The First COVID Wave: Comparing Experiences of Adults Age 50 and Older in the U.S. and Europe

Abstract

• Issue: The first wave of COVID-19, from March to September 2020, had significant health, social, and financial consequences for older Americans and their European peers. Comparing their COVID-19 experiences is important for understanding the variable impacts of the pandemic.
• Goals: Analyze and compare how older adults, who are more vulnerable to the health consequences of COVID-19, were affected during the first wave of COVID-19. We examined how adults in 29 countries were affected by four adverse COVID-19 experiences: being infected with or hospitalized because of COVID-19; forgoing care; experiencing the death of a friend or relative from COVID-19; and losing a job.
• Methods: Responses to three representative and longitudinal household surveys, involving nearly 44,700 adults age 50 and older in the United States and 28 European countries, were analyzed for our assessment of impact: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the Survey of Health, Ageing, and Retirement in Europe (SHARE).
• Key Findings and Conclusion: During the first COVID-19 wave, older Americans were much more likely than their European peers to report at least one of the four adverse COVID-19 experiences we studied. These experiences could have lasting effects on older adults in the U.S.

Introduction

Three years after the COVID-19 pandemic began, the United States remains one of the hardest-hit countries, with more than 1 million confirmed coronavirus deaths, of which more than 91 percent involved people 50 years and older.¹ Beyond causing this enormous loss of life, the pandemic has had other significant adverse consequences, including hospitalizations, job loss, and delayed care for millions of Americans.

In this brief, we examine how U.S. adults age 50 and older fared during the first wave of the pandemic in the summer of 2020, compared with their peers in European countries. Using three different databases and questionnaires, we focused on four adverse experiences:

1. Being infected or hospitalized with COVID-19: This includes older adults who reported testing positive for COVID-19 or being hospitalized because of the coronavirus.² Even though these events may result in different health outcomes (e.g., those who are infected could be asymptomatic), we combined them to increase the sample size.
2. Forgoing care: This includes older adults who reported that they needed medical or dental care but delayed getting it or did not get it at all; asked for an appointment for medical treatment and did not get one; or had a hospital operation or treatment cancelled or were unable to see or talk to a general practitioner.
3. Having a friend or relative die from COVID-19: This includes older adults who reported experiencing the death of someone they knew or someone close to them, such as a friend or family member.
4. Losing employment: This includes older adults who reported that they stopped working entirely because of losing their job, being furloughed, quitting, or for another reason; or became unemployed, were laid off, or had to close their business because of the coronavirus.

Key Findings

After calculating the relative risk (odds ratios relative to the U.S.) and controlling for age, gender, education level,³ and self-assessed health, we found that older adults in the U.S. were significantly more likely to report having at least one adverse COVID-19 experience, compared with their peers in all European countries (Exhibit 1).⁴

Being Infected or Hospitalized with COVID-19

In our sample, very few people reported being infected or hospitalized with COVID-19 between March and September 2020 (Exhibit 2). More adults in the U.S. were infected or hospitalized compared with adults in Europe.

In part, the low numbers can be explained by the selected nature of the sample, which comprised people living at home and excluded nursing home residents and hospitalized individuals, as well as by the deaths of some people who had been infected or hospitalized. The shortage of COVID tests and the lack of public COVID-19 testing in several countries at the time may be additional factors. For instance, in Scandinavia, the United Kingdom, and Spain, only people who had symptoms and also met specific criteria were tested systematically.

Forgoing Care

Nearly one-third of Americans reported forgoing care — from delaying treatment to being unable to see a provider — during the first wave of the pandemic (Exhibit 3). The English, Lithuanians, and French followed with 19.3 percent, 12.2 percent, and 10.1 percent forgoing care, respectively. This result is consistent with percentages reported in 2021 by the Organisation for Economic Co-operation and Development (OECD).⁵

Experiencing the Death of a Friend or Relative

Experiencing the death of a friend or relative was also more prevalent in the U.S. than in other countries (Exhibit 4). Nearly one in five older Americans reported the death of a relative, followed by Belgium (11%) and Spain (9%).

Losing Employment

Compared with their European peers, older Americans suffered the most, with 13 percent reporting job loss during the first wave of the pandemic (Exhibit 5). In all other countries, fewer than 10 percent reported loss of employment.

Half of Older Americans Had at Least One Adverse COVID-19 Experience

Overall, half of older Americans reported at least one adverse COVID-19 experience during the first wave. After analyzing the raw probability of self-reported adverse COVID-19 experiences across countries, we found the share of older adults having at least one adverse COVID-19 experience was much lower in European countries, including in the United Kingdom (29%), Belgium (21%), and France (19%) (Exhibit 6).

Discussion

What are possible explanations for why older adults in the United States may have been more vulnerable early in the pandemic to adverse COVID-19 experiences compared with their European peers?

The pandemic was more intense in other countries than in the U.S. when the surveys were conducted during the first wave. On August 1, 2020, the U.S. ranked 6th for confirmed COVID-19 deaths per million (460) after Belgium (848), England (613), Spain (599), Italy (593) and Sweden (555).⁶ However, older adults in the U.S. were even more likely to report adverse COVID-19 experiences than their peers in these five countries with higher COVID-19 death rates.

U.S. public policies did not protect employment as well as policies in many European countries. Despite the Paycheck Protection Program established by the CARES Act, the U.S. had fewer policies incentivizing employers to keep their workers on the payroll.⁷ Temporary income supports in the U.S. were also of more limited duration compared to other developed countries. And, given the more severe short-term unemployment shock in the U.S., the nation’s comparatively weaker health care and unemployment insurance protections likely exacerbated the negative impact on families’ health and well-being.⁸

COVID-19 policies in the U.S. were not as stringent as those in many European countries. According to a stringency index based on school and workplace closures, stay-at-home orders, and other restrictions, the U.S. ranked 12th out of 29 countries.⁹ Looser public policies may have allowed the epidemic to spread in the U.S., which may explain why older Americans were more likely than older Europeans to have had at least one adverse COVID experience.

The U.S. health care system was less prepared to deliver care during the pandemic. Compared with many European countries, health system capacity and resources are more limited in the U.S. For instance, in 2020, the U.S. had about 2.8 hospital beds per 1,000 individuals, compared with 4.4 hospital beds per 1,000 individuals on average for OECD member countries. The number of physicians per 1,000 individuals is also less in the U.S. compared with OECD countries: 2.8 versus 4.4, respectively.¹⁰ Lack of universal health coverage in the U.S. also has contributed to unmet needs during the pandemic; 9.4 percent of adults ages 46 to 64 were uninsured in 2021, an exception among high-income countries.¹¹

Conclusion

The four adverse COVID-19 experiences we examined in our study may contribute to a decline in the physical and mental health of older adults in the United States. Studies have shown that unemployment is associated with poorer health status, higher mortality, and higher health costs.¹² Testing positive (with symptoms) or being hospitalized for COVID-19 may result in long-lasting disease symptoms.¹³ Experiencing the death of a loved one can alter mental health status.¹⁴ And having to forgo needed care can lead to negative health outcomes that negatively impact quality of life.¹⁵

It will be crucial to monitor these effects to understand the long-term impacts of adverse COVID-19 experiences on older adults in the U.S. Doing so may help policymakers in the U.S. and elsewhere better prepare for the next pandemic.