PRACTICE MANAGEMENT

Living and dying in New Zealand in 2020

Russell Hutchinson looks at how expected mortality rates have been affected by Covid-19.

How long will people live? Has that changed much? What has been the impact of Covid-19? Have measures to control Covid-19 made life expectancy longer or shorter? Rarely is there so much interest in mortality data as a subject by general media than over the last couple of months.

Financial advice would be a heck of a lot easier to give if we had more certainty. One of the most interesting numbers we could possibly have is the date of death. It would revolutionise retirement planning and destroy insurance planning. Instead we have to live with uncertainty. Most people seem to get along okay knowing this. But they still form a view about how long they may expect to live, and that shapes their view about how bad things would be if they died much earlier. For example: in 1800 few adult men could expect to live much past 50 years – even having navigated the dangerous years of early childhood successfully. It was a tough market for life insurance, and most people relied on family and church to cushion the blows of fate. On the other hand, today, most people expect to live well into retirement, so early death would represent a major blow to their expected fortunes. They are – relatively – keen to agree that they should buy a little insurance cover.

How has Covid-19 affected the rate at which people die in New Zealand? It’s complicated, it’s a story that is still unfolding and death rates have, briefly, became very political.

First, a baseline. A few months ago, Statistics New Zealand released new period life tables. Based on death rates in New Zealand for 2017-19 they found the following data. Life expectancy at birth is 80.0 years for males and 83.5 years for females. Life expectancy at age 65 is 19.5 years for males and 21.7 years for females. Life expectancy at all ages reduced very slightly from 2016-18 (allowing for revised population estimates). Life expectancy at birth has increased by about six months for males and four months for females since 2012-14 (see New Zealand period life tables: 2012-14).

More detail will be made available later this year. A brief explanation of how these numbers work: period life expectancy is the average length of life remaining at a given age, assuming people experience the age-specific death rates of a specific period from the given age onwards. For example, life expectancies for the period 2017-19 are based on death rates for that period and take no account of changes in death rates after 2017-19. As a result, if death rates continue to decline, the period life expectancies will underestimate actual life spans. Or put another way, we have become used to the idea that life expectancy tends to improve over time – so this is not an idle caution. Although this need not necessarily be so. Big public health crises can make a difference. In some parts of the US the life expectancy of some groups is worsening considerably – a major factor is rising deaths due to drug overdoses. In Russia, life expectancy has been falling for some time.

Public health experts were very, very worried that we could experience thousands, or even tens of thousands of deaths from Covid-19. We were very fortunate that the first cases took as long to get here as they did. It meant that we had some data from China, and perhaps more importantly, South Korea and Taiwan, to help get our heads around what might happen. Although some people point out that if we closed our border sooner, we could have avoided some of the economic pain of the lockdown, it cannot really be disputed that the lockdown has done a very effective job of controlling Covid-19. We are now in the happy position that,

“Most people expect to live well into retirement, so early death would represent a major blow to their expected fortunes.”

“Public health experts were very, very worried that we could experience thousands, or even tens of thousands of deaths from Covid-19.”

as I write, tens of thousands of people were able to gather again to watch sport.

During the height of the lockdown even as we saw our numbers fall we saw the numbers rise dramatically in the UK and in New York. Some people literally could not believe the numbers and thought that deaths from other causes were being counted as Covid-19. But good data is kept on the number of deaths in both the UK and the US and what we saw was, if anything, that the number of Covid-19 deaths explained only about half to two thirds of excess mortality that was being seen over the average of previous years. So, in line with Covid-19 infections there were more deaths.

Some may have been Covid-19 and were not counted (because they got counted as a heart attack, say), while some others may have been additional heart attacks that would have survived, but they were not seeking treatment soon enough due to concerns about health services, or catching Covid-19. That led to some speculation that lockdown itself may be causing some of the excess deaths seen as not as many people were using health services as would be expected. That theme was explored by the The Economist1 in the UK where there was some evidence to suggest that it was a contributing factor to their excess mortality.

In our own local version, because lockdown was successfully controlling Covid-19, some people thought that the lockdown could also be causing deaths, and were so keen to prove that, they didn’t wait for the actual data to come out. Rumours circulated on Twitter raising the spectre of a sharp rise in suicide deaths. That was quickly contradicted by the Ministry of Health, and subsequently by the Chief Coroner2 . Farah Hancock of Newsroom did some great data-based journalism and could not find any excess mortality here3 , although in non-age standardised review there were 129 more deaths at the point of their analysis than there were in the same period in 2019. Since then I have had one of my staff produce an age and population standardised review of mortality (and we had a few weeks of additional data) and now deaths are running at below trend for last year – about 400 less when controlling for those other factors. You might expect that to be the case: after all, seasonal influenza has reduced almost to zero, as well as road traffic reductions reducing the road toll, and with noone on construction sites or adventure tourism sites for a while workplace accidents fell as well.

There is still time for knock-on effects to be felt – delays to some treatments, and the economic pain that will be felt for at least the next couple of years, will have an effect. We hope, and we will work to avoid that effect, but as insurers must make estimates of claims, we also have to be realistic. You can do your bit to try and help too. Here is a list of services to which you can refer people if you believe that they need to talk. A

Russell Hutchinson is director of Chatswood Consulting and Quality Product Research, which operates Quotemonster. 1737, Need to talk?

Free call or text 1737 to talk to a trained counsellor

Depression.org.nz

0800 111 757 or text 4202

Lifeline

0800 543 354

Suicide Crisis Helpline

0508 828 865 (0508 TAUTOKO)

Kidsline

0800 54 37 54 for people up to 18 years old – open 24/7

Youthline

0800 376 633, free text 234, email talk@youthline.co.nz, web chat and other support options at youthline.co.nz

Rural Support Trust

0800 787 254

Samaritans

0800 726 666

What's Up

0800 942 8787 (for 5-18 year olds). Phone counselling available Monday-Friday, noon-11pm – and weekends, 3pm-11pm. Online chat is available 3pm-10pm daily.

thelowdown.co.nz

Web chat, email chat or free text 5626

Anxiety New Zealand

0800 ANXIETY (0800 269 4389)

Supporting Families in Mental Illness

0800 732 825.

In a life-threatening situation call 111.

1 https://www.economist.com/graphic-detail/2020/04/16/tracking-covid-19-excess-deaths-across-countries 2 https://www.stuff.co.nz/national/health/coronavirus/121556568/chief-coroner-opposes-rumours-suicide-rate-increased-during-covid19-lockdown 3 https://www.newsroom.co.nz/2020/05/05/1157173/are-there-hidden-covid-19-deaths-in-nzs-statistics