It is now widely accepted that COVID-19 (Coronavirus Disease 2019) will have a broad, lasting impact around the globe, and in the U.S. in particular. The magnitude of that impact is still unknown, but that there will be a measurable impact has become indisputable. The life settlements population represents a unique cohort of individuals who may experience greater vulnerability to COVID-19 than the broader U.S. public. This is the first in a series of blog posts written by Longevity Holdings’ Data Science Team[i] investigating the potential short- and long-term impact of COVID-19 within the life settlements population.
In this post, we will be focusing on the disparate COVID-19 mortality outcomes by age. The life settlements population skews significantly older, with a median age about 86.5 years old, and that may put this cohort at greater risk than the broader U.S. public. We used the ITM TwentyFirst and Fasano Associates datasets of life settlement lives, along with publicly available data on the U.S. population, to estimate the difference in mortality risk within life settlements compared to the general U.S. population.
Figure 1. Age Distribution of U.S. Population vs. Life Settlements
Sources: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2018 ITM TwentyFirst and Fasano Associates Life Settlements Datasets
A recent study conducted by the CDC COVID-19 Response Team[ii] looked at 2,449 cases of COVID-19 in the United States between February 12 and March 16. The study was limited by incomplete data, so the authors estimated a lower bound on case-fatality by the percentage of deaths among all cases and they estimated an upper bound by the percentage of deaths among cases with known outcomes. They found the mortality risk for patients over 85 was 100 times greater than for patients between 20 and 44 years. This result aligns with an earlier result from a study out of China that found the mortality risk of patients 80 years and older was 74 times that of patients between 10 and 39 years[iii].
Figure 2. Comparison of Population to Estimated Case-Fatality Rate
Sources: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2018 ITM TwentyFirst and Fasano Associates Life Settlements Datasets CDC COVID-19 Response Team’s Report
The majority of the life settlements population falls within the highest risk cohort (85+) of the CDC study, suggesting the settlements population is highly vulnerable to the disease. The age-weighted case-fatality rate for the U.S. population using the lower bound CDC estimate is 0.92%. For life settlements, the age-weighted rate is 7.93%, 8.6 times greater than the broader U.S. population. Using the upper bound CDC estimate, the age-weighted rate is 1.96% for the U.S. population and 20.48% for life settlements, a 10.5 multiple increase.
This simple analysis estimates a mortality rate within life settlements 9-10 times that of the greater U.S. population. If the conclusion holds, and if the U.S. experiences 1 death per 10,000 individuals (32,300 total deaths), life settlements might experience 1 death in 1,000. If 1 in 1,500 Americans die from COVID-19 (215,000 total deaths, in-line with some current estimates), 1 in 150 settlement insureds could die. If one million Americans die, 3% of the life settlements population could die. For comparison, the annualized mortality rate of life settlements from 2017 through 2019 was 6%. Therefore, the middle case of 1 settlement death per 150 lives would correspond to an 11% increase in mortalities.
We are not here estimating the net impact on the American population, only the potential relative impact on the life settlements population. At the time of this writing, 3,400 American deaths are credited to COVID-19, and Dr. Anthony Fauci, one of the leading experts on the White House’s coronavirus task force, recently estimated 100,000 to 200,000 American deaths might occur from COVID-19, quickly adding “I don’t want to be held to that” because “it is such a moving target that you could so easily be wrong.”[iv]
Some cautions of our analysis are warranted. First, the CDC study did not offer more granularity on age-based risk above age 85. The median life settlements age within that cohort was 89.6. Our data source did not include data on the distribution of ages within that cohort of the U.S. population. Second, some evidence suggests males have a greater COVID-19 mortality risk than females. For example, the Chinese Center for Disease Control study found a case-fatality rate among females of 1.7% and among males of 2.8%, a 65% increase. Males are over-represented in life settlements. Third, life settlements represents a different profile of comorbidities than the broader U.S. For example, fewer life settlements individuals are smokers, a known comorbidity with COVID-19 – about 3% in life settlements compared to 8.4% of seniors nationwide[v]. Fourth, life settlements lives, being a wealthier population overall, may have access to better-than-average medical care and may be less at-risk to ventilator and ICU bed shortages – although this is speculative and may depend more on geography than wealth. We plan to look deeper into some of these other factors in future posts.
Using the latest CDC age-based case-fatality rates and cross-referencing with census and settlements population data, we estimated a 9- to 10-fold greater mortality rate within life settlements than among the broader American populace. Notwithstanding the limitations of this analysis, we believe settlements lives are particularly vulnerable to this disease and it will have a measurable impact within life settlements if the United States is unsuccessful in containing its spread or reducing its case-fatality rate.
[i] Longevity Holdings is the parent company of ITM21st and Fasano Associates.
[ii] CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease (COVID-19) – United States, February 12-March 16, 2020. Morbidity and Mortality Weekly Report.
[iii] The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) – China, 2020. Chinese Center for Disease Control and Prevention Weekly.