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Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, Novotney A, LeGrand KE, Xu YY, Dai X, Nicholson SI, Stafford LK, Carter A, Ross JM, Abbastabar H, Abdoun M, Abdulah DM, Aboagye RG, Abolhassani H, Abrha WA, Abubaker Ali H, Abu-Gharbieh E, Aburuz S, Addo IY, Adepoju AV, Adhikari K, Adnani QES, Adra S, Afework A, Aghamiri S, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed H, Ahmed M, Ahmed A, Akinosoglou K, AL-Ahdal TMA, Alam N, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Ali A, Ali EA, Ali L, Ali Z, Ali SSS, Allel K, Altaf A, Al-Tawfiq JA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amani R, Amusa GA, Amzat J, Andrews JR, Anil A, Anwer R, Aravkin AY, Areda D, Artamonov AA, Aruleba RT, Asemahagn MA, Atre SR, Aujayeb A, Azadi D, Azadnajafabad S, Azzam AY, Badar M, Badiye AD, Bagherieh S, Bahadorikhalili S, Baig AA, Banach M, Banik B, Bardhan M, Barqawi HJ, Basharat Z, Baskaran P, Basu S, Beiranvand M, Belete MA, Belew MA, Belgaumi UI, Beloukas A, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhargava A, Bhat V, Bhatti JS, Bhatti GK, Bikbov B, Bitra VR, Bjegovic-Mikanovic V, Buonsenso D, Burkart K, Bustanji Y, Butt ZA, Camargos P, Cao Y, Carr S, Carvalho F, Cegolon L, Cenderadewi M, Cevik M, Chahine Y, Chattu VK, Ching PR, Chopra H, Chung E, Claassens MM, Coberly K, Cruz-Martins N, Dabo B, Dadana S, Dadras O, Darban I, Darega Gela J, Darwesh AM, Dashti M, Demessa BH, Demisse B, Demissie S, Derese AMA, Deribe K, Desai HD, Devanbu VGC, Dhali A, Dhama K, Dhingra S, Do THP, Dongarwar D, Dsouza HL, Dube J, Dziedzic AM, Ed-Dra A, Efendi F, Effendi DE, Eftekharimehrabad A, Ekadinata N, Ekundayo TC, Elhadi M, Elilo LT, Emeto TI, Engelbert Bain L, Fagbamigbe AF, Fahim A, Feizkhah A, Fetensa G, Fischer F, Gaipov A, Gandhi AP, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebrekidan KG, Ghaffari K, Ghassemi F, Ghazy RM, Goodridge A, Goyal A, Guan SY, Gudeta MD, Guled RA, Gultom NB, Gupta VB, Gupta VK, Gupta S, Hagins H, Hailu SG, Hailu WB, Hamidi S, Hanif A, Harapan H, Hasan RS, Hassan S, Haubold J, Hezam K, Hong SH, Horita N, Hossain MB, Hosseinzadeh M, Hostiuc M, Hostiuc S, Huynh HH, Ibitoye SE, Ikuta KS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Ismail F, Jafarzadeh A, Jakovljevic M, Jalili M, Janodia MD, Jomehzadeh N, Jonas JB, Joseph N, Joshua CE, Kabir Z, Kamble BD, Kanchan T, Kandel H, Kanmodi KK, Kantar RS, Karaye IM, Karimi Behnagh A, Kassa GG, Kaur RJ, Kaur N, Khajuria H, Khamesipour F, Khan YH, Khan MN, Khan Suheb MZ, Khatab K, Khatami F, Kim MS, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krishan K, Kucuk Bicer B, Kuddus MA, Kulimbet M, Kumar N, Lal DK, Landires I, Latief K, Le TDT, Le TTT, Ledda C, Lee M, Lee SW, Lerango TL, Lim SS, Liu C, Liu X, Lopukhov PD, Luo H, Lv H, Mahajan PB, Mahboobipour AA, Majeed A, Malakan Rad E, Malhotra K, Malik MSA, Malinga LA, Mallhi TH, Manilal A, Martinez-Guerra BA, Martins-Melo FR, Marzo RR, Masoumi-Asl H, Mathur V, Maude RJ, Mehrotra R, Memish ZA, Mendoza W, Menezes RG, Merza MA, Mestrovic T, Mhlanga L, Misra S, Misra AK, Mithra P, Moazen B, Mohammed H, Mokdad AH, Monasta L, Moore CE, Mousavi P, Mulita F, Musaigwa F, Muthusamy R, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nair S, Nair TS, Natto ZS, Nayak BP, Negash H, Nguyen DH, Nguyen VT, Niazi RK, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Oancea B, Obamiro KO, Odetokun IA, Odo DBO, Odukoya OO, Oh IH, Okereke CO, Okonji OC, Oren E, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Parija PP, Parikh RR, Park S, Parthasarathi A, Patil S, Pawar S, Peng M, Pepito VCF, Peprah P, Perdigão J, Perico N, Pham HT, Postma MJ, Prabhu ARA, Prasad M, Prashant A, Prates EJS, Rahim F, Rahman M, Rahman MA, Rahmati M, Rajaa S, Ramasamy SK, Rao IR, Rao SJ, Rapaka D, Rashid AM, Ratan ZA, Ravikumar N, Rawaf S, Reddy MMRK, Redwan EMM, Remuzzi G, Reyes LF, Rezaei N, Rezaeian M, Rezahosseini O, Rodrigues M, Roy P, Ruela GDA, Sabour S, Saddik B, Saeed U, Safi SZ, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahiledengle B, Sahoo SS, Salam N, Salami AA, Saleem S, Saleh MA, Samadi Kafil H, Samadzadeh S, Samodra YL, Sanjeev RK, Saravanan A, Sawyer SM, Selvaraj S, Senapati S, Senthilkumaran S, Shah PA, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Sharath M, Sherchan SP, Shetty RS, Shirzad-Aski H, Shittu A, Siddig EE, Silva JP, Singh S, Singh P, Singh H, Singh JA, Siraj MS, Siswanto S, Solanki R, Solomon Y, Soriano JB, Sreeramareddy CT, Srivastava VK, Steiropoulos P, Swain CK, Tabuchi T, Tampa M, Tamuzi JJLL, Tat NY, Tavakoli Oliaee R, Teklay G, Tesfaye EG, Tessema B, Thangaraju P, Thapar R, Thum CCC, Ticoalu JHV, Tleyjeh IM, Tobe-Gai R, Toma TM, Tram KH, Udoakang AJ, Umar TP, Umeokonkwo CD, Vahabi SM, Vaithinathan AG, van Boven JFM, Varthya SB, Wang Z, Warsame MSA, Westerman R, Wonde TE, Yaghoubi S, Yi S, Yiğit V, Yon DK, Yonemoto N, Yu C, Zakham F, Zangiabadian M, Zeukeng F, Zhang H, Zhao Y, Zheng P, Zielińska M, Salomon JA, Reiner Jr RC, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. THE LANCET. INFECTIOUS DISEASES 2024; 24:698-725. [PMID: 38518787 PMCID: PMC11187709 DOI: 10.1016/s1473-3099(24)00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. METHODS We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. FINDINGS We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. INTERPRETATION Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. FUNDING Bill & Melinda Gates Foundation.
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Fess LJ, Fell A, O'Toole S, D'Heilly P, Holzbauer S, Kollmann L, Markelz A, Morris K, Ruhland A, Seys S, Schiffman E, Wienkes H, Zirnhelt Z, Meyer S, Como-Sabetti K. COVID-19 Death Determination Methods, Minnesota, USA, 2020-2022 1. Emerg Infect Dis 2024; 30:1352-1360. [PMID: 38916546 PMCID: PMC11210668 DOI: 10.3201/eid3007.231522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Accurate and timely mortality surveillance is crucial for elucidating risk factors, particularly for emerging diseases. We compared use of COVID-19 keywords on death certificates alone to identify COVID-19 deaths in Minnesota, USA, during 2020-2022, with use of a standardized mortality definition incorporating additional clinical data. For analyses, we used likelihood ratio χ2 and median 1-way tests. Death certificates alone identified 96% of COVID-19 deaths confirmed by the standardized definition and an additional 3% of deaths that had been classified as non-COVID-19 deaths by the standardized definition. Agreement between methods was >90% for most groups except children, although agreement among adults varied by demographics and location at death. Overall median time from death to filing of death certificate was 3 days; decedent characteristics and whether autopsy was performed varied. Death certificates are an efficient and timely source of COVID-19 mortality data when paired with SARS-CoV-2 testing data.
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Paganuzzi M, Nattino G, Ghilardi GI, Costantino G, Rossi C, Cortellaro F, Cosentini R, Paglia S, Migliori M, Mira A, Bertolini G. Assessing the heterogeneity of the impact of COVID-19 incidence on all-cause excess mortality among healthcare districts in Lombardy, Italy, to evaluate the local response to the pandemic: an ecological study. BMJ Open 2024; 14:e077476. [PMID: 38326265 PMCID: PMC10860029 DOI: 10.1136/bmjopen-2023-077476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The fragmentation of the response to the COVID-19 pandemic at national, regional and local levels is a possible source of variability in the impact of the pandemic on society. This study aims to assess how much of this variability affected the burden of COVID-19, measured in terms of all-cause 2020 excess mortality. DESIGN Ecological retrospective study. SETTING Lombardy region of Italy, 2015-2020. OUTCOME MEASURES We evaluated the relationship between the intensity of the epidemics and excess mortality, assessing the heterogeneity of this relationship across the 91 districts after adjusting for relevant confounders. RESULTS The epidemic intensity was quantified as the COVID-19 hospitalisations per 1000 inhabitants. Five confounders were identified through a directed acyclic graph: age distribution, population density, pro-capita gross domestic product, restriction policy and population mobility.Analyses were based on a negative binomial regression model with district-specific random effects. We found a strong, positive association between COVID-19 hospitalisations and 2020 excess mortality (p<0.001), estimating that an increase of one hospitalised COVID-19 patient per 1000 inhabitants resulted in a 15.5% increase in excess mortality. After adjusting for confounders, no district differed in terms of COVID-19-unrelated excess mortality from the average district. Minimal heterogeneity emerged in the district-specific relationships between COVID-19 hospitalisations and excess mortality (6 confidence intervals out of 91 did not cover the null value). CONCLUSIONS The homogeneous effect of the COVID-19 spread on the excess mortality in the Lombardy districts suggests that, despite the unprecedented conditions, the pandemic reactions did not result in health disparities in the region.
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Affiliation(s)
- Marco Paganuzzi
- University of Milan, Milan, Italy
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giulia Irene Ghilardi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giorgio Costantino
- University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | | | | | - Antonietta Mira
- Università della Svizzera italiana, Lugano, Switzerland
- University of Insubria, Varese, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
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Lugo O, Rivera R. A Closer Look at Indirect Causes of Death After Hurricane Maria Using a Semiparametric Model. Disaster Med Public Health Prep 2023; 17:e528. [PMID: 37970871 DOI: 10.1017/dmp.2023.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic as well as other recent natural emergencies have put the spotlight on emergency planning. One important aspect is that natural disasters or emergencies often lead to indirect deaths, and studying the behavior of indirect deaths during emergencies can guide emergency planning. While many studies have suggested many indirect deaths in Puerto Rico due to Hurricane Maria; the specific causes of these deaths have not been carefully studied. METHODS In this study, we use a semiparametric model and mortality data to evaluate cause of death trends. Our model adjusts for cause of death effect potentially varying over time while also inferring on how long excess deaths occurred. RESULTS From September 2017 to March 2018, after adjusting for intra-annual variability and population displacement, we find evidence of significant excess deaths due to Alzheimer's/Parkinson, heart disease, sepsis, diabetes, renal failure, and pneumonia and influenza. CONCLUSIONS In contrast, for the same time period we find no evidence of significant excess deaths due to cancer, hypertension, respiratory diseases, cerebrovascular disease, suicide, homicide, falling accidents, and traffic accidents.
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Affiliation(s)
- Oscar Lugo
- Department of Mathematical Sciences, University of Puerto Rico, Mayaguez, Puerto Rico
| | - Roberto Rivera
- Department of Mathematical Sciences, University of Puerto Rico, Mayaguez, Puerto Rico
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González-Leonardo M, Spijker J. The impact of Covid-19 on demographic components in Spain, 2020-31: A scenario approach. POPULATION STUDIES 2023; 77:497-513. [PMID: 36377742 DOI: 10.1080/00324728.2022.2138521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
While considerable attention has been paid to the impact of Covid-19 on mortality and fertility, few studies have attempted to evaluate the pandemic's effect on international migration. We analyse the impact of Covid-19 on births, deaths, and international migration in Spain during 2020, comparing observed data with estimated values assuming there had been no pandemic. We also assess the consequences of three post-pandemic scenarios on the size and structure of the population to 2031. Results show that in 2020, excess mortality equalled 16.2 per cent and births were 6.5 per cent lower than expected. Immigration was the most affected component, at 36.0 per cent lower than expected, while emigration was reduced by 23.8 per cent. If net migration values recover to pre-pandemic levels in 2022, the size and structure of the population in 2031 will be barely affected. Conversely, if levels do not recover until 2025, there will be important changes to Spain's age structure.
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Holleyman RJ, Barnard S, Bauer-Staeb C, Hughes A, Dunn S, Fox S, Newton JN, Fitzpatrick J, Waller Z, Deehan DJ, Charlett A, Gregson CL, Wilson R, Fryers P, Goldblatt P, Burton P. Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals. BMC Med Res Methodol 2023; 23:241. [PMID: 37853353 PMCID: PMC10585864 DOI: 10.1186/s12874-023-01984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Near-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed "harvesting" in the literature. METHODS We present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a "ball and urn" model. RESULTS Among the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy. CONCLUSION Our results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement - both in its length and prevalence - by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally.
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Affiliation(s)
- Richard James Holleyman
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK.
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Sharmani Barnard
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Clarissa Bauer-Staeb
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Andrew Hughes
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Samantha Dunn
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Sebastian Fox
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - John N Newton
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Justine Fitzpatrick
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Zachary Waller
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - David John Deehan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
| | - Andre Charlett
- UK Health Security Agency, Wellington House; 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU, UK
| | - Rebecca Wilson
- Department of Public Health, Policy and Systems, University of Liverpool Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK
| | - Paul Fryers
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Peter Goldblatt
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
- Department of Epidemiology & Public Health, UCL Institute of Health Equity, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Paul Burton
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
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Ferenci T. Comparing methods to predict baseline mortality for excess mortality calculations. BMC Med Res Methodol 2023; 23:239. [PMID: 37853374 PMCID: PMC10585880 DOI: 10.1186/s12874-023-02061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO)'s excess mortality estimates presented in May 2022 stirred controversy, due in part to the high estimate provided for Germany, which was later attributed to the spline model used. This paper aims to reproduce the problem using synthetic datasets, thus allowing the investigation of its sensitivity to parameters, both of the mortality curve and of the used method, thereby shedding light on the conditions that gave rise to this error and identifying possible remedies. METHODS A negative binomial model was used accounting for long-term change, seasonality, flu seasons, and heat waves. Simulated mortality curves from this model were then analysed using simple methods (mean, linear trend), the WHO method, and the method of Acosta and Irizarry. RESULTS The performance of the WHO's method with its original parametrization was indeed very poor, however it can be profoundly improved by a better choice of parameters. The Acosta-Irizarry method outperformed the WHO method despite being also based on splines, but it was also dependent on its parameters. Linear extrapolation could produce very good results, but was highly dependent on the choice of the starting year, while the average was the worst in almost all cases. CONCLUSIONS Splines are not inherently unsuitable for predicting baseline mortality, but caution should be taken. In particular, the results suggest that the key issue is that the splines should not be too flexible to avoid overfitting. Even after having investigated a limited number of scenarios, the results suggest that there is not a single method that outperforms the others in all situations. As the WHO method on the German data illustrates, whatever method is chosen, it remains important to visualize the data, the fit, and the predictions before trusting any result. It will be interesting to see whether further research including other scenarios will come to similar conclusions.
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Affiliation(s)
- Tamás Ferenci
- Physiological Controls Research Center, Obuda University, Budapest, Hungary.
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary.
- National Laboratory for Health Security, Budapest, Hungary.
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Chong KC, Chan PK, Hung CT, Wong CK, Xiong X, Wei Y, Zhao S, Guo Z, Wang H, Yam CH, Chow TY, Li C, Jiang X, Leung SY, Kwok KL, Yeoh EK, Li K. Changes in all-cause and cause-specific excess mortality before and after the Omicron outbreak of COVID-19 in Hong Kong. J Glob Health 2023; 13:06017. [PMID: 37114968 PMCID: PMC10143112 DOI: 10.7189/jogh.13.06017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background While coronavirus 2019 (COVID-19) deaths were generally underestimated in many countries, Hong Kong may show a different trend of excess mortality due to stringent measures, especially for deaths related to respiratory diseases. Nevertheless, the Omicron outbreak in Hong Kong evolved into a territory-wide transmission, similar to other settings such as Singapore, South Korea, and recently, mainland China. We hypothesized that the excess mortality would differ substantially before and after the Omicron outbreak. Methods We conducted a time-series analysis of daily deaths stratified by age, reported causes, and epidemic wave. We determined the excess mortality from the difference between observed and expected mortality from 23 January 2020 to 1 June 2022 by fitting mortality data from 2013 to 2019. Results During the early phase of the pandemic, the estimated excess mortality was -19.92 (95% confidence interval (CI) = -29.09, -10.75) and -115.57 (95% CI = -161.34, -69.79) per 100 000 population overall and for the elderly, respectively. However, the overall excess mortality rate was 234.08 (95% CI = 224.66, 243.50) per 100 000 population overall and as high as 928.09 (95% CI = 885.14, 971.04) per 100 000 population for the elderly during the Omicron epidemic. We generally observed negative excess mortality rates of non-COVID-19 respiratory diseases before and after the Omicron outbreak. In contrast, increases in excess mortality were generally reported in non-respiratory diseases after the Omicron outbreak. Conclusions Our results highlighted the averted mortality before 2022 among the elderly and patients with non-COVID-19 respiratory diseases, due to indirect benefits from stringent non-pharmaceutical interventions. The high excess mortality during the Omicron epidemic demonstrated a significant impact from the surge of COVID-19 infections in a SARS-CoV-2 infection-naive population, particularly evident in the elderly group.
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Affiliation(s)
- Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Paul Ks Chan
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chi Tim Hung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carlos Kh Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuchen Wei
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shi Zhao
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Zihao Guo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Huwen Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carrie Hk Yam
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tsz Yu Chow
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Conglu Li
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiaoting Jiang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shuk Yu Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - Ka Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - Eng Kiong Yeoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kehang Li
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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9
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Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain. Sci Rep 2023; 13:1634. [PMID: 36717651 PMCID: PMC9885064 DOI: 10.1038/s41598-023-28831-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
We assessed the impact of the first wave of COVID-19 pandemic on non-COVID hospital admissions, non-COVID mortality, factors associated with non-COVID mortality, and changes in the profile of non-COVID patients admitted to hospital. We used the Spanish Minimum Basic Data Set with diagnosis grouped according to the Diagnostic Related Groups. A total of 10,594 patients (3% COVID-19; 97% non-COVID) hospitalised during the first wave in 2020 (27-February/07-June) were compared with those hospitalised within the same dates of 2017-2019 (average annual admissions: 14,037). We found a decrease in non-COVID medical (22%) and surgical (33%) hospitalisations and a 25.7% increase in hospital mortality among non-COVID patients during the first pandemic wave compared to pre-pandemic years. During the officially declared sub-period of excess mortality in the area (17-March/20-April, in-hospital non-COVID mortality was even higher (58.7% higher than the pre-pandemic years). Non-COVID patients hospitalised during the first pandemic wave (compared to pre-pandemic years) were older, more frequently men, with longer hospital stay and increased disease severity. Hospitalisation during the first pandemic wave in 2020, compared to hospitalisation during the pre-pandemic years, was an independent risk factor for non-COVID mortality (HR 1.30, 95% CI 1.07-1.57, p = 0.008), reflecting the negative impact of the pandemic on hospitalised patients.
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10
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Yung J, Li J, Kehm RD, Cone JE, Parton H, Huynh M, Farfel MR. COVID-19-Specific Mortality among World Trade Center Health Registry Enrollees Who Resided in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14348. [PMID: 36361222 PMCID: PMC9654565 DOI: 10.3390/ijerph192114348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
We examined the all-cause and COVID-19-specific mortality among World Trade Center Health Registry (WTCHR) enrollees. We also examined the socioeconomic factors associated with COVID-19-specific death. Mortality data from the NYC Bureau of Vital Statistics between 2015-2020 were linked to the WTCHR. COVID-19-specific death was defined as having positive COVID-19 tests that match to a death certificate or COVID-19 mentioned on the death certificate via text searching. We conducted step change and pulse regression to assess excess deaths. Limiting to those who died in 2019 (n = 210) and 2020 (n = 286), we examined factors associated with COVID-19-specific deaths using multinomial logistic regression. Death rate among WTCHR enrollees increased during the pandemic (RR: 1.70, 95% CL: 1.25-2.32), driven by the pulse in March-April 2020 (RR: 3.38, 95% CL: 2.62-4.30). No significantly increased death rate was observed during May-December 2020. Being non-Hispanic Black and having at least one co-morbidity had a higher likelihood of COVID-19-associated mortality than being non-Hispanic White and not having any co-morbidity (AOR: 2.43, 95% CL: 1.23-4.77; AOR: 2.86, 95% CL: 1.19-6.88, respectively). The racial disparity in COVID-19-specific deaths attenuated after including neighborhood proportion of essential workers in the model (AOR:1.98, 95% CL: 0.98-4.01). Racial disparities continue to impact mortality by differential occupational exposure and structural inequality in neighborhood representation. The WTC-exposed population are no exception. Continued efforts to reduce transmission risk in communities of color is crucial for addressing health inequities.
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Affiliation(s)
- Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA
| | - Rebecca D. Kehm
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Diseases, New York, NY 11101, USA
| | - Mary Huynh
- New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics, New York, NY 10013, USA
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 11101, USA
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11
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Aizenman J, Cukierman A, Jinjarak Y, Nair-Desai S, Xin W. Gaps between official and excess Covid-19 mortality measures: The effects of institutional quality and vaccinations. ECONOMIC MODELLING 2022; 116:105990. [PMID: 36034169 PMCID: PMC9396456 DOI: 10.1016/j.econmod.2022.105990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/29/2022] [Accepted: 08/03/2022] [Indexed: 05/27/2023]
Abstract
We evaluate quartile rankings of countries during the Covid-19 pandemic using both official (confirmed) and excess mortality data. By December 2021, the quartile rankings of three-fifths of the countries differ when ranked by excess vs. official mortality. Countries that are 'doing substantially better' in the excess mortality are characterized by higher urban population shares; higher GDP/Capita; and higher scores on institutional and policy variables. We perform two regressions in which the ratio of Cumulative Excess to Official Covid-19 mortalities (E/O ratio) is regressed on covariates. In a narrow study, controlling for GDP/Capita and vaccination rates, by December 2021 the E/O ratio was smaller in countries with higher vaccination rates. In a broad study, adding institutional and policy variables, the E/O ratio was smaller in countries with higher degree of voice and accountability. The arrival of vaccines in 2021 and voice and accountability had a discernible association on the E/O ratio.
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Affiliation(s)
- Joshua Aizenman
- Economics and POIR, University of Southern California and NBER, Los Angeles, CA, 90089-0043, USA
| | - Alex Cukierman
- Tel-Aviv University School of Economics, Tel-Aviv, 69978, Israel
| | - Yothin Jinjarak
- ERCD and Asian Development Bank, 1550 Metro Manila, Mandaluyong City, Philippines
| | - Sameer Nair-Desai
- Stanford Institute for Economic and Policy Research and Meridian Collective, Palo Alto, CA, 94305, USA
| | - Weining Xin
- International Monetary Fund, 700 19th St NW, Washington, DC, 20431, USA
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12
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Maruotti A, Ciccozzi M, Jona-Lasinio G. COVID-19-induced excess mortality in Italy during the Omicron wave. IJID REGIONS 2022; 4:85-87. [PMID: 35822189 PMCID: PMC9263599 DOI: 10.1016/j.ijregi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
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13
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Zhang Y, Chang HH, Iuliano AD, Reed C. Application of Bayesian spatial-temporal models for estimating unrecognized COVID-19 deaths in the United States. SPATIAL STATISTICS 2022; 50:100584. [PMID: 35013705 PMCID: PMC8730676 DOI: 10.1016/j.spasta.2021.100584] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 05/10/2023]
Abstract
In the United States, COVID-19 has become a leading cause of death since 2020. However, the number of COVID-19 deaths reported from death certificates is likely to represent an underestimate of the total deaths related to SARS-CoV-2 infections. Estimating those deaths not captured through death certificates is important to understanding the full burden of COVID-19 on mortality. In this work, we explored enhancements to an existing approach by employing Bayesian hierarchical models to estimate unrecognized deaths attributed to COVID-19 using weekly state-level COVID-19 viral surveillance and mortality data in the United States from March 2020 to April 2021. We demonstrated our model using those aged ≥ 85 years who died. First, we used a spatial-temporal binomial regression model to estimate the percent of positive SARS-CoV-2 test results. A spatial-temporal negative-binomial model was then used to estimate unrecognized COVID-19 deaths by exploiting the spatial-temporal association between SARS-CoV-2 percent positive and all-cause mortality counts using an excess mortality approach. Computationally efficient Bayesian inference was accomplished via the Polya-Gamma representation of the binomial and negative-binomial models. Among those aged ≥ 85 years, we estimated 58,200 (95% CI: 51,300, 64,900) unrecognized COVID-19 deaths, which accounts for 26% (95% CI: 24%, 29%) of total COVID-19 deaths in this age group. Our modeling results suggest that COVID-19 mortality and the proportion of unrecognized deaths among deaths attributed to COVID-19 vary by time and across states.
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Affiliation(s)
- Yuzi Zhang
- Department of Biostatistics and Bioinformatics, The Rollins School of Public Health of Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, The Rollins School of Public Health of Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA
| | - A Danielle Iuliano
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Habibdoust A, Tatar M, Wilson FA. Estimating Excess Deaths by Race/Ethnicity in the State of California During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01349-9. [PMID: 35818019 PMCID: PMC9273689 DOI: 10.1007/s40615-022-01349-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Introduction To examine excess mortality among minorities in California during the COVID-19 pandemic. Methods Using seasonal autoregressive integrated moving average time series, we estimated counterfactual total deaths using historical data (2014–2019) of all-cause mortality by race/ethnicity. Estimates were compared to pandemic mortality trends (January 2020 to January 2021) to predict excess deaths during the pandemic for each race/ethnic group. Results Our findings show a significant disparity among minority excess deaths, including 7892 (24.6% increase), 4903 (20.4%), 30,186 (47.7%), and 22,027 (12.6%) excess deaths, including deaths identified as COVID-19-related, for Asian, Black, Hispanic, and White non-Hispanic individuals, respectively. Estimated increases in all-cause deaths excluding COVID-19 deaths were 1331, 1436, 3009, and 5194 for Asian, Black, Hispanic, and White non-Hispanic individuals, respectively. However, the rate of excess deaths excluding COVID-19 recorded deaths per 100 k was disproportionately high for Black (66 per 100 k) compared to White non-Hispanic (36 per 100 k). The rates for Asians and Hispanics were 23 and 19 per 100 k. Conclusions Our findings emphasize the importance of targeted policies for minority populations to lessen the disproportionate impact of COVID-19 on their communities.
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Affiliation(s)
- Amir Habibdoust
- Department of Economics and Accounting, University of Guilan, Persian Gulf Highway, Rasht, Iran.
| | - Moosa Tatar
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, 84108, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Economics, University of Utah, Salt Lake City, UT, USA
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15
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Infodemiological study on the impact of the COVID-19 pandemic on increased headache incidences at the world level. Sci Rep 2022; 12:10253. [PMID: 35715461 PMCID: PMC9205282 DOI: 10.1038/s41598-022-13663-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/17/2022] [Indexed: 12/21/2022] Open
Abstract
The analysis of the public interest as reflected by Internet queries has become a highly valuable tool in many fields. The Google Trends platform, providing timely and informative data, has become increasingly popular in health and medical studies. This study explores whether Internet search frequencies for the keyword “headache” have been increasing after the COVID-19 pandemic outbreak, which could signal an increased incidence of the health problem. Weekly search volume data for 5 years spanning February 2017 to February 2022 were sourced from Google Trends. Six statistical and machine-learning methods were implemented on training and testing sets via pre-set automated forecasting algorithms. Holt-Winters has been identified as overperforming in predicting web query trends through several accuracy measures and the DM test for forecasting superiority and has been employed for producing the baseline level in the estimation of excess query level over the first pandemic wave. Findings indicate that the COVID-19 pandemic resulted in an increased global incidence of headache (as proxied by related web queries) in the first 6 months after its outbreak, with an excess occurrence of 4.53% globally. However, the study also concludes that the increasing trend in headache incidence at the world level would have continued in the absence of the pandemic, but it has been accelerated by the pandemic event. Results further show mixed correlations at the country-level between COVID-19 infection rates and population web-search behavior, suggesting that the increased headache incidence is caused by pandemic-related factors (i.e. increased stress and mental health problems), rather than a direct effect of coronavirus infections. Other noteworthy findings entail that in the Philippines, the term "headache" was the most frequently searched term in the period spanning February 2020 to February 2022, indicating that headache occurrences are a significant aspect that defines population health at the country level. High relative interest is also detected in Kenya and South Africa after the pandemic outbreak. Additionally, research findings indicate that the relative interest has decreased in some countries (i.e. US, Canada, and Australia), whereas it has increased in others (i.e. India and Pakistan) after the pandemic outbreak. We conclude that observing Internet search habits can provide timely information for policymakers on collective health trends, as opposed to ex-post statistics, and can furthermore yield valuable information for the pain management drug market key players about aggregate consumer behavior.
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16
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Excess mortality associated with the COVID-19 pandemic in Latvia: a population-level analysis of all-cause and noncommunicable disease deaths in 2020. BMC Public Health 2022; 22:1109. [PMID: 35659648 PMCID: PMC9163859 DOI: 10.1186/s12889-022-13491-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/19/2022] [Indexed: 02/08/2023] Open
Abstract
Background Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases. Methods A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis. Results Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 – 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths. Conclusions All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13491-4.
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17
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Peretz C, Rotem N, Keinan-Boker L, Furshpan A, Green M, Bitan M, Steinberg DM. Excess mortality in Israel associated with COVID-19 in 2020-2021 by age group and with estimates based on daily mortality patterns in 2000-2019. Int J Epidemiol 2022; 51:727-736. [PMID: 35356971 PMCID: PMC8992356 DOI: 10.1093/ije/dyac047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background We aimed to build a basic daily mortality curve in Israel based on 20-year data accounting for long-term and annual trends, influenza-like illness (ILI) and climate factors among others, and to use the basic curve to estimate excess mortality during 65 weeks of the COVID-19 pandemic in 2020–2021 stratified by age groups. Methods Using daily mortality counts for the period 1 January 2000 to 31 December 2019, weekly ILI counts, daily climate and yearly population sizes, we fitted a quasi-Poisson model that included other temporal covariates (a smooth yearly trend, season, day of week) to define a basic mortality curve. Excess mortality was calculated as the difference between the observed and expected deaths on a weekly and periodic level. Analyses were stratified by age group. Results Between 23 March 2020 and 28 March 2021, a total of 51 361 deaths were reported in Israel, which was 12% higher than the expected number for the same period (expected 45 756 deaths; 95% prediction interval, 45 325–46 188; excess deaths, 5605). In the same period, the number of COVID-19 deaths was 6135 (12% of all observed deaths), 9.5% larger than the estimated excess mortality. Stratification by age group yielded a heterogeneous age-dependent pattern. Whereas in ages 90+ years (11% excess), 100% of excess mortality was attributed to COVID-19, in ages 70–79 years there was a greater excess (21%) with only 82% attributed to COVID-19. In ages 60–69 and 20–59 years, excess mortality was 14% and 10%, respectively, and the number of COVID-19 deaths was higher than the excess mortality. In ages 0–19 years, we found 19% fewer deaths than expected. Conclusion The findings of an age-dependent pattern of excess mortality may be related to indirect pathways in mortality risk, specifically in ages <80 years, and to the implementation of the lockdown policies, specifically in ages 0–19 years with lower deaths than expected.
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Affiliation(s)
- Chava Peretz
- Department of Epidemiology, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Naama Rotem
- Central Bureau of Statistics, Jerusalem, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel.,Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | | | - Manfred Green
- School of Public Health, University of Haifa, Haifa, Israel
| | - Michal Bitan
- Department of Statistics and Operations Research, School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
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18
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Gregory G, Zhu L, Hayen A, Bell KJL. Learning from the pandemic: mortality trends and seasonality of deaths in Australia in 2020. Int J Epidemiol 2022; 51:718-726. [PMID: 35288728 PMCID: PMC9189967 DOI: 10.1093/ije/dyac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
Aim To assess whether the observed numbers and seasonality of deaths in Australia during 2020 differed from expected trends based on 2015–19 data. Methods We used provisional death data from the Australian Bureau of Statistics, stratified by state, age, sex and cause of death. We compared 2020 deaths with 2015-19 deaths using interrupted time series adjusted for time trend and seasonality. We measured the following outcomes along with 95% confidence intervals: observed/expected deaths (rate ratio: RR), change in seasonal variation in mortality (amplitude ratio: AR) and change in week of peak seasonal mortality (phase difference: PD). Results Overall 4% fewer deaths from all causes were registered in Australia than expected in 2020 [RR 0·96 (0·95-0·98)] with reductions across states, ages and sex strata. There were fewer deaths from respiratory illness [RR 0·79 (0·76-0·83)] and dementia [RR 0·95 (0·93-0·98)] but more from diabetes [RR 1·08 (1·04-1·13)]. Seasonal variation was reduced for deaths overall [AR 0·94 (0·92-0·95)], and for deaths due to respiratory illnesses [AR 0·78 (0·74-0·83)], dementia [AR 0.92 (0.89-0.95)] and ischaemic heart disease [0.95 (0.90-0.97)]. Conclusions The observed reductions in respiratory and dementia deaths and the reduced seasonality in ischaemic heart disease deaths may reflect reductions in circulating respiratory (non-SARS-CoV-2) pathogens resulting from the public health measures taken in 2020. The observed increase in diabetes deaths is unexplained and merits further study.
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Affiliation(s)
- Gabriel Gregory
- School of Public Health, University of Sydney, Sydney, NSW, Australia and
| | - Lin Zhu
- School of Public Health, University of Sydney, Sydney, NSW, Australia and
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Katy J L Bell
- School of Public Health, University of Sydney, Sydney, NSW, Australia and
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19
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Modelli de Andrade LG, de Sandes-Freitas TV, Requião-Moura LR, Viana LA, Cristelli MP, Garcia VD, Alcântara ALC, Esmeraldo RDM, Abbud Filho M, Pacheco-Silva A, de Lima Carneiro ECR, Manfro RC, Costa KMAH, Simão DR, de Sousa MV, Santana VBBDM, Noronha IL, Romão EA, Zanocco JA, Arimatea GGQ, De Boni Monteiro de Carvalho D, Tedesco-Silva H, Medina-Pestana J. Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients. Am J Transplant 2022; 22:610-625. [PMID: 34416075 PMCID: PMC8441938 DOI: 10.1111/ajt.16807] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/25/2023]
Abstract
This analysis, using data from the Brazilian kidney transplant (KT) COVID-19 study, seeks to develop a prediction score to assist in COVID-19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28-day fatality after the COVID-19 diagnosis, assessed by the area under the ROC curve (AUC-ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28-day fatality rate was 17% (n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID-19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC-ROC of 0.767 (95% CI 0.698-0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non-hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776.
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Affiliation(s)
| | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil,Hospital Universitário Walter Cantídio, Fortaleza, Brazil,Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Lúcio R. Requião-Moura
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, Brazil,Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil,Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil,Correspondence Lúcio R. Requião-Moura, Nephrology Division – Department of Medicine, Federal University of São Paulo. Rua Botucatu, São Paulo – SP, Brazil.
| | - Laila Almeida Viana
- Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
| | | | | | | | | | - Mario Abbud Filho
- Hospital de Base, Medical School FAMERP, São José do Rio Preto, Brazil
| | | | | | - Roberto Ceratti Manfro
- Hospital de Clínicas de Porto Alegre, Federal Univertisy of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Marcos Vinicius de Sousa
- Division of Nephrology, School of Medical Sciences, Renal Transplant Unit, Renal Transplant Research Laboratoy, University of Campinas – UNICAMP, Campinas, Brazil
| | | | - Irene L. Noronha
- Hospital Beneficência Portuguesa de São Paulo (BP), São Paulo, Brazil
| | - Elen Almeida Romão
- Division of Nephrology, School of Medicine of Ribeirão Preto, University of Sao Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Helio Tedesco-Silva
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, Brazil,Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - José Medina-Pestana
- Department of Medicine, Nephrology Division, Federal University of São Paulo, São Paulo, Brazil,Department of Transplantation, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
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20
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Postill G, Murray R, Wilton AS, Wells RA, Sirbu R, Daley MJ, Rosella L. The use of cremation data for timely mortality surveillance: the example of the COVID-19 pandemic in Ontario, Canada. JMIR Public Health Surveill 2022; 8:e32426. [PMID: 35038302 PMCID: PMC8862761 DOI: 10.2196/32426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. Objective This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. Methods Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. Results Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. Conclusions The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.
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Affiliation(s)
- Gemma Postill
- Western University, London, CA.,Office of the Chief Coroner for Ontario, Toronto, CA.,Dalla Lana School of Public Health, 155 College Street, Suite 600, Toronto, CA
| | - Regan Murray
- Office of the Chief Coroner for Ontario, Toronto, CA.,Public Health Agency of Canada, Toronto, CA
| | | | | | - Renee Sirbu
- Office of the Chief Coroner for Ontario, Toronto, CA.,Dalla Lana School of Public Health, 155 College Street, Suite 600, Toronto, CA
| | | | - Laura Rosella
- Dalla Lana School of Public Health, 155 College Street, Suite 600, Toronto, CA.,ICES, Toronto, CA.,The Vector Institute for Artificial Intelligence, Toronto, CA.,Institute for Better Health, Trillium Health Partners, Mississauga, CA
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21
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Hong JJ, Hwang S, Moon DB, Kim YH, Shin S, Kim IO, Lee SR, Lee AY, Woo J. An analysis of the number of liver and kidney transplantations during COVID-19 pandemic in Korea. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:247-252. [PMID: 35769853 PMCID: PMC9235458 DOI: 10.4285/kjt.21.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
Background The severity of the coronavirus disease 2019 (COVID-19) pandemic has discouraged organ donation. However, the prevalence of COVID-19 in Korea was much lower in comparison to Western countries. With this, the authors decided to determine the real-world impact of COVID-19 on organ donation and transplantation in Korea. Methods The number of kidney transplantations (KTs) and liver transplantations (LTs) performed in 2020 were compared with those in 2019 using the Korean Network for Organ Sharing database and Asan Medical Center (AMC) database. Results The annual number of deceased donors (DDs) was 450 in 2019 compared to 478 in 2020. Monthly DD number was 37.5±5.9 in 2019 and 39.8±4.4 in 2020 (P=0.284). Annual number of DD kidney transplant (DDKT) was 794 in 2019 and 848 in 2020, and monthly number was 66.1±10.4 in 2019 and 70.7±9.8 in 2020 (P=0.285). The annual number of DDLT was 391 in 2019 and 395 in 2020, and the monthly number was 32.6±5.7, 2019 and 32.9±4.7 in 2020 (P=0.877). The annual number of living donor (LD) KT was 2,293 in 2019 and 1,432 in 2020, and the monthly number was 191.1±19.5 in 2019 and 119.3±11.7 in 2020 (P<0.001). Annual number of living donor LDLT was 1,577 in 2019 and 1,146 in 2020, and monthly number was 131.4±18.1 in 2019 and 95.5±8.0 in 2020 (P<0.001). In the AMC, not all types of KT and LT changed significantly. Conclusions The results of this study indicate that the number of DD organ transplantations remained stable in Korea in 2020, but the number of LD organ transplantations was significantly reduced. However, the number of organ transplantations did not change in the AMC.
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Affiliation(s)
- Jung-Ja Hong
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deog-Bok Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ok Kim
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Rom Lee
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah-Young Lee
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Woo
- Organ Transplantation Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Brandily P, Brébion C, Briole S, Khoury L. A poorly understood disease? The impact of COVID-19 on the income gradient in mortality over the course of the pandemic. EUROPEAN ECONOMIC REVIEW 2021; 140:103923. [PMID: 34629487 PMCID: PMC8492390 DOI: 10.1016/j.euroecorev.2021.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 05/12/2023]
Abstract
Mortality inequalities remain substantial in many countries, and large shocks such as pandemics could amplify them further. The unequal distribution of COVID-19 confirmed cases suggests that this is the case. Yet, evidence on the causal effect of the epidemic on mortality inequalities remains scarce. In this paper, we exploit exhaustive municipality-level data in France, one of the most severely hit country in the world, to identify a negative relationship between income and excess mortality within urban areas, that persists over COVID-19 waves. Over the year 2020, the poorest municipalities experienced a 30% higher increase in excess mortality. Our analyses can rule out an independent contribution of lockdown policies to this heterogeneous impact. Finally, we find evidence that both labor-market exposure and housing conditions are major determinants of the epidemic-induced effects of COVID-19 on mortality inequalities, but that their respective role depends on the state of the epidemic.
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Affiliation(s)
| | - Clément Brébion
- Copenhagen Business School, Denmark
- Centre d'Etudes de l'Emploi et du Travail, France
| | - Simon Briole
- Paris School of Economics, Chaire Travail & J-PAL Europe, France
| | - Laura Khoury
- Department of Economics, Norwegian School of Economics, Norway
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23
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Khader Y, Al Nsour M. Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis. JMIR Public Health Surveill 2021; 7:e32559. [PMID: 34617910 PMCID: PMC8500348 DOI: 10.2196/32559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. Objective This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. Methods Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. Results Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. Conclusions The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.
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Affiliation(s)
- Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
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24
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Sempé L, Lloyd-Sherlock P, Martínez R, Ebrahim S, McKee M, Acosta E. Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic. LANCET REGIONAL HEALTH. AMERICAS 2021; 2:None. [PMID: 34693394 PMCID: PMC8507430 DOI: 10.1016/j.lana.2021.100039] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. METHODS Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish).We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. FINDINGS We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. INTERPRETATION Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account. FUNDING None.
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Affiliation(s)
- Lucas Sempé
- University of East Anglia, Norwich, UK & Universidad Católica San Pablo, Arequipa, Peru
| | | | | | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Enrique Acosta
- Max Planck Institute for Demographic Research, Rostock, Germany
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25
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Iuliano AD, Chang HH, Patel NN, Threlkel R, Kniss K, Reich J, Steele M, Hall AJ, Fry AM, Reed C. Estimating under-recognized COVID-19 deaths, United States, march 2020-may 2021 using an excess mortality modelling approach. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100019. [PMID: 34386789 PMCID: PMC8275579 DOI: 10.1016/j.lana.2021.100019] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the United States, Coronavirus Disease 2019 (COVID-19) deaths are captured through the National Notifiable Disease Surveillance System and death certificates reported to the National Vital Statistics System (NVSS). However, not all COVID-19 deaths are recognized and reported because of limitations in testing, exacerbation of chronic health conditions that are listed as the cause of death, or delays in reporting. Estimating deaths may provide a more comprehensive understanding of total COVID-19-attributable deaths. METHODS We estimated COVID-19 unrecognized attributable deaths, from March 2020-April 2021, using all-cause deaths reported to NVSS by week and six age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) for 50 states, New York City, and the District of Columbia using a linear time series regression model. Reported COVID-19 deaths were subtracted from all-cause deaths before applying the model. Weekly expected deaths, assuming no SARS-CoV-2 circulation and predicted all-cause deaths using SARS-CoV-2 weekly percent positive as a covariate were modelled by age group and including state as a random intercept. COVID-19-attributable unrecognized deaths were calculated for each state and age group by subtracting the expected all-cause deaths from the predicted deaths. FINDINGS We estimated that 766,611 deaths attributable to COVID-19 occurred in the United States from March 8, 2020-May 29, 2021. Of these, 184,477 (24%) deaths were not documented on death certificates. Eighty-two percent of unrecognized deaths were among persons aged ≥65 years; the proportion of unrecognized deaths were 0•24-0•31 times lower among those 0-17 years relative to all other age groups. More COVID-19-attributable deaths were not captured during the early months of the pandemic (March-May 2020) and during increases in SARS-CoV-2 activity (July 2020, November 2020-February 2021). INTERPRETATION Estimating COVID-19-attributable unrecognized deaths provides a better understanding of the COVID-19 mortality burden and may better quantify the severity of the COVID-19 pandemic. FUNDING None.
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Affiliation(s)
- A. Danielle Iuliano
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States,United States Public Health Service, United States,Corresponding author: A. Danielle Iuliano, 1600 Clifton Road, MS A-32, Atlanta, GA 30329-4027, United States, Phone: 404-680-3654.
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Neha N. Patel
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States,Abt Associates, Division of Health and Environment, Atlanta, GA, United States
| | - Ryan Threlkel
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States,General Dynamics Information Technology, Atlanta, GA, United States
| | - Krista Kniss
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeremy Reich
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,IHRC, Incorporated, Atlanta, GA, United States
| | - Molly Steele
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Aron J. Hall
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M. Fry
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States,United States Public Health Service, United States
| | - Carrie Reed
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, United States,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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26
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Meng Y, Wong MS, Xing H, Kwan MP, Zhu R. Assessing the Country-Level Excess All-Cause Mortality and the Impacts of Air Pollution and Human Activity during the COVID-19 Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6883. [PMID: 34206915 PMCID: PMC8295924 DOI: 10.3390/ijerph18136883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
The impact of Coronavirus Disease 2019 (COVID-19) on cause-specific mortality has been investigated on a global scale. However, less is known about the excess all-cause mortality and air pollution-human activity responses. This study estimated the weekly excess all-cause mortality during COVID-19 and evaluated the impacts of air pollution and human activities on mortality variations during the 10th to 52nd weeks of 2020 among sixteen countries. A SARIMA model was adopted to estimate the mortality benchmark based on short-term mortality during 2015-2019 and calculate excess mortality. A quasi-likelihood Poisson-based GAM model was further applied for air pollution/human activity response evaluation, namely ground-level NO2 and PM2.5 and the visit frequencies of parks and workplaces. The findings showed that, compared with COVID-19 mortality (i.e., cause-specific mortality), excess all-cause mortality changed from -26.52% to 373.60% during the 10th to 52nd weeks across the sixteen countries examined, revealing higher excess all-cause mortality than COVID-19 mortality in most countries. For the impact of air pollution and human activities, the average country-level relative risk showed that one unit increase in weekly NO2, PM2.5, park visits and workplace visits was associated with approximately 1.54% increase and 0.19%, 0.23%, and 0.23% decrease in excess all-cause mortality, respectively. Moreover, compared with the impact on COVID-19 mortality, the relative risks of weekly NO2 and PM2.5 were lower, and the relative risks of weekly park and workplace visits were higher for excess all-cause mortality. These results suggest that the estimation based on excess all-cause mortality reduced the potential impact of air pollution and enhanced the influence of human activities compared with the estimation based on COVID-19 mortality.
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Affiliation(s)
- Yuan Meng
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
- Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hong Kong
| | - Hanfa Xing
- School of Geography, South China Normal University, Guangzhou 510000, China;
- College of Geography and Environment, Shandong Normal University, Jinan 250000, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong;
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong
- Department of Human Geography and Spatial Planning, Utrecht University, 3584 CB Utrecht, The Netherlands
| | - Rui Zhu
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
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27
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Cerqua A, Di Stefano R, Letta M, Miccoli S. Local mortality estimates during the COVID-19 pandemic in Italy. JOURNAL OF POPULATION ECONOMICS 2021; 34:1189-1217. [PMID: 34177122 PMCID: PMC8214048 DOI: 10.1007/s00148-021-00857-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/17/2021] [Indexed: 05/24/2023]
Abstract
Estimates of the real death toll of the COVID-19 pandemic have proven to be problematic in many countries, Italy being no exception. Mortality estimates at the local level are even more uncertain as they require stringent conditions, such as granularity and accuracy of the data at hand, which are rarely met. The "official" approach adopted by public institutions to estimate the "excess mortality" during the pandemic draws on a comparison between observed all-cause mortality data for 2020 and averages of mortality figures in the past years for the same period. In this paper, we apply the recently developed machine learning control method to build a more realistic counterfactual scenario of mortality in the absence of COVID-19. We demonstrate that supervised machine learning techniques outperform the official method by substantially improving the prediction accuracy of the local mortality in "ordinary" years, especially in small- and medium-sized municipalities. We then apply the best-performing algorithms to derive estimates of local excess mortality for the period between February and September 2020. Such estimates allow us to provide insights about the demographic evolution of the first wave of the pandemic throughout the country. To help improve diagnostic and monitoring efforts, our dataset is freely available to the research community. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s00148-021-00857-y.
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Affiliation(s)
- Augusto Cerqua
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Roberta Di Stefano
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Letta
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Sara Miccoli
- Department of Methods and Models for Economics, Territory and Finance, Sapienza University of Rome, Rome, Italy
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Li D, Gaynor SM, Quick C, Chen JT, Stephenson BJK, Coull BA, Lin X. Identifying US County-level characteristics associated with high COVID-19 burden. BMC Public Health 2021; 21:1007. [PMID: 34049526 PMCID: PMC8162162 DOI: 10.1186/s12889-021-11060-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Identifying county-level characteristics associated with high coronavirus 2019 (COVID-19) burden can help allow for data-driven, equitable allocation of public health intervention resources and reduce burdens on health care systems. METHODS Synthesizing data from various government and nonprofit institutions for all 3142 United States (US) counties, we studied county-level characteristics that were associated with cumulative and weekly case and death rates through 12/21/2020. We used generalized linear mixed models to model cumulative and weekly (40 repeated measures per county) cases and deaths. Cumulative and weekly models included state fixed effects and county-specific random effects. Weekly models additionally allowed covariate effects to vary by season and included US Census region-specific B-splines to adjust for temporal trends. RESULTS Rural counties, counties with more minorities and white/non-white segregation, and counties with more people with no high school diploma and with medical comorbidities were associated with higher cumulative COVID-19 case and death rates. In the spring, urban counties and counties with more minorities and white/non-white segregation were associated with increased weekly case and death rates. In the fall, rural counties were associated with larger weekly case and death rates. In the spring, summer, and fall, counties with more residents with socioeconomic disadvantage and medical comorbidities were associated greater weekly case and death rates. CONCLUSIONS These county-level associations are based off complete data from the entire country, come from a single modeling framework that longitudinally analyzes the US COVID-19 pandemic at the county-level, and are applicable to guiding government resource allocation policies to different US counties.
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Affiliation(s)
- Daniel Li
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA
- Ohio State University College of Medicine, Columbus, OH, USA
| | - Sheila M Gaynor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA
| | - Corbin Quick
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Briana J K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Building II, Room 419, Boston, MA, 02115, USA.
- Department of Statistics, Harvard University, Cambridge, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Musellim B, Kul S, Ay P, Küçük FÇU, Dağlı E, Itil O, Bayram H. Excess Mortality During COVID-19 Pandemic in İstanbul. Turk Thorac J 2021; 22:137-141. [PMID: 33871337 DOI: 10.5152/turkthoracj.2021.20258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Epidemiological studies have shown that mortality owing to the coronavirus disease 2019 (COVID-19) could be under-reported under different conditions. Excess mortality analysis is suggested as a useful tool in estimating the impact of the disease. MATERIAL AND METHODS Mortality data between January 01 and May 18, 2020, were analyzed to evaluate the excess mortality owing to COVID-19 in Istanbul, the city most affected by the pandemic in Turkey. The average weekly percentage changes in the number of deaths in 4 previous years were compared with those in the year 2020 using excess mortality analysis. RESULTS The number of deaths in Istanbul was significantly higher in 2020 (p=0.001), with a 10% weekly increase between the 10th and 15th weeks, which started to decrease until the 20th week. The excess mortality found during the study period was 4,084 deaths, higher than the officially reported COVID-19 mortality. CONCLUSION Our findings demonstrated that mortality owing to COVID-19 could be higher than the official figures reported by health authorities.
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Affiliation(s)
- Benan Musellim
- Turkish Thoracic Society, COVID-19 Task Force, İstanbul, Turkey
| | - Seval Kul
- Department of Biostatistics and Medical Informatics, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Pınar Ay
- Department of Public Health, Marmara University School of Medicine, İstanbul, Turkey
| | | | - Elif Dağlı
- Health Institute Association, Istanbul, Turkey
| | - Oya Itil
- Department of Pulmonary Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koç University School of Medicine, İstanbul, Turkey
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