 18 countries, from 20 to 109 per 1,000 population. Roughly 60% of the total PYLL were among people older than 80 years, and 30% occurred in those aged 65 to 80.
If the pandemic hadn't occurred, over half (9.8 million) of the 16.8 million PYLL would likely have been lived without disability. Of all PYLL, 11.6 to 13.2 million were due to COVID-19 deaths, and 3.6 to 5.3 million were due to non-COVID deaths. PYLL attributed to COVID-19 declined after 2021, following the introduction of COVID-19 vaccines, but PYLL related to other causes of death continued to rise from 2020 to 2022 in most countries.
About 2.3 million years of life were lost in the United Kingdom and Germany, 3.2 million in Spain, 2.5 million in Poland, 1.8 million in Italy, and 1.1 million years of life in France.
Lower-income countries had higher PYLL per capita and a greater proportion of disability-free PYLL from 2020 to 2022, with comparable patterns for life expectancy. In 2021, life expectancy at age 35 (LE-35) fell by as many as 2.8 years, with over two-thirds being disability-free. Except for Sweden, LE-35 in the studied countries did not recover to 2019 levels by 2022.
### **Need for better pandemic preparedness**
"Our findings illustrate the pandemic’s long-term impact, which extends beyond COVID-19 deaths," lead author Sara Ahmadi-Abhari, MD, PhD, of Imperial College London, said in a PLOS [news release](https://www.eurekalert.org/news-releases/1075822). "While vaccination played an important role to limit direct losses from COVID, the continuously rising loss of life from other causes highlight the broader consequences of the pandemic, possibly arising from disruptions in healthcare."
> The substantial proportion of years of life lost without disability bring to light an instinctive underestimation of the pandemic’s impact, especially on the older population.
The results, the authors said, suggest that the pandemic also exacerbated socioeconomic inequities in premature death among countries and widened sex differences in life expectancy.
"The substantial proportion of years of life lost without disability bring to light an instinctive underestimation of the pandemic’s impact, especially on the older population," they wrote. "These findings highlight a need for better pandemic preparedness in Europe, ideally, as part of a more comprehensive global public health agenda."