Valuing the years of life lost due to COVID-19: the differences and pitfalls
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COMMENTARY
Valuing the years of life lost due to COVID-19: the differences and pitfalls Brecht Devleesschauwer1,2
•
Scott A. McDonald3
•
Niko Speybroeck4
•
Grant M. A. Wyper5
Received: 25 June 2020 / Revised: 25 June 2020 / Accepted: 6 July 2020 Ó The Author(s) 2020
The only thing that is certain about death is that upon it, no life remains, and that the risk of death during a person’s lifetime is 1. These facts cannot be disputed; however, assessments over how much life has been prematurely lost upon death have led to polarised views. The impact of COVID-19 is drawing increased attention on how we approach putting a value on the life prematurely lost by death (Appleby 2020; Hanlon et al. 2020; Kirigia and Muthuri 2020). Years of life lost to premature mortality (YLL) is a frequently used population health metric, originating back to the 1940s (Haenszel 1950). The idea is appealingly simple—instead of merely counting the number of deaths, each death is weighted as a function of the age at death, reflecting the common appreciation that deaths at young ages are more severe than deaths at advanced ages. However, there is no single unique way to operationalise the concept, reflecting the reality that YLL can never be observed. Indeed, the estimation of YLL requires assumptions on the counterfactual, parallel world that did not happen—how long would the person have lived had they not have died? The debate around this normative assumption is largely centred on the choice of mortality risk that residual values & Grant M. A. Wyper [email protected] 1
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
2
Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
3
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
4
School of Public Health and Research Institute of Health and Society, Catholic University of Louvain, Brussels, Belgium
5
Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
for age-conditional life expectancy in YLL calculations are based on. Should they be based upon mortality risks that are country-specific, or risks that are external to the population studied, and are chosen to be aspirationally low? It may seem rational to use national life tables, reflecting the country-specific mortality risks, until we estimate residual life expectancy for sub-national units. This highlights that particular groups, such as those with a socioeconomic disadvantage, have very different mortality risks. Take Singapore, which has the highest life expectancy in the world (Institute for Health Metrics and Evaluation. GBD results tool. Global Health Data Exchange 2020). The mortality risk in Singapore is not representative for that in Scotland—for instance, the former country has a residual life expectancy for females aged 75 that is 3.67 years higher than the latter. However, looking at differences between
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