Estimating changes in life expectancy in Hong Kong during the COVID-19 pandemic: a longitudinal ecological study

Abstract

<p>Background: Hong Kong has one of the longest life expectancies in the world but was heavily impacted by COVID-19 in 2022. We aimed to estimate patterns in mortality rates and changes in life expectancy in Hong Kong during the COVID-19 pandemic. Methods: We constructed sex-specific life tables from 1998 to 2023 using parametric bootstrapping to account for statistical uncertainty in mortality rates. We used Arriaga's decomposition method to estimate age- and cause-specific contributions to overall changes in life expectancy for 2020–2023, with 2019 as the reference year. We also estimated cause-specific mortality rates. Findings: Hong Kong reported 50,666 deaths in 2020, 51,354 in 2021, 63,692 in 2022, and 54,731 in 2023. Estimates of life expectancy in males and females in 2020 and 2021 were similar to the pre-pandemic trend from 1998 to 2019 but declined significantly in 2022. Compared to the pre-pandemic trend, the 2022 values of 80.4 years for males and 86.4 years for females corresponded to reductions by 2.22 (95% CI: 2.08, 2.36) years in males and 2.30 (95% CI: 2.17, 2.43) years in females. The loss in life expectancy in 2022 was mainly attributed to increased respiratory mortality rates, with a negative contribution to life expectancy of 1.47 and 1.26 years for males and females respectively. In 2023 life expectancy increased by 0.60 (95% CI: 0.46, 0.75) years in males and by 1.10 (95% CI: 0.95, 1.26) years in females. Interpretation: In 2022 a very high respiratory mortality rate in older adults in Hong Kong during the COVID-19 pandemic was associated with a reduction in life expectancy by more than 2 years. In 2023 life expectancy increased towards the pre-pandemic trend. Funding: Health and Medical Research Fund, Hong Kong.</p>