Excess Mortality and Life Expectancy in Israel in 2020

Since the outbreak of the Covid-19 pandemic, public discourse has centered around the question of Covid-related excess mortality. It is clear that the Covid pandemic has increased mortality in Israel; the full extent of this, though, needs to be understood in order to evaluate how well the system has handled the epidemic. This study examines excess mortality in Israel over the course of 2020, mortality according to age group, and the effect of excess mortality in Israel in 2020 on life expectancy.

It should be noted that identifying Covid-related mortality is a fairly challenging task, since it is difficult to know whether the virus was the main cause of death, a contributing factor or a background characteristic, and whether the patient was near death or whether he would have lived for many more years if not for Covid. Another challenge is to differentiate between the direct effects of the virus on mortality and its indirect effects, such as the shifting of healthcare system resources to dealing with the pandemic at the expense of treating and preventing other medical situations.

Findings of the research on excess mortality and life expectancy in Israel in 2020

Mortality rates in Israel in 2020

• In the initial months of 2020, mortality rates in Israel were lower than they ever were – less than 11 cases of death per 100,000 population per week, a decline of 7% relative to the same period between 2017 and 2019.
• The effect of Covid-19 on mortality rates began to be felt at the end of March 2020 and even more so from early July until late September.
• Between the pandemic waves, mortality rates fell to lower levels than those observed between 2017 and 2019.

The effects of Covid on excess morality according to age profile

In view of the large variation in the mortality risk across age groups, it is clear that nationwide differences in the effect of Covid on mortality are almost exclusively a function of the ability to maintain a low level of infection, particularly among the elderly.

• Throughout the pandemic (in 2020), confirmed cases in Israel were disproportionately concentrated among the 20–55 age group, with higher representation in particular among individuals in their 20s.
• The pattern of change in mortality rates among the younger age groups supports claims of a continuing downward trend in overall (all-cause) mortality rates in the population as a whole: among the 0–19 age group mortality in 2020 was 23% lower than between 2017 and 2019, and among the 20–29 age group it was lower by about 4%.
• In the first wave of high mortality rates, the rate of confirmed patients among the 80+ age group was about 40% higher than their share of the population. By September, the number of infections in this group dropped to about 60% of its share in the population; in October it again shot up temporarily; and in the final months of the year, there was again a drop. This trend could also be seen in the second highest risk group, i.e., individuals aged 60+.
• These trends point to the partial success of the healthcare system in Israel in protecting the elderly against infection. However, the low rates of mortality are to a large extent also a result of the difference between the age pattern of infection in Israel and the age profile of the population. If the rates of infection had been in line with Israel’s age profile, then there would have been 31% more deaths. If the infection rates had been in line with the age profile in the OECD countries, the number of deaths would have been double.

Effect on life expectancy

• The excess mortality in 2020 led to a drop of 2.2 months in life expectancy at birth and of 2.6–2.9 months in life expectancy at the age of 65.
• Taking into account the rate of population growth in Israel, the wave of mortality during the Covid-19 pandemic increased the number of deaths by about 7%. However, if the expected reduction in mortality in the absence of Covid is also considered, the pandemic increased the death rate by about 10%. This constitutes a significant increase, although it is less than in other countries.
• The data indicate that about one-half of the infections among the 65+ age group up to mid-October 2020 were among the Haredi (ultra-Orthodox Jewish) population. Among this group, Covid-related mortality rates are 4 times greater than this group’s share in the overall population. Therefore, the drop in life expectancy in 2020 was concentrated disproportionately in Haredi areas.
• Excess mortality was also higher among the Arab population in Israel most likely due to high rates of pre-existing conditions, particularly diabetes, which raises the likelihood of death from Covid considerably.