Unequal impact of the Covid-19 pandemic on excess deaths, life expectancy, and premature mortality across Spanish regions in 2020 and 2021

Spain is one of the most heavily affected countries by the Covid-19 pandemic. In this study, we estimated the regional inequalities in excess deaths and premature mortality in Spain. Between January 2020 and June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in the 17 Spanish regions with a substantial variability (highest in Madrid: 22,000, lowest in Canary Islands: -210). Highest reductions in life expectancy at birth ( e 0 ) in 2020 were observed in Madrid (men: -3.48 years, women: -2.15), Castile La Mancha (men: -2.67, women: -2.30), and Castile and León (men: -2.00, women: -1.32). In the first six months of 2021, the highest reduction in e 0 was observed in Valencian Community (men: -2.04, women: -1.63), Madrid (men: - 2.37), and Andalusia (men: -1.75; women: -1.43). In some Spanish regions, life expectancy at age 65 during the Covid-19 pandemic in 2020 was comparable to that observed as far back as 20 years ago.