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Based on the current understanding of the associations between school disruption and decreased educational attainment and between decreased educational attainment and lower life expectancy, is it possible to estimate the association between school closure during the coronavirus disease 2019 pandemic and decreased life expectancy of publicly educated primary school–aged children in the United States?
This decision analytical model found that missed instruction during 2020 could be associated with an estimated 13.8 (95% CI 2.5-42.1) million years of life lost based on data from US studies and an estimated 0.8 (95% CI 0.1-2.4) million years of life lost based on data from European studies. This estimated loss in life expectancy was likely to be greater than would have been observed if leaving primary schools open had led to an expansion of the first wave of the pandemic.
These findings suggest that the decision to close US public primary schools in the early months of 2020 may be associated with a decrease in life expectancy for US children.
United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption.
To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open.
Design, Setting, and Participants
This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Published peer-reviewed studies (2 US studies, 5 European studies) were identified that provided estimates of the relative risk (RR) of annual mortality related to educational attainment, which were weighted and applied to the most recent life table data to obtain YLL estimates across the life course. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated.
Main Outcomes and Measures
Years of life lost.
A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.15 (95% credible interval [CI], 0.08-0.22) years of final educational attainment for boys and 0.12 (95% CI, 0.06-0.19) years for girls. Summed across the population, based on the RR from US studies, an estimated 13.8 million (95% CI, 2.5-42.1) YLL may be associated with school closures. Summed across the population, based on the RR from the European studies, an estimated 0.8 million (95% CI, 0.1 -2.4) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, an estimated 4.4 million (95% CI 2.29-6.41,) YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both “schools open” and “schools closed” conditions, based on the US studies and the European studies, the analysis observed a 98.9% probability and a 26.3% probability, respectively, that school opening would have been associated with a lower total YLL than school closure.
Conclusions and Relevance
In this decision analytical model of years of life potentially lost under differing conditions of school closure, based on the US studies, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children’s health.
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Accepted for Publication: October 14, 2020.
Published: November 12, 2020. doi:10.1001/jamanetworkopen.2020.28786
Correction: This article was corrected on January 8, 2021, to fix computational errors and an incorrect analysis.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Christakis DA et al. JAMA Network Open.
Corresponding Author: Dimitri A. Christakis, MD, MPH, Department of Pediatrics, Seattle Children’s Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA 98101 (email@example.com).
Author Contributions: Dr Van Cleve had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Van Cleve, Zimmerman.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: All authors.
Administrative, technical, or material support: Christakis.
Supervision: Christakis, Zimmerman.
Conflict of Interest Disclosures: Dr Christakis reported serving as a member of the Children and Screens Advisory Board. No other disclosures were reported.
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