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Lookup NU author(s): Dr Richard Holleyman, Emeritus Professor Paul BurtonORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 Hughes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Uncertainty about the prior health status of those dying during the pandemic has fuelled debate about its impact. To date, attempts to quantify life years lost during the pandemic have relied on using life tables without taking into account varying levels of vulnerability among those that died. Methods: Using retrospective, linked data from March 2020 to September 2022 for the cohort of all individuals in England alive at outset, we quantified the risk of death, associated with a wide variety of comorbidities, using primary care and hospital data, as well as evidence of vaccination and COVID-19 infection. We then simulated the survival of every individual in the population with a positive COVID-19 test, with and without the assumption that COVID-19 affected their survival, taking account of their personal vulnerability. We used the difference between these simulated survival times to estimate mortality displacement (how long those who died would have lived, had they not tested positive). We used the displacement estimates for those aged 65 and older to revise estimates of excess deaths. Results: We estimated median mortality displacement of 4.8 (IQR = 1.5 to 16) years for females and 4.4 (IQR = 1.4 to 12.6) years for males at ages 65 and over. We estimate 28% of those dying with COVID-19 aged 65 and over would have survived five years or more without the infection (66% for females aged 65–74). Conclusions Life expectancy of those who died with COVID-19 was substantial and, based on our analysis of vulnerability, most of those who died at ages 65 and over are unlikely to have been close to death. In future pandemics, real-time modelling of displacement would be helpful in assessing the mortality impact of the pandemic.
Author(s): Hughes A, Barnard S, Bauer-Staeb C, Holleyman R, Dunn S, Fryers P, Newton JN, Fitzpatrick J, Burton P, Goldblatt P
Publication type: Article
Publication status: Published
Journal: PLoS ONE
Year: 2026
Volume: 21
Issue: 5
Online publication date: 08/05/2026
Acceptance date: 18/04/2026
Date deposited: 18/05/2026
ISSN (electronic): 1932-6203
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pone.0348575
DOI: 10.1371/journal.pone.0348575
Data Access Statement: This study required the linkage of record-level population healthcare datasets using identifiable data that were available to the Office for Health Improvement and Disparities (OHID) and the UK Health Security Agency (UKHSA) under the direction of the UK Secretary of State for Health and Social Care, for the purpose of responding to the COVID-19 pandemic. Onward sharing of the study dataset with any other party is against UK law. Practically, replicating the linked database would be an immense task, but all the data used are held within NHS England’s Data Access Request Service and may be requested from them - enquiries@nhsdigital.nhs.uk, https://digital.nhs.uk/services/data-access-request-service-dars.
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