Economic burden of lives lost due to COVID-19 in California State

A total of 63,891 coronavirus deaths had been reported across the state of California as of 28 July 28 2021. These deaths resulted in an estimated 913,682 YPLL (range: 770,352–1,126,069) and approximately US$219.9 billion VSL (range: US$185.4–$271 billion) (Table 1 & Figure 3 & 4). The mean YPLL per person was 14.3 (range: 12.1–17.6). Deaths from the 35–49, 50–59 and 60–64 age ranges contributed to almost half of the total YPLL, at 14.6%, 20.4% and 13.8%, respectively. By race and ethnicity, Latinos accounted for over half of the total YPLL and VSL, at 56.5% and 64.9%, respectively, followed by Whites, Asians and African Americans (Table 4, Figures 5& 6).

In LA County, excluding Long Beach and Pasadena, coronavirus deaths totaled 23,380 as of 30 July 2021. These deaths contributed to an estimated 343,186 YPLL (range: 249,297–465,948) and approximately US$82.7 billion VSL (range: US$59.6–$112.1 billion). The average YPLL per person was 14.7 (range: 10.7–19.9) (Table 1). Fatalities from the 50–64 and 65–79 age ranges contributed to more than half of the total YPLL and VSL, at 36% and 32.7%, respectively (Figures 1 & 2).

This study estimated the VSL lost and the YPLL in California State and LA County, excluding Long Beach and Pasadena, from the beginning of the pandemic (1 March 2020) through July 2021. Across California, the monetary value of lives lost exceeded US$219.9 billion, with LA County accounting for roughly US$82.7 billion, as of 28 July 2021. Among all California counties, LA County was disproportionately impacted, with nearly five-times as many deaths as the next highest county [15]. These findings may reflect a combination of factors, including population density, poverty, race and ethnicity, homelessness and high household densities in LA County compared with other areas of the state [16]. Analysis by age range determined that older individuals accounted for most of the monetary cost of lives lost due to this pandemic, in spite of the fact that older populations tend to have fewer years of life remaining. These findings are consistent with prior literature demonstrating that older individuals over 50, and especially over 60, face elevated mortality risk due to COVID-19 [17].

Sub-analysis by race and ethnicity further indicated that certain racial and ethnic minority groups were more heavily impacted by the COVID-19 pandemic. Latinos comprise 39.4% of the population of California State but accounted for the greatest economic burden of lives lost (56.5% and 64.9% of YPLL and VSL respectively) [9]. They had the highest total YPLL and VSL, at 516,288 and US$124.3 billion, respectively. Similarly, African Americans make up only 6.5% of California's population yet had a higher total YPLL (62,010) than Asians and Whites, who account for 15.5% and 36.5% of California's population, respectively [18]. These differences may be due to a combination of environmental and health factors. Individuals of color are more likely to have poor access to healthcare and underlying health conditions, such as asthma, diabetes and hypertension, which increase their risk of COVID-19 complications and fatality [19]. Compared with Whites and Asians, Latinos and African Americans are more likely to live in more crowded households with insufficient space for social distancing and self-isolation [20]. Furthermore, individuals of color are more likely to work in service and public-facing jobs that do not offer the ability to telework, thereby increasing their vulnerability and susceptibility to COVID-19 infection [19]. Latinos and African Americans are also more likely to live in poverty [21]. Prior literature has identified an association between low socioeconomic status, crowded households and an inability to telework and a disproportionate COVID-19 positivity and mortality rate among communities of color in California [22,23]. Specifically, prior literature has shown an increased rate of hospitalizations among individuals of color due to COVID-19, even after adjusting for comorbidities, highlighting the impact of social inequality during this pandemic [23].

With nearly 40 million residents, California has the largest population of any US state; it is also among the youngest and most diverse, with more Latino than White residents since 2014 [21]. California also accounts for 15% of the US economy [24]. In this context, the magnitude of the financial burden of COVID-19 mortality in California, as well its disproportionate impact on non-White communities, is particularly significant and concerning.

The results of the present study are consistent with similar disparities analyzed in New York, Ohio and Illinois. In New York and Ohio, older individuals bore the greatest economic burden of life lost, with individuals over the age of 60 experiencing the greatest impact [4,25]. In Chicago, Illinois, and in Cook County in general, Black and Hispanic residents experienced a disproportionate COVID-19 burden and premature loss of life [26,27]. In Cook County specifically, Latinos had a YPLL rate 4.8-times greater than Asians, the least affected group [26]. In Chicago, geospatial analysis identified COVID-19 mortality hot spots in neighborhoods of color and low socioeconomic status as well as higher rates of chronic comorbidities [27]. While the current data cannot be directly extrapolated to other states, the current findings are worrisome for similar trends across the USA.

The current study has several limitations. Most notably, the values included here were current as of July 2021; they do not reflect the full extent of the pandemic, as new fatality reports are confirmed and updated daily, particularly in the setting of new and more transmissible variants [28]. Furthermore, the COVID-19 pandemic has led to an excess of non-COVID deaths, related to factors such as delays in or avoidance of medical care, drug use and mental health crises [29,30]. As a result, the calculated YPLL and VSLs are surely an underestimation of the current economic losses and loss of life experienced across California and LA County due to COVID-19. Additionally, some data were incomplete at the time of analysis: 566 fatality reports listed an unknown or ‘missing’ age (Tables 2 & 3), precluding calculation and inclusion of YPLL and VSL in the analyses. Another important limitation is the lack of data stratified by both age and sex. As a result, the authors used an average of the male and female period life expectancy when determining YPLL.

VSLY also has important limitations. The VSLY utilized in this paper assumed an age- and income-adjusted but otherwise standard VSL, regardless of factors such as: community preferences, values and work-related risk exposures [14,31]. Although the present approach is consistent with prior research [25], and no universally accepted mathematical model of VSLY exists, alternate models of VSLY may incorporate additional variables and arrive at different valuations [31,32] Consequently, the results of this study should be understood as estimates of the financial value of COVID-19 risk reductions across groups, with the trends toward racial and ethnic disparities observed here likely to be more meaningful than precise values. Furthermore, while it is possible that other methodologies would yield less-pronounced racial and ethnic disparities, the current findings may, in fact, be more likely to underestimate the disparities in VSL across racial and ethnic groups, due to the higher COVID-19 exposure risks associated with many low-income jobs, which are often disproportionately held by non-White workers [3]. Finally, it has been argued that VSLY-based cost–benefit analyses should be used with caution in analyses of social distancing measures for COVID-19 [14]. However, a superior metric has not been proposed [14]. Because VSLY remains a broadly understood and accepted tool for evaluating the costs and cost–benefit of risk-reduction interventions [31], the authors feel it is an appropriate and useful strategy for evaluating the financial costs associated with COVID-related deaths.

The economic burden of lives lost due to the coronavirus pandemic across California and LA County, excluding Long Beach and Pasadena, is substantial. Among the various age groups, ages 50–64 bore the greatest burden of statistical value of lives lost and estimated YPLL. By race and ethnicity, Latinos experienced the greatest economic burden of lives lost. This study may help inform important policy decisions and community interventions to promote health equity amid an ongoing COVID-19 pandemic, minimize further loss of life and help plan for a post-pandemic future in California State.

M Zheng, B Lui, RS White and MM Hoyler contributed to the conception and design of this project. M Zheng and B Lui conducted statistical analysis. M Zheng, B Lui, RS White and MM Hoyler interpreted the data. M Zheng, AGA Komlan and CR Bonaparte drafted the manuscript. M Zheng, B Lui, AGA Komlan, CR Bonaparte, RS White and MM Hoyler critically revised the manuscript.

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

This study used publicly available data and did not need approval from the IRB.