Background: The COVID-19 pandemic caused substantial health losses but not much is known about how these are distributed across the population. We aimed to estimate the distribution of years of life lost (YLL) due to COVID-19 and investigate its variation across the Dutch population, taking into account pre-existing differences in health.

Methods: We used linked administrative data covering the entire 50+ Dutch population over 2012-2018 (n=6102334) to estimate counterfactual individual-level life expectancy for those who died from COVID-19 in 2020 and 2021. We estimated survival models and used Cox-LASSO and Cox-Elastic Net to perform variable selection among the large set of potential predictors in our data. Using individual level life-expectancy predictions, we generated the distribution of YLL due to COVID-19 for the entire 50+ population by age and income.

Results: On average, we estimate that individuals who died of COVID-19 had a counterfactual life expectancy about 28% lower than that of the rest of the population. Within this average there was substantial heterogeneity, with 20% of all individuals who died of COVID-19 having an estimated life expectancy exceeding that of the age-specific population average. Both the richest and poorest COVID-19 decedents lost the same average number of YLL, which were similarly dispersed.

Conclusions: Accounting for pre-existing health problems is crucial when estimating YLL due to COVID-19. While average life expectancy among COVID-19 decedents was substantially lower than for the rest of the population, the popular notion that only the frail died from COVID-19 is not true.

Keywords: Age Distribution; COVID-19; Health Distribution; Income Distribution; Mortality; Years of Life Lost.

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

背景：

新冠肺炎疫情造成了巨大的健康损失，但这些损失在人口中的分布情况尚不清楚。我们的目标是估算由于新冠病毒导致的寿命年损失（YLL）的分布，并调查其在荷兰人口中的变化，同时考虑现有的健康差异。

方法：

我们使用了2012年至2018年间覆盖整个50岁及以上荷兰人口的链接行政数据（n=6,102,334）来估计因新冠病毒死亡的人在2020年和2021年的反事实个人生命期望。我们估算了生存模型，并使用Cox-LASSO和Cox-Elastic Net方法对大量潜在预测变量进行选择。利用个体水平的生命预期预测，我们生成了整个50岁以上人口因新冠病毒导致的寿命年损失分布情况，按年龄和收入划分。

结果：

平均而言，我们认为因新冠肺炎死亡的人们的反事实生命期望比其余人口低约28%。在这一平均水平内存在很大的异质性，其中20%因新冠肺炎死亡的个体估计的生命期望超过了同年龄段人群的平均值。最富裕和最贫困的新冠病毒死者失去的寿命年数相同，并且分布相似。

结论：

在估算新冠病毒导致的寿命年损失时，考虑现有健康问题是至关重要的。尽管新冠病毒死者的平均生命期望比其余人口低得多，但普遍认为只有脆弱的人因新冠病毒死亡这一观点并不准确。

关键词：年龄分布；新冠肺炎；健康分布；收入分布；死亡率；寿命年损失。