COVID-19 pandemic led to large and unequal declines in life expectancy in India

A new paper published in Science Advances today indicates that life expectancy in India suffered large and unequal declines during the COVID-19 pandemic - with life expectancy 2.6 years lower in 2020 than 2019. 

The article, co-authored by the Department’s Dr Aashish Gupta and Professor Ridhi Kashyap, uses survey data from 765,180 individuals to show how the pandemic led to larger life expectancy declines in more disadvantaged and marginalised groups.

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The COVID-19 pandemic generated a global mortality shock, resulting in large losses in life expectancy worldwide. These life expectancy declines are well understood in high-income countries, where increased disparities across race and socioeconomic status are noted.

However, life expectancy changes are relatively unstudied in low- and middle-income countries, mostly due to a lack of mortality monitoring and high-quality data. 

Because India is the most populous country in the world, understanding the global toll of the pandemic relies on accurately estimating pandemic mortality in India.

Our findings uncover large and unequal effects of the pandemic in India, and show that disadvantages can be exacerbated in times of a mortality crisis.

Using information from India’s fifth Demographic and Health Survey, this paper estimates changes in life expectancy at birth by sex and social group between 2019 and 2020 in India – a country where one-third of global pandemic excess deaths are thought to have occurred.

The study reveals that, when comparing 2020 to 2019, life expectancy in India was 2.6 years lower. This decrease is larger than the loss in life expectancy in any high-income country during that same period.

In India, mortality increased in almost all age groups, most prominently among the youngest and oldest age groups – a stark contrast to higher income countries, where life expectancy declines were primarily driven by mortality increases in groups above age 60.

This excess mortality in the youngest age groups may have occurred due to the increased vulnerability of children to COVID-19 in contexts with comparatively higher deficits in early-life health.

It may also have been caused by indirect effects of the pandemic and subsequent lockdowns, including deteriorating economic conditions and disruptions to public health services such as childhood immunisations, tuberculosis treatment, and hospital births.

In another contrast to global patterns, females in India experienced a life expectancy decline that was one year larger (3.1 years) than losses for males (2.1 years). 

Among other factors, gender inequality in healthcare and allocation of resources within households may explain this pattern. Consistent with this explanation, the paper found larger losses among females compared to males among almost all Indian social groups and classes.

Marginalised social groups within India also experienced greater life expectancy declines than the most privileged social groups. 

While high caste Hindu groups experienced a life expectancy decline of 1.3 years, the loss for Muslims was 5.4 years and for Scheduled Tribes was 4.1 years.

Dr Aashish Gupta, Marie Sklodowska-Curie Fellow, said:

Marginalised groups already had lower life expectancy, and the pandemic further increased the gap between the most privileged Indian social groups, and the most marginalised social groups in India.

Overall, mortality across India was 17% higher in 2020 compared to 2019, implying 1.19 million excess deaths.

Compared to other estimates during the same period, this estimate for all-India excess deaths is about eight times the official number of COVID-19 deaths in India, 1.5 times the WHO’s extrapolated estimate of excess deaths in India, and more than 2.5 times the estimated excess deaths in the United States in 2020.

Ridhi Kashyap, Professor of Demography and Computational Social Science, said:

Our findings challenge the view that 2020 was not significant in terms of the mortality impacts and severity of the COVID-19 pandemic in India.

While a mortality surge caused by the Delta variant in 2021 received more attention, our study reveals significant and unequal mortality increases even earlier on in the pandemic.

This study shows the potential for accurately estimating mortality – even for short periods – using retrospective mortality information collected in a large-scale sample survey in a relatively poor context.

From a policy perspective, the findings underscore that pandemics can worsen, rather than equalise, existing disparities. The study reinforces the importance of considering social conditions as a fundamental cause of health and mortality.

By examining these dimensions, researchers have emphasised the need for policies that address the underlying social determinants of health to mitigate the impact of future health crises.