2.1. Overview

The proposed model comprises three parameter levels. The first-level parameters capture the long-term pattern of mortality and include the age, period, and cohort components that are also seen in many existing stochastic mortality models including the Lee-Carter model (Lee & Carter, Reference Lee and Carter1992) and the Cairns-Blake-Dowd model (Cairns et al. Reference Cairns, Blake and Dowd2006). The first-level parameters are informed by historical mortality data, capturing the dynamics of mortality in the absence of a pandemic like COVID. The second-level parameters gauge the short-term age-specific excess mortality caused by COVID and are calibrated using external forecasts of COVID deaths made in infectious disease studies. Since external forecasts utilise the most recent development of the disease, the second-level parameters update the mortality model with the newest information. The third-level parameters draw on expert opinions concerning the long-term impact of COVID, including experts’ views on how the excess mortality due to COVID may reduce over time, whether COVID will induce positive long-term impact on the society, and how likely a COVID-alike pandemic will occur in the future.

The proposed model, developed for use amid a pandemic, aims at updating mortality models with the newest development in infectious disease studies and enabling users to incorporate the short-term and long-term impact of COVID-alike events into their mortality scenarios. It can also be used post-pandemic, when calibrated to the realised excess mortality. In this paper, we illustrate the proposed model under the assumption that the pandemic is still unfolding and there is significant uncertainty associated with the pandemic impact.

2.2. The long-term mortality pattern without the impact of COVID

We decompose the long-term mortality pattern into age and period effects in the same way as the Lee-Carter model. Historical mortality data in the sample age range of $[x_0,x_1]$ and the sample period of $[t_0,t_1]$ are used to estimate the Lee-Carter components. Let $D_{x,t}$ , $E_{x,t}$ , and $m_{x,t}$ be the number of deaths, the number of exposures-at-risk, and the central death rate at age x in year t, respectively. We assume that $D_{x,t}$ follows a Poisson distribution with a mean of $E_{x,t}m_{x,t}$ . The long-term pattern for $\ln m_{x,t}$ is expressed as follows:

\begin{equation*}a_x+b_xk_t\end{equation*}

where $a_x$ represents the average log mortality at age x, $k_t$ is the period effect driving long-term mortality improvements over time, and $b_x$ measures the sensitivity of the long-term mortality at age x to changes in $k_t$ . To stipulate parameter uniqueness, we impose the following identifiability constraints: $\sum_x b_x=1$ , and $k_{t_0}=0$ . Although other constraints for the period effects may be used, we choose $k_{t_0}=0$ to facilitate the one-stage PQL estimation method. This constraint is further discussed in section 4.3.

We assume that $\{k_t\}$ follows a random walk of drift:

\begin{equation*} k_t=k_{t-1}+\mu+\epsilon_{t} \end{equation*}

where $\mu$ is the drift and $\{\epsilon_{t}\}$ is a sequence of i.i.d. normal random variables with a mean of 0 and a standard deviation of $\sigma$ . Other processes such as autoregressive integrated moving average (ARIMA) can also be used if necessary.

The first parameter level contains all of the parameters that are related to long-term mortality dynamics, including $a_x$ , $b_x$ , $k_t$ , $\mu$ , and $\sigma$ . It should be noted that the first-level parameter level may be built on other models such as the Cairns-Blake-Dowd (CBD) model. We choose to use the Lee-Carter structure due to its simplicity.

2.3. Excess age-specific mortality due to COVID

Before the end of a pandemic, it is difficult to predict how long the excessive mortality caused by the pandemic will last. In an early study on COVID mortality, Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020) argued that COVID-related deaths will mostly occur in 2020 with a large peak if no measure is taken to suppress the transmission of the disease, but spread across two years with smaller peaks if suppression strategies are enforced. In this regard, we believe that it is important to allow for both single-year and multi-year impacts of COVID in the modelling work.

The impact of a pandemic on mortality depends heavily on age. Half of the deaths caused by the 1918 flu pandemic occurred among 20- to 40-year-olds, but older people are the most vulnerable to COVID as shown by various studies (Ferguson et al., Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020; O’Driscoll et al., Reference O’Driscoll, Ribeiro Dos Santos, Wang, Cummings, Azman, Paireau, Fontanet, Cauchemez and Salje2021). The dependence on age is taken into account in our modelling work through a set of age-specific parameters that are reserved for the excess mortality due to COVID.

Assume that the pandemic begins in year T and its impact on mortality lasts for n years. We extend the Lee-Carter structure to capture age-specific excess mortality caused by COVID as follows:

(1) \begin{equation} \ln m_{x,t}=a_x+b_xk_t+c_{x,t}\pi_t{\unicode[Times]{x1D7D9}}_{\{T\leq t\leq T+n\}}\end{equation}

where $\pi_t$ represents the overall severity of the pandemic in year t, and $c_{x,t}$ captures the age pattern of the pandemic impact in year t. The proposed model assumes that COVID increases central death rates by the multiplicative factor $e^{c_{x,t}\pi_t{\unicode[Times]{x1D7D9}}_{\{T\leq t\leq T+n\}}}$ . The assumption of a multiplicative impact of COVID on mortality is justified by the apparent proportional relationship between COVID mortality and non-COVID mortality at adult ages, as demonstrated by Cairns et al. (Reference Cairns, Blake, Kessler and Kessler2020). By letting $c_{x,t}$ depend on t, we allow the age pattern of the impact of COVID on mortality to change throughout the course of the pandemic. If the user expects that the age pattern should remain unchanged over time, then $c_{x,t}$ can be replaced by $c_x$ .

Theoretically, we can use $c_{x,t}$ instead of $c_{x,t}\pi_t$ to represent the age-specific excess mortality caused by COVID. We choose to use $c_{x,t}\pi_t$ since it shares a similar structure with the long-term mortality improvement term $b_xk_t$ and thus facilitates the comparison between the long-term mortality change and the pandemic impact. This multiplicative structure introduces an identification problem, because given a set of estimates $\hat{c}_{x,t}$ and $\hat{\pi}_t$ , we can construct another set of estimates $c^*_{x,t}=\hat{c}_{x,t}\times u$ and $\pi_t^*=\hat{\pi}_t/u$ , the product of which is $\hat{c}_{x,t}\hat{\pi}_t$ . To ensure parameter uniqueness, we impose three constraint $\sum_x b_x=1$ , $k_{t_0}=0$ , and $\sum_{x}c_{x,t}=1$ . Since $b_x$ and $c_{x,t}$ are subject to the same constraint, their estimated values are on the same scale. As a result, the estimate of $\pi_t$ is comparable to that of $k_t$ and provides a clear indication of the pandemic severity.

The second-level parameters include $c_{x,t}$ and $\pi_t$ . The value of these parameters is determined by considering external forecasts of excess deaths from infectious disease studies. Forecasts from infectious disease studies are often built on both data collected during the current pandemic and relevant past pandemic experiences. By estimating the second-level parameters using the external forecasts, we inform the model with the new development of the pandemic and also implicitly incorporate information learned from past experience.

2.4. Expert opinions on the long-term impact of COVID

The parameters in the third level gauge the long-term impacts of pandemics, which include the following: excess mortality over an extended period, potential positive impact due to behavioural changes and improved healthcare practice, and possible occurrence of pandemics similar to COVID in the future. Adding the third-level parameters, our proposed model becomes

\begin{eqnarray*}\ln m_{x,t}&=&a_x+b_xk_t+\sum_i \left(c_{x,t}^{(i)}\pi_t^{(i)}{\unicode[Times]{x1D7D9}}_{\{T_i\leq t\leq T_i+n_i\}})+d_{x,t}^{(i)}\psi_t^{(i)}{\unicode[Times]{x1D7D9}}_{\{t\geq T_i+1\}}\right)\end{eqnarray*}

where $T_i$ represents the arrival year of the ith pandemic, $n_i$ is the duration of excess mortality due to the ith pandemic, $c_{x,t}^{(i)}$ and $\pi_{t}^{(i)}$ capture the age pattern and size of the excess mortality due to the ith pandemic in year t, and $d_{x,t}^{(i)}$ and $\psi_t^{(i)}$ are the age pattern and size of the positive impact induced by the ith pandemic. We assume that the positive impact emerges one year after a pandemic occurs. If expert opinions suggest that the positive impact begins m years after, we can simply set $\psi_t^{(i)}$ to 0 for $T_i+1\leq t<T_i+m$ . To ensure parameter uniqueness, we impose the following constraints: $\sum_x b_x=1$ , $k_{t_0}=0$ , $\sum_{x}c^{(i)}_{x,t}=1$ , and $\sum_{x}d^{(i)}_{x,t}=1$ .

External forecasts of the impact of a pandemic typically focus on short-term excess mortality and are performed using infectious disease models. The long-term impact of the pandemic may not be effectively predicted in the same manner, for reasons including but not limited to virus mutations, policy changes, and medical breakthroughs. We therefore believe that it is more appropriate to estimate the third-level parameters using expert opinions instead of external forecasts.

Some believe that COVID will end with the rollout of the vaccine and the establishment of herd immunity, while others may think that the virus will never be completely eradicated but become a seasonal flu. We do not side with any opinion, but offer an approach to incorporate such opinions into the mortality model. To model how the excess mortality tapers off, we may use a power function or exponential function for $\pi_t$ . If the expert believes that the pandemic will become a seasonal flu over time, we may change $c_{x,t}^{(i)}$ to match the age pattern of excess mortality caused by a flu.

Noymer (Reference Noymer2011) reveals that the 1918 influenza pandemic reduced tuberculosis mortality and transmission since many with tuberculosis were killed in 1918. Cairns et al. (Reference Cairns, Blake, Kessler and Kessler2020) argue that COVID accelerates the death of the unhealthy and results in a modest increase of life expectancy among the survivors. While these positive impacts seem temporary, a pandemic may also lead to permanent improvements in mortality due to, for example, behavioural changes and improved health care. Medical research may also be accelerated due to additional investments triggered by the pandemic. We may let $\psi_t^{(i)}$ take a functional form to capture the variation of the positive impact of the ith pandemic over time. The function can be chosen on the basis of expert opinions.

We assume that the arrival of pandemics follows a Poisson process. Equivalently speaking, the interarrival time, i.e., the time between successive pandemics, is exponentially distributed. Assuming that pandemics occur once per $\lambda$ years on average, the mean interarrival time is $\lambda$ years and the exponential distribution has a parameter of $1/\lambda$ . The distribution of the interarrival time can be written as follows:

\begin{equation*}T_i-T_{i-1}\sim \text{Exponential}(1/\lambda)\end{equation*}

The value of $\lambda$ is not easy to determine as pandemics are of a low-frequency nature. We therefore choose $\lambda$ on the basis of expert opinions. Some scientists including Ross et al. (Reference Ross, Crowe and Tyndall2015) believe that the potential for diseases to spread and the risk of pandemics are increasing due to deepening globalisation and human impact on the environment. To accommodate such opinions, we can adopt a non-homogeneous Poisson process for the arrival of pandemics by letting $\lambda$ to be time-dependent.

4.1. Missing data and imputation

In the literature, parameters in the Lee-Carter model are often estimated by a two-stage procedure. In the first stage, parameters representing age and period effects are estimated by methods such as least squares or maximum likelihood. In the second stage, a time-series process is calibrated for the period effects. When applied to our proposed model, the procedure requires the total number of deaths, including both COVID and non-COVID deaths. While we have COVID death estimates from the three studies mentioned in section 3, the total number of non-COVID deaths is still unknown at the time of writing (when our proposed model is estimated). To address this problem, we use multiple imputation to obtain a set of non-COVID death estimates. This method incorporates the uncertainty arising from the missing data by considering a large number of plausible imputed data sets.

Assume that log central death rates in 2020 and onward when COVID is hypothetically absent can be expressed as follows:

\begin{equation*} \ln m_{x,t}=a_x+b_xk_t\end{equation*}

For simplicity, we assume that the number of deaths due to other causes is not affected by COVID. The following steps are taken to obtain multiple imputed values of $D_{x,t}$ for $t\geq 2020$ :

1. 1. Fit the original Lee-Carter model to the 1970–2019 mortality data and obtain estimates of $a_x$ , $b_x$ , and $k_t$ .

2. 2. Estimate a random walk with drift for $k_t$ .

3. 3. Simulate one path for $k_{t}$ , where $t=2020,2021,\ldots$ , using the estimated random walk with drift.

4. 4. Calculate the corresponding simulated path of $m_{x,t}$ , where $t=2020,2021,\ldots$ , using the relation $m_{x,t}=e^{a_x+b_xk_t}$ , the simulated path of $k_t$ , and the estimates of $a_x$ and $b_x$ .

5. 5. Calculate simulated values for $q_{x,t}$ , where $t=2020,2021,\ldots$ , using the approximation $q_{x,t}\approx 1-e^{m_{x,t}}$ .

6. 6. Given the simulated value of $q_{x,t}$ , simulate the number of non-COVID deaths for age x and year t, $d_{x,t}$ , by generating a random number from a binomial distribution with parameters $l_{x,t}$ and $q_{x,t}$ , where $l_{x,t}$ is the population size for age x at the beginning of year t. Then, calculate the population size at the beginning of the following year, using the relation $l_{x,t+1} = l_{x,t}-d_{x,t}$ .

7. 7. Repeat the previous step for year $t+1, t+2,\ldots$

8. 8. Calculate the imputed total number of deaths for each year t, where $t=2020,2021,\ldots$ , as the sum of the simulated number of non-COVID deaths and the number COVID deaths (obtained from one of the three mentioned external forecasts).

9. 9. To obtain N sets of imputed death counts, repeat Steps 3–8 N times.

For each set of imputed death counts, we estimate the first and second level of parameters in the mortality model. We will examine the variability of the estimated parameters arising from multiple imputation in section 4.

4.2. A two-stage maximum likelihood estimation method

We first attempt to estimate the model shown in (1) using a two-stage procedure. Assuming that $D_{x,t}$ follows Poisson distribution with a mean of $E_{x,t}m_{x,t}$ , the likelihood function can be expressed as

\begin{equation*} \prod_{t,x}\frac{(E_{x,t}m_{x,t})^{D_{x,t}}e^{-E_{x,t}m_{x,t}}}{D_{x,t}!}\propto e^{\sum_{t,x}[D_{x,t}\ln m_{x,t}-E_{x,t} m_{x,t}]}\end{equation*}

In the first stage, the estimates of $a_x$ , $b_x$ , $k_t$ , $c_{x,t}$ , and $\pi_t$ are obtained by maximising the loglikelihood function

(2) \begin{equation} ll=\sum_{t,x}[D_{x,t}\ln m_{x,t}-E_{x,t} m_{x,t}]\end{equation}

Details of this approach can be found in Brouhns et al. (Reference Brouhns, Denuit and Vermunt2002). In the second stage, we estimate a random walk with drift for $k_t$ .

We illustrate the estimation using the observed numbers of deaths and exposures-at-risk in 1970–2019 and a set of imputed numbers of deaths in 2020. Only the age range of 20–100 is considered in the estimation. The numbers of COVID deaths used in the imputation are based on the scenario with a 80% infection percentage in 2020 and the best IFR estimates from Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020). We assume that all COVID deaths occur in 2020. The number of exposures-at-risk in 2020, $E_{x,2020}$ , is approximated by $l_{x,2020}-0.5D_{x,2020}$ . The set of imputed numbers of non-COVID deaths and total number of deaths are shown in Figure 3.

Figure 3.

A set of imputed numbers of non-COVID deaths and total deaths in 2020 using a 80% infection percentage and the best IFR estimates from Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020).

Figure 4 presents two sets of parameter estimates obtained from the two-stage estimation procedure. The black lines represent the estimates of $a_x$ , $b_x$ , and $k_t$ in the original Lee-Carter model when the model is fitted the 1970–2019 mortality data. The black dots represent the estimates of $a_x$ , $b_x$ , $k_t$ , and $c_x$ in model (1) when the model is fitted to the 1970–2020 data, in which the age-specific death counts for 2020 are imputed.

Figure 4.

Estimates of $a_x$ , $b_x$ , $k_t,$ and $c_{x,2020}$ obtained from the two-stage estimation procedure.

Despite the differences in the estimates of $a_x$ , $b_x$ , and $k_t$ obtained from the two sets of data, the 2019 mortality rates implied by the two estimated models are very close to each other for all ages. However, the small difference in the slope of $k_t$ may lead to a large difference in predicted future mortality rates over the long run.

When fitting model (1) to the 1970–2020 data, the estimated series of $k_{t}$ dips at $t=2020$ . Since $k_t$ represents the mortality level in year t without the influence of the pandemic, we expect the series of $k_{t}$ to be relatively smooth and follow the downward trend observed in previous periods. The large dip in 2020 is due to the fact that there is no constraint in the optimisation to ensure that $k_{2020}$ would follow the typical pattern of $k_t$ and $c_{x,2020}\pi_{2020}$ would capture the pandemic impact. In particular, the impact of COVID on the 2020 mortality is split between two components, $b_xk_{2020}$ and $c_{x,2020}\pi_{2020}$ , both of which capture the interaction of age and period effects, in a way that maximises likelihood.

4.3. Penalised quasi-likelihood estimation

To address the erratic behaviour of $k_{2020}$ , we propose to use a single-stage estimation procedure which simultaneously estimates all first- and second-level parameters, including $\mu$ and $\sigma$ in the random walk with drift for $k_t$ . This procedure is developed to estimate parameters for generalised linear mixed models by Breslow & Clayton (Reference Breslow and Clayton1993). In fact, our model can be written in the form of a generalised linear mixed model (GLMM) with a Poisson distribution for the response variable and a logarithm link function. Although our model differs from a common GLMM in that we impose parameter constraints on both fixed and random effects, the single-stage estimation procedure can still apply.

Breslow & Clayton (Reference Breslow and Clayton1993) show that the approximation of the marginal quasi-likelihood using Laplace’s method leads to estimating a GLMM based on PQL for the mean parameters. The mean parameters in our model include $a_x$ , $b_x$ , $k_t$ , $\mu$ , $c_{x,t,}$ and $\pi_t$ . Since $k_{t_0}$ is constrained to 0, we do not need to estimate it. Let us denote $[k_{t_0+1},k_{t_0+2},\ldots,k_{t_1}]'$ by $\boldsymbol{k}$ . Assuming a random walk with drift for the series of $\{k_t\}$ , $\boldsymbol{k}$ simply follows a multivariate normal distribution with a mean vector $\boldsymbol{\mu}$ and a variance-covariance matrix $\boldsymbol{V}$ . It is easy to show that

\begin{eqnarray*}\boldsymbol{\mu}&=&[\mu,2\mu,\ldots,(t_1-t_0)\mu]', \mbox{ and}\\\boldsymbol{V}_{ij}&=&(\!\min\!(i,\;j)-1)\sigma^2\end{eqnarray*}

where $\boldsymbol{V}_{ij}$ is the (i, j)-th entry of $\boldsymbol{V}$ . The joint pdf of the vector $\boldsymbol{k}$ is denoted by $f(\boldsymbol{k})$ and can be expressed as

\begin{equation*}f(\boldsymbol{k})=2\pi^{-\frac{t_1-t_0}{2}}|\boldsymbol{V}|^{-\frac{1}{2}}e^{-\frac{1}{2}(\boldsymbol{k}-\boldsymbol{\mu})'\boldsymbol{V}^{-1}(\boldsymbol{k}-\boldsymbol{\mu})}\end{equation*}

where $|\boldsymbol{V}|$ is the determinant of the matrix $\boldsymbol{V}$ . The constraint $k_{t_0}=0$ not only ensures parameter uniqueness but also initialises the time-series of $k_t$ . Given $k_{t_0}=0$ , it is straightforward to calculate the joint pdf of $\boldsymbol{k}$ . Although setting $k_{t_1}=0$ or $\sum_t k_t=0$ would also lead to unique parameter estimates, the calculation of the joint pdf under such constraints is much more complex.

The integrated (quasi-) likelihood function of our model can be written as

\begin{eqnarray*}&&\int_{\boldsymbol{k}}\prod_{t,x}\frac{(E_{x,t}m_{x,t})^{D_{x,t}}e^{-E_{x,t}m_{x,t}}}{D_{x,t}!}f(\boldsymbol{k})d\boldsymbol{k}\\&\propto &|\boldsymbol{V}|^{-1/2}\int_{\boldsymbol{k}}e^{\sum_{x,t}[D_{x,t}\ln m_{x,t}-E_{x,t} m_{x,t}]-\frac{1}{2}(\boldsymbol{k}-\boldsymbol{\mu})'\boldsymbol{V}^{-1}(\boldsymbol{k}-\boldsymbol{\mu})}d\boldsymbol{k}\\&=&|\boldsymbol{V}|^{-1/2}\int_{\boldsymbol{k}}e^{-g(\boldsymbol{k})}d\boldsymbol{k}\end{eqnarray*}

where $-g(\boldsymbol{k})$ is the PQL function and

(3) \begin{eqnarray}-g(\boldsymbol{k})=\sum_{x,t}(D_{x,t}\ln m_{x,t}-E_{x,t} m_{x,t})-\frac{1}{2}(\boldsymbol{k}-\boldsymbol{\mu})'\boldsymbol{V}^{-1}(\boldsymbol{k}-\boldsymbol{\mu})\end{eqnarray}

When a Poisson distribution is used for the response variable, the quasi-likelihood is equivalent to the true likelihoodFootnote ¹ . The PQL differs from the loglikelihood functions shown in (2) only by the penalty term $-\frac{1}{2}(\boldsymbol{k}-\boldsymbol{\mu})'\boldsymbol{V}^{-1}(\boldsymbol{k}-\boldsymbol{\mu})$ .

Breslow & Clayton (Reference Breslow and Clayton1993) show that the estimates of the mean parameters in a GLMM can be obtained by maximising the PQL and the obtained estimates approximately maximise the integrated quasi-likelihood. With the mean parameters substituted by their estimated values, the variance parameter $\sigma$ can be obtained by maximising the approximate profile quasi-likelihood function which is expressed as follows:

\begin{eqnarray*}&&-\frac{1}{2}\ln|\boldsymbol{V}|-\frac{1}{2}\ln|g''(\tilde{\boldsymbol{k}})|-g(\tilde{\boldsymbol{k}})\end{eqnarray*}

where $\tilde{\boldsymbol{k}}$ is the estimated value of $\boldsymbol{k}$ . The following iterative procedure is taken to obtain the final estimates:

1. 1. Set initial values for $a_x$ , $b_x$ , $k_t$ , $c_{x,t}$ , $\pi_{t}$ , $\mu$ , and $\sigma$ .

2. 2. Estimate $a_x$ , $b_x$ , $k_t$ , $c_{x,t}$ , $\pi_{t}$ and $\mu$ by maximising the PQL. The optimum is obtained using an iterative Newton’s method with a tolerance level of 0.0001.

3. 3. Take a Newton step towards a new value of $\sigma$ with the objective of maximising the approximate profile quasi-likelihood function.

4. 4. Repeat steps 2 and 3 until the change of the profile likelihood is smaller than a tolerance value, which we set to 0.0001.

The iterative procedure is implemented with the authors’ own codes. Although the MASS (Venables & Ripley Reference Venables and Ripley2002) package can perform the PQL estimation for a GLMM, it cannot handle our parameter constraints and thus is not suitable for estimating the proposed model. The parameter estimates obtained from the two-stage procedure and the PQL method are compared in Figure 5. The estimated series of $k_t$ exhibits no visible dip in year 2020 when the PQL approach is used, suggesting that the one-stage estimation approach is capable of disentangling the impact of COVID and long-term mortality improvements. The two procedures lead to similar estimates for $a_x$ , $b_x$ , and $c_{x,2020}$ . However, the estimated value of $\pi_t$ obtained from the one-stage procedure is 45.62, while that obtained from the two-stage procedure is 60.74. Since $\pi_t$ represents the severity of the pandemic, the two-stage procedure seems to overestimate the impact of the pandemic and simultaneously underestimate the value of $k_t$ in 2020.

Figure 5.

Comparison between the estimates of $a_x$ , $b_x$ , $k_t,$ and $c_{x, 2020}$ obtained from the two-stage estimation method and the single-stage PQL approach.

We also observe from Figure 5 that the estimates of $c_{x,2020}$ do not always increase with age. Our model assumes a multiplicative impact of COVID on mortality. The multiplicative factor $e^{c_{x,t}\pi_{t}}$ is the ratio of the mortality rate with the impact of COVID to that without. Although both rates increase with age, the ratio of the two rates does not necessarily increase with age.

The PQL estimation procedure can also be used to calibrate the realised impact of COVID when the total number of deaths are fully observed. Its advantage of disentangling the impact of COVID and long-term mortality improvements remains in this situation.

The PQL method is similar to the penalised likelihood estimation approach proposed by Delwarde et al. (Reference Delwarde, Denuit and Eilers2007). Both approaches add a penalty term to the likelihood function shown in (2). Delwarde et al. (Reference Delwarde, Denuit and Eilers2007) achieve smoothed age-specific patterns $b_x$ at the expense of likelihood. The approach of Delwarde et al. (Reference Delwarde, Denuit and Eilers2007) has been applied to smooth other parameters, including $a_x$ and $k_t$ in mortality models by Li et al. (Reference Li, Zhou, Liu, Graziani, Hall, Haid, Peterson and Pinzur2020). Although we may use penalised likelihood estimation to smooth the estimates of $k_t$ and avoid the dip at $t=2020$ , the volatility of the estimated $k_t$ would be significantly reduced in this way. Consequently, future mortality scenarios simulated from the estimated model would understate the true volatility in mortality improvements as well as the longevity risk inherited in pension and annuity portfolios. In contrast, the PQL approach considers how closely the vector $\boldsymbol{k}$ follows a multivariate Gaussian distribution, so it preserves the variability in the estimated $k_t$ . The PQL approach is therefore more suitable for estimating our model, which is developed for users to gauge the range of possible mortality outcomes in the future.

We note that penalising the deviation from a multivariate normal distribution does not guarantee that the estimated $k_t$ follows a multivariate normal distribution. We may consider a stiffer penalty, $-\frac{1}{2}\rho(\boldsymbol{k}-\boldsymbol{\mu})'\boldsymbol{V}^{-1}(\boldsymbol{k}-\boldsymbol{\mu})$ , where $\rho$ is a tuning parameter and $\rho\geq 1$ . The estimated $k_t$ will be more likely to follow a multivariate normal distribution as $\rho$ increases. However, this comes at the cost of the goodness-of-fit and the theoretical foundation of the PQL approach. How to choose the tuning parameter is also a challenging question. Since $\rho=1$ works well for our dataset, we do not consider other values of $\rho$ .

McCulloch & Neuhaus (Reference McCulloch and Neuhaus2011) examine the estimation robustness to the assumed distribution for a random effect when using maximum likelihood methods for fitting a GLMM. They find that the empirical probability density of the estimated random effects can be quite sensitive to the assumed distribution. Since maximising PQL approximates maximising the true likelihood, we expect that the assumed distribution for $k_t$ will also have a significant impact on the distribution of the estimated $k_t$ . Therefore, it is important to assume a suitable distribution for $k_t$ .

Normal distribution is often assumed for the period effect $k_t$ in existing literature. To justify the normal assumption, we first fit a Lee-Carter model to the 1970–2019 mortality data with the two-stage estimation approach and then perform the Shapiro–Wilk normality test to the difference of the estimated $k_t$ . Since the estimation of $k_t$ with the two-stage approach does not require any distribution assumption for $k_t$ and no pandemic occurred during 1970–2019, the distribution of the estimated $k_t$ should be close to the true distribution of $k_t$ . The Shapiro–Wilk test returns a p-value of 0.44 which indicates that we cannot reject normality. Therefore, the normal assumption for $k_t$ seems reasonable.

Alternative to the PQL approach, we may consider a Bayesian approach and view the proposed model as a Bayesian hierarchical model. To implement the Bayesian estimation for our model, we should assume a normal prior for $k_t$ with parameters $\mu$ and $\sigma$ treated as hyperparameters. The hyperparameters are assumed to be random variables with their own prior distributions. Prior distributions are also required for $a_x$ , $b_x$ , and pandemic-related parameters. Inferences are then drawn from the derived posterior distributions. Since a posterior distribution is influenced by the assumed prior distribution to some extent, the normal prior plays a similar role with the penalty term in PQL in separating the changes in the long-term mortality improvement from the pandemic shock. A prior sensitivity analysis is necessary to examine the impact of the normal prior on the posterior. It would be interesting in the future research to carry out a Bayesian estimation of our model and compare the estimates obtained from the two approaches.

4.4. Combining estimates from multiple imputations

Using the multiple imputation procedure described earlier, we obtain 100 sets of imputed age-specific death counts in 2020. The variability of the imputed values arises from the randomness in $k_{2020}$ and $D_{x,2020}$ . To examine how imputation affects the estimated parameters, we repeat the one-stage estimation procedure for each set of imputed values and plot the estimated parameters in Figure 6.

Figure 6.

Estimates of $a_x$ , $b_x$ , $k_t$ , $c_{x,2020}$ , and $\pi_{2020}$ obtained using 100 sets of imputed non-COVID death counts in 2020.

Figure 6 shows that different sets of imputed values result in similar estimates of $a_x$ , $b_x$ , and $k_t$ . Therefore, the variability in the imputed values has a minimal impact on the estimates of the first-level parameters. However, the values of $c_{x, 2020}$ for young ages and very high ages somewhat vary across different sets of imputed values, because at these ages COVID-related deaths are small so that the impact of the COVID on mortality is more difficult to quantify.

The uncertainty arising from the imputation can be viewed as parameter risk. We can incorporate this piece of uncertainty into simulated future mortality paths by taking the following steps:

1. 1. Obtain a set of imputed non-COVID death counts.

2. 2. Estimate the mortality model based on the set of imputed values.

3. 3. Simulate 100 mortality paths using the estimated parameters in Step 2.

4. 4. Repeat steps 1–3 for 100 sets of imputed values.

We find that the randomness in simulated $k_t$ dominates the uncertainty in the simulated mortality paths. Incorporating the uncertainty from the imputed value in the simulation does not lead to any visible change in the resulting prediction intervals.

6.1. Infection percentage

The results presented in the previous sections are obtained using an assumed infection percentage of 80%. The infection percentage may change significantly, if different suppression strategies are adopted. As policy changes cannot be statistically modelled, we consider a number of possible infection percentages and examine the resulting parameter estimates for each. The specific choice of the assumed infection percentage is a subjective judgement, which may be informed by expert opinions.

The left panel of Figure 9 presents the estimates of $c_{x,2020}$ and $\pi_{2020}$ obtained using the best IFR estimates from Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020) and various assumed infection percentages. We observe that the estimates of $c_{x,2020}$ only change slightly as the assumed infection percentage increases. The right panel of Figure 9 plots the estimate of $\pi_{2020}$ against the assumed infection percentage. The estimate of $\pi_{2020}$ increases with the assumed infection percentage in a close to linear fashion. Similar observations can be made when considering IFR estimates from Centres for Disease Control and Prevention (2020) and O’Driscoll et al. (Reference O’Driscoll, Ribeiro Dos Santos, Wang, Cummings, Azman, Paireau, Fontanet, Cauchemez and Salje2021), as shown in Figures 10 and 11. These observations can be accounted for as follows. If the infection percentage increases while the age-specific IFRs remain unchanged, then the projected overall severity of the pandemic would increase but the distribution of the impact across ages would not be affected. As a consequence, parameter $\pi_{2020}$ , which measures the overall fatality level and infectiousness of COVID in 2020, increases with the assumed infection percentage, but the pattern of $c_{x,2020}$ , which can be viewed as the standardised age-specific pattern of the impact of COVID, remains largely unchanged.

Figure 9.

Estimates of $c_{x,2020}$ and $\pi_{2020}$ obtained using the best IFR estimates from Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020) and various assumed infection percentages.

Figure 10.

Estimates of $c_{x,2020}$ and $\pi_{2020}$ obtained using the best IFR estimates from the Centres for Disease Control and Prevention (2020) and various infection percentages.

Figure 11.

Estimates of $c_{x,2020}$ and $\pi_{2020}$ obtained using the best IFR estimates from O’Driscoll et al. (Reference O’Driscoll, Ribeiro Dos Santos, Wang, Cummings, Azman, Paireau, Fontanet, Cauchemez and Salje2021) and various infection percentages.

Figures 9, 10, and 11 also suggest a simple method to adjust the estimated model when the infection percentage changes while IFRs remain the same. Let us suppose that expert opinions suggest that the infection percentage would be reduced to 25% due to new restrictions. The new value of $\pi_{2020}$ can be approximated by a linear interpolation between the values of $\pi_{2020}$ corresponding to infection percentages of 20% and 30%. The approximation yields 18.50 as an estimate for $\pi_{2020}$ , while re-estimating the model completely produces an estimate of 18.58. The approximation method appears to be sufficiently accurate and may be used to save the computational burden of a complete re-estimation.

Although we assume in this paper that the infection percentage is age invariant, we are aware that researchers such as Davies et al. (Reference Davies, Klepac, Liu, Prem, Jit, Pearson, Quilty, Kucharski, Gibbs, Clifford, Gimma, van Zandvoort, Munday, Diamond, Edmunds, Houben, Hellewell, Russell, Abbott, Funk, Bosse, Sun, Flasche, Rosello, Jarvis, Eggo and Working Group2020) have demonstrated age-dependent effects in the transmission and control of COVID. Should age-specific infection percentages are available and used as an input of our proposed model, the dependence between age and infection percentage would be reflected in the series of $c_{x,t}$ .

6.2. Long-term impact of COVID

It is very challenging to predict the long-term impact of COVID due to the uncertainty concerning vaccination, virus mutation, and government policies. In what follows, we present three possible scenarios of the long-term impact of COVID, taking into account of a range of assumed expert opinions. In these scenarios, we assume that IFRs do not change over time but the infection rate decreases gradually. Each scenario is illustrated by a simulated path of $m_{70,t}$ for t beyond 2020. The model used in the simulation is estimated based on the best IFR estimates from Ferguson et al. (Reference Ferguson, Laydon, Nedjati-Gilani, Imai, Ainslie, Baguelin, Bhatia, Boonyasiri, Cucunubá, Cuomo-Dannenburg and Dighe2020) and a 40% infection rate in 2020.

Scenario 1: Excess mortality tapers off and mortality dynamics revert back to the long-term COVID-free trend

Let $F_t$ be the infection rate in year t. We use a function of time to describe the reduction in infection rate over time. A possible choice is a power function expressed as $F_t=F_{2020}\delta^{t-2020}$ , where $0<\delta<1$ . The value of $\pi_t$ for $t>2020$ can be approximated by the linear interpolation described in section 6.1. When such a power function is used, $F_t$ approaches to 0 as t increases, so that the impact of COVID will not completely disappear but will reduce to a negligible level.

In the top left panel of Figure 12, we show simulated paths of $m_{70,t}$ beyond $t = 2020$ , for different values of $\delta$ in the power function for $F_t$ . For comparison, we also plot a simulated path that is not subject to any COVID impact. As the value of $\delta$ increases, it takes longer for the mortality dynamics to revert to the long-term COVID-free trend. Using $\delta=0.1$ , reversion is almost complete in 4 years; but with $\delta$ set to 0.9, the impact of COVID is still visible in 30 years.

Figure 12.

Simulated paths of $m_{70,t}$ for 2021 and beyond in the three scenarios of long-term COVID impact under consideration.

Scenario 2: Excess mortality reduces for several years and then remains constant

In this scenario, the impact of COVID is long-lasting, but will become much lighter compared to the 2020 level due to, for example, vaccination. This scenario echoes the view of Oliver (Reference Oliver2020), who asserts that COVID may have long-term health effects that survivors may suffer from. Assuming that the excess mortality caused by COVID reduces for n years and then remains level, a suitable function for modelling the residual effect of COVID is $F_t=F_{2020}\delta^{\min(t-2020,n)}$ .

In the top right panel of Figure 12, we plot a simulated path of $m_{70,t}$ with $\delta=0.5$ and n set to various values. When n is set to 3, excess mortality ceases to reduce in year 3 and significant excess mortality remains afterwards. When n is raised to 5, the reduction in excess mortality lasts longer and the residual excess mortality after the cessation of reduction in year 6 is smaller.

Scenario 3: Excess mortality gradually reduces and a permanent downward shift in mortality occurs due to positive behavioural changes and improved healthcare practice

This scenario combines the wear-off of excess mortality and a permanent downward shift in mortality. The downward shift is represented by $d_{x,t}^{(i)}\psi_t^{(i)}{\unicode[Times]{x1D7D9}}_{\{t\geq T_i+1\}}$ in the mortality model. The positive impact may be driven by behavioural changes and changes in health care system (Edwards, Reference Edwards2020). The positive impact induced by COVID is very difficult to be modelled statistically, so expert opinions are sought to determine the relevant parameters.

We illustrate this scenario by assuming that expert opinions indicate a positive impact of COVID will begin from 2021 and will be uniform across all ages. Accordingly, we set $d_{x,t}^{(i)}\psi_t^{(i)}=-0.05$ and $\delta=0.5$ . A simulated path of $m_{70.t}$ obtained from this setting is shown in the bottom panel of Figure 12. We observe that the death rate reduces continuously and its trajectory becomes lower than the long-term COVID-free pattern in 4 years. The positive impact is permanent, affecting all death rates starting from 2021.

6.3. COVID-alike pandemics in the future

As pandemics are very rare events, a reliable statistical estimation of the expected inter-arrival time of pandemics is not possible. To illustrate the impact of possible COVID-alike pandemics in the future, let us suppose that expert opinions indicate that pandemics like COVID are 1-in-100-years events. Accordingly, we set $\lambda$ to $1/100$ .

Figure 13 presents a simulated path of $m_{70,t}$ , which is perturbed by not only COVID but also a COVID-alike pandemic that occurs in 2029. In the simulation, the wear-off parameter $\delta$ is set to $0.5$ . Although the same values of $c_{x,t}$ and $\pi_t$ are used for the 2020 and 2029 pandemics, the size of jump in $m_{70,t}$ is much lower for 2029 than 2020. This outcome is due to the fact that our model implies a multiplicative pandemic effect, as discussed in section 2.4. Specifically, our model implies that a mortality rate that incorporates pandemic impacts is the product of the corresponding mortality rate that is not subject to any pandemic impact and a multiplicative factor of $e^{c_{x,t}\pi_t}$ . As the pandemic-free mortality $m_{70,t}$ in 2029 is lower than that in 2020 due to long-term mortality improvements, the absolute value of excess mortality in 2029 is lower than that in 2020.

Figure 13.

A simulated path of $m_{70,t}$ beyond 2021, under the assumption that COVID-alike pandemics will occur at a rate of $\lambda = 1/100$ .

We further present the fanplot for 10,000 simulated paths of $m_{70,t}$ in Figure 14. The paths shown in the left panel incorporate the possibility that COVID-alike pandemics will occur in the future, while those shown in the right panel do not. The median, 80th percentile, and 90th percentile appear to be very similar between the two panels. However, the 95th and 99th percentiles in the left panel are very spiky due to the possible future pandemics. As the frequency of pandemics is very low, only the sample paths corresponding to the worst scenarios are affected.

Figure 14.

Simulated paths of $m_{70,t}$ under the assumptions that COVID-alike pandemics will occur (left panel) and will not occur (right panel) in the future.