COVID-19, Cause-Specific Mortality, and Life Expectancy Decomposition: Evidence from the USA and France

Abstract

This paper examines post-pandemic trends in life expectancy and cause-specific mortality using a decomposition framework based on three indicators: the average mortality improvement rate and life disparity (combined in the Level 1 term), and their covariance term (Level 2). Drawing on official mortality data from the Human Mortality Database and the Human Cause-of-Death Database, we quantify the contributions of major disease groups, including a separate COVID-19 category, to annual changes in life expectancy during the recovery phase (2020–2022) in the USA and France, distinguishing between Level 1 and Level 2 components. We additionally compare post-pandemic patterns with pre-pandemic mortality dynamics (2015–2019). This contrast highlights how the recovery in 2020–2022 is primarily driven by declining COVID-19 mortality, whereas several non-COVID causes continue to perform worse than before the pandemic. Results show that cardiovascular diseases and malignant neoplasms make substantial but heterogeneous contributions across the two countries, while COVID-19 and other respiratory causes are key drivers of post-pandemic trajectories. Positive Level 1 contributions from circulatory causes and neoplasms reflect survival gains at ages with high remaining life expectancy. In contrast, negative covariance terms for respiratory diseases in the USA indicate mortality reductions concentrated at older ages, tempering their overall impact. In France, several non-COVID-19 groups, notably those related to circulatory, respiratory, and digestive diseases, continue to exert downward pressure on life expectancy, limiting the rebound. Malignant neoplasms yield moderate and consistent gains in both countries, whereas digestive diseases and external causes show heterogeneous and sometimes adverse patterns. Our extension of the Vaupel and Canudas-Romo framework, which considers the cause-specific decomposition, disentangles structural intensity from age-compositional effects in mortality change, clarifying how specific causes of death either accelerate or delay the recovery of life expectancy.