{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T04:42:31Z","timestamp":1760416951354,"version":"build-2065373602"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed to verify the hypothesis that the improvement in the subjective assessment of population health in certain European countries after the COVID-19 pandemic was driven by the mortality of the majority of vulnerable citizens with the worst health status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We extended the trend of the share of the oldest age group and compared it with the observed fraction, thereby identifying the \u201cmissing population.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed a substantial deficit in the population of the oldest age group, especially in countries where people tend not to age well.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The temporary improvement in population health indicators, as measured by Healthy Life Years (HLY), during the pandemic in some countries was most likely an artifact resulting from the mortality of the majority of vulnerable individuals with poor health status. It is unlikely that this apparent improvement reflects healthier lifestyles or genuine gains in the efficiency or resilience of health systems during the pandemic. Therefore, the interpretation and use of HLY values from the COVID-19 period in Europe should be carefully reconsidered and further validated.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1592366","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T04:16:03Z","timestamp":1760415363000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The paradox of better population health after the pandemic: what is the cause?"],"prefix":"10.3389","volume":"13","author":[{"given":"Marek","family":"Biernacki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Ostasiewicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"ref1","first-page":"E64","article-title":"The Spanish influenza pandemic: a lesson from history 100 years after 1918","volume":"60","author":"Martini","year":"2019","journal-title":"J Prev Med Hyg"},{"key":"ref2","year":"2022"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1017\/S0022050722000407","article-title":"Pandemics depress the economy, public health interventions do not: evidence from the 1918 flu","author":"Correia","year":"2022","journal-title":"J Econ Hist"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e69336","DOI":"10.7554\/eLife.69336","article-title":"Tracking excess mortality across countries during the COVID-19 pandemic with the world mortality dataset","volume":"10","author":"Karlinsky","year":"2021","journal-title":"eLife"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.jinf.2020.09.012","article-title":"Excess mortality due to COVID-19 in Germany","volume":"81","author":"Stang","year":"2020","journal-title":"J Infect"},{"key":"ref6","volume-title":"Health at a galance 2021, OECD indicators","year":""},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/jmv.26587","article-title":"Long COVID and chronic COVID syndromes","volume":"93","author":"Halpin","year":"2021","journal-title":"J Med Virol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.dsx.2021.04.007","article-title":"Long COVID: an overview","volume":"15","author":"Raveendran","year":"2021","journal-title":"Diabetes Metab Syndr Clin Res Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"113426","DOI":"10.1016\/j.socscimed.2020.113426","article-title":"How and why patients made long covid","volume":"268","author":"Callard","year":"2021","journal-title":"Soc Sci Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"m3026","DOI":"10.1136\/bmj.m3026","article-title":"Management of post-acute covid-19 in primary care","volume":"370","author":"Greenhalgh","year":"2020","journal-title":"BMJ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"993","DOI":"10.15585\/mmwr.mm6930e1","article-title":"IVY network investigators; CDC COVID-19 response team; IVY network investigators. 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