Evaluating Premature Mortality in Bangladesh During the COVID-19 Pandemic: A Comparative Analysis of Absolute and Relative Measures.

The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted global mortality trends, affecting all age groups and leading to an increase in premature mortality. Accurately estimating premature mortality during such sudden epidemics is challenging, as different measures capture distinct aspects of mortality. Using period life tables from the 2024 World Population Prospects, this study assessed the impact of COVID-19 on premature mortality in Bangladesh during 2020 and 2021 using four complementary measures: potential years of life lost (PYLL) to quantify the absolute burden of premature deaths, period-expected years of life lost (PEYLL) to capture mortality exceeding expected levels, and two threshold ages based on lifespan disparity and life-table entropy to reflect shifts in lifespan distribution and inequality. Results showed most measures of premature mortality in Bangladesh showed a temporary decline in 2020, followed by a partial rebound in 2021. For both sexes, PYLL and the crude PYLL rate decreased in 2020 relative to 2019 but increased again in 2021, reflecting a renewed rise in premature mortality during the second pandemic year. Relative measures exhibited more nuanced patterns: The lifespan-disparity-based threshold age declined for both males and females, whereas the entropy-based threshold age decreased in 2020 for both sexes but slightly rebounded for males in 2021 and continued to decline for females, highlighting sex-specific shifts in the distribution of deaths across ages. These findings demonstrate that applying multiple metrics provides a more nuanced understanding of how the pandemic affected different sexes and age groups, critical insights for guiding public health planning and pandemic response strategies.