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Woolf SH, Lee JH, Chapman DA, Sabo RT, Zimmerman E. Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023. Am J Public Health 2024; 114:882-891. [PMID: 39024530 PMCID: PMC11306623 DOI: 10.2105/ajph.2024.307731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation. Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures. Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures. Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded. (Am J Public Health. 2024;114(9):882-891. https://doi.org/10.2105/AJPH.2024.307731).
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Affiliation(s)
- Steven H Woolf
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Jong Hyung Lee
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Derek A Chapman
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Roy T Sabo
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
| | - Emily Zimmerman
- Steven H. Woolf and Jong Hyung Lee are with the Department of Family Medicine, Virginia Commonwealth University (VCU) School of Medicine, Richmond. Derek A. Chapman and Emily Zimmerman are with the Department of Epidemiology, VCU School of Population Health, Richmond. Roy T. Sabo is with the Department of Biostatistics, VCU School of Population Health
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Liu N, Wu S, Guo J. Spillover health losses of COVID-19 in China: evidence from non-COVID-19-related mortality. Public Health 2024; 235:8-14. [PMID: 39033719 DOI: 10.1016/j.puhe.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/26/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES With the seeming end of the COVID-19 epidemic, international focus is rethinking its spillover consequences, such as on the routine provision and usage of healthcare. This study uses China's national death records to estimate the potential spillover effects of the COVID-19 pandemic on the mortality of non-COVID diseases in China, such as chronic diseases and mental disorders. STUDY DESIGN A longitudinal study. METHODS Using the difference-in-difference strategy, our results showed a sizeable increase in total non-COVID deaths and mortality from cardiovascular diseases, chronic kidney disease, diabetes, mental diseases, and suicide. RESULTS Notably, the deaths from diabetes and suicide increased by 4.60% and 7.08%, respectively, relative to the regions without pandemic cases in the first outbreak and escalated by 3.57% and 5.00%, respectively, when the control group switched to the same period in 2019. CONCLUSIONS These results documented adverse spillover effects of COVID-19 on mortality of non-COVID diseases, suggesting inadequate provision and utilization of regular healthcare. The government and healthcare industry should adopt expedient policies for non-epidemic diseases and reallocate health resources to mitigate future pandemics like COVID-19.
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Affiliation(s)
- N Liu
- School of Management, Lanzhou University, Lanzhou 730000, China; China Research Center for Government Performance Management, Lanzhou University, Lanzhou 730000, China
| | - S Wu
- School of Government, Sun Yat-Sen University, Guangzhou, China.
| | - J Guo
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
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Mahadhika CK, Aldila D. A deterministic transmission model for analytics-driven optimization of COVID-19 post-pandemic vaccination and quarantine strategies. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:4956-4988. [PMID: 38872522 DOI: 10.3934/mbe.2024219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
This study developed a deterministic transmission model for the coronavirus disease of 2019 (COVID-19), considering various factors such as vaccination, awareness, quarantine, and treatment resource limitations for infected individuals in quarantine facilities. The proposed model comprised five compartments: susceptible, vaccinated, quarantined, infected, and recovery. It also considered awareness and limited resources by using a saturated function. Dynamic analyses, including equilibrium points, control reproduction numbers, and bifurcation analyses, were conducted in this research, employing analytics to derive insights. Our results indicated the possibility of an endemic equilibrium even if the reproduction number for control was less than one. Using incidence data from West Java, Indonesia, we estimated our model parameter values to calibrate them with the real situation in the field. Elasticity analysis highlighted the crucial role of contact restrictions in reducing the spread of COVID-19, especially when combined with community awareness. This emphasized the analytics-driven nature of our approach. We transformed our model into an optimal control framework due to budget constraints. Leveraging Pontriagin's maximum principle, we meticulously formulated and solved our optimal control problem using the forward-backward sweep method. Our experiments underscored the pivotal role of vaccination in infection containment. Vaccination effectively reduces the risk of infection among vaccinated individuals, leading to a lower overall infection rate. However, combining vaccination and quarantine measures yields even more promising results than vaccination alone. A second crucial finding emphasized the need for early intervention during outbreaks rather than delayed responses. Early interventions significantly reduce the number of preventable infections, underscoring their importance.
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Affiliation(s)
- C K Mahadhika
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok 16424, Indonesia
| | - Dipo Aldila
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok 16424, Indonesia
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Michenka P, Marx D. Hospital-Level COVID-19 Preparedness and Crisis Management in Czechia. Int J Public Health 2023; 68:1606398. [PMID: 38155687 PMCID: PMC10752954 DOI: 10.3389/ijph.2023.1606398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Objectives: The COVID-19 pandemic exposed the inadequacy of pandemic preparedness mechanisms worldwide. This study gathered comprehensive data from Czech hospitals, identified possible weaknesses in important areas of crisis preparedness, and quantified changes performed to enhance crisis resilience of healthcare facilities. Methods: Drawing on literature review on pandemic preparedness and hospital crisis management and detailed interviews with hospital representatives, a questionnaire was designed and distributed by email among quality managers of all Czech hospitals. Statistical analysis of their responses was conducted using EZR software. Fisher's exact test and Kruskal-Wallis test, with post hoc testing, were used to assess statistical significance. Results: Achieving response rate of 31.9%, responses from 65 hospitals were analysed. New crisis management policies were necessary in 72.3% of responding hospitals. Furthermore, a majority of the respondents changes indicated the need for changes in policies on general pandemic, human resources and infrastructure and material preparedness. Conclusion: The COVID-19 crisis required significant alterations to previously established hospital crisis management protocols and establishment of new ones. The absence of a unified system for crisis preparedness was noted at hospital and national levels.
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Affiliation(s)
- Petr Michenka
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - David Marx
- Department of Public Health, Third Faculty of Medicine, Charles University, Prague, Czechia
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Locatelli I, Rousson V. Two complementary approaches to estimate an excess of mortality: The case of Switzerland 2022. PLoS One 2023; 18:e0290160. [PMID: 37582109 PMCID: PMC10426989 DOI: 10.1371/journal.pone.0290160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, excess mortality has generally been estimated comparing overall mortality in a given year with either past mortality levels or past mortality trends, with different results. Our objective was to illustrate and compare the two approaches using mortality data for Switzerland in 2022, the third year of the COVID-19 pandemic. METHODS Using data from the Swiss Federal Statistical Office, standardized mortality rates and life expectancies in 2022 were compared with those of the last pre-pandemic year 2019 (first approach), as well as with those that would be expected if the pre-pandemic downward trend in mortality had continued during the pandemic (second approach). The pre-pandemic trend was estimated via a Poisson log-linear model on age-specific mortality over the period 2010-19. RESULTS Using the first approach, we estimated in Switzerland in 2022 an excess mortality of 2.6% (95%CI: 1.0%-4.1%) for men and 2.5% (95%CI: 1.0%-4.0%) for women, while the excess mortality rose to 8.4% (95%CI: 6.9%-9.9%) for men and 6.0% (95%CI: 4.6%-7.5%) for women using the second approach. Age classes over 80 were the main responsible for the excess mortality in 2022 for both sexes using the first approach, although a significant excess mortality was also found in most age classes above 30 using the second approach. Life expectancy in 2022 has been reduced by 2.7 months for men and 2.4 months for women according to the first approach, whereas it was reduced by respectively 8.8 and 6.0 months according to the second approach. CONCLUSIONS The excess mortality and loss of life expectancy in Switzerland in 2022 are around three times greater if the pre-pandemic trend is taken into account than if we simply compare 2022 with 2019. These two different approaches, one being more speculative and the other more factual, can also be applied simultaneously and provide complementary results. In Switzerland, such a dual-approach strategy has shown that the pre-pandemic downward trend in mortality is currently halted, while pre-pandemic mortality levels have largely been recovered by 2022.
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Affiliation(s)
- Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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White P, Crowe C, Bowe A, Brennan A, Bruton O, O'Sullivan MB, O'Mahony MT, Sheahan A, Barrett P. An audit of COVID-19 death reporting in counties Cork and Kerry, Ireland, winter 2021-2022. Ir J Med Sci 2023; 192:1589-1594. [PMID: 36383325 PMCID: PMC9666975 DOI: 10.1007/s11845-022-03211-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Ireland, a 'COVID-19 death' is defined as any death in which the decedent was COVID-19 positive and had no clear alternative cause of death unrelated to COVID-19, a definition based on World Health Organization guidance. AIMS The objectives of this audit were to determine the proportion of COVID-19 deaths notified in the Cork/Kerry region of Ireland during winter 2021-2022 which adhered to this national definition, and to determine whether COVID-19 was deemed to be the primary cause of death, or a contributory or incidental factor. METHODS A review of all deaths in individuals who were COVID-19 positive at the time of death notified to the Department of Public Health for Cork and Kerry between 22 November 2021 and 31 January 2022 was conducted to determine whether each death adhered to the national COVID-19 death definition. The clinical opinion on cause of death was obtained by contacting decedents' clinicians. RESULTS Sixty deaths in individuals who were COVID-19 positive at the time of death were notified to the Department in the study period. Of deaths notified as being due to COVID-19, COVID-19 was deemed the primary cause of death, a contributory factor or an incidental factor in 72.7%, 21.8%, and 5.5% of cases, respectively. Most (93.3%) notified deaths adhered to the national COVID-19 death definition. CONCLUSIONS The COVID-19 death definition in Ireland may require revision so it can distinguish between deaths caused by COVID-19 and those in which COVID-19 played a less direct role. The current COVID-19 mortality reporting system may also need updating to capture more clinical nuance.
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Affiliation(s)
- Philippa White
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland.
| | - Catherine Crowe
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Andrea Bowe
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Aline Brennan
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Orla Bruton
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Margaret B O'Sullivan
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Mary T O'Mahony
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Anne Sheahan
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
| | - Peter Barrett
- Department of Public Health, HSE-South (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland
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Steul K, Heudorf U, Uphoff H, Kowall B. Excess mortality during the SARS-CoV-2 pandemic in the City of Frankfurt/Main, Germany, in 2020 and 2021, adjusted for age trends and pandemic phases. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc08. [PMID: 37261058 PMCID: PMC10227495 DOI: 10.3205/dgkh000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population. Methods Population data for Frankfurt/Main for 2016-2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMRcrude, the mean mortality rate from the years 2016-2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMRadjusted, this procedure was performed separately for five age groups, and the numbers of expected deaths per age group were added. Results SMRcrude was 1.006 (95% CI: 0.980-1.031) in 2020, and 1.047 (95% CI: 1.021-1.073) in 2021. SMRadjusted was 0.976 (95% CI: 0.951-1.001) in 2020 and 0.998 (95% CI: 0.973-1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3. Conclusion Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt /Main, mortality would have been greatly overestimated.
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Affiliation(s)
- Katrin Steul
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ursel Heudorf
- Institute of Hygiene and Environmental Medicine, Justus Liebig University, Giessen, Germany
| | - Helmut Uphoff
- Department of Infectious Disease Epidemiology, Hessian State Examination and Investigation Office in Health Care (HLPUG), Dillenburg, Germany
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany
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Aweimer A, Petschulat L, Jettkant B, Köditz R, Finkeldei J, Dietrich JW, Breuer T, Draese C, Frey UH, Rahmel T, Adamzik M, Buchwald D, Useini D, Brechmann T, Hosbach I, Bünger J, Ewers A, El-Battrawy I, Mügge A. Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany. Sci Rep 2023; 13:5143. [PMID: 36991018 PMCID: PMC10054204 DOI: 10.1038/s41598-023-31944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients' outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in day-to-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63.8% male, median age 67 years). Fifty patients (33.6%) received additional ECMO support. On average, ECMO therapy was initiated 15.6 ± 9.4 days after symptom onset, 10.6 ± 7.1 days after hospital admission, and 4.8 ± 6.4 days after the start of IMV. Male sex and higher SOFA and RESP scores were observed significantly more often in the high-volume ECMO center. Pre-medication with antidepressants was more often detected in survivors (22.0% vs. 6.5%; p = 0.006). ECMO patients were 14 years younger and presented a lower rate of concomitant cardiovascular diseases (18.0% vs. 47.5%; p = 0.0004). Additionally, cytokine-adsorption (46.0% vs. 13.1%; p < 0.0001) and renal replacement therapy (76.0% vs. 43.4%; p = 0.0001) were carried out more frequently; in ECMO patients thrombocytes were transfused 12-fold more often related to more than fourfold higher bleeding complications. Undulating C-reactive protein (CRP) and massive increase in bilirubin levels (at terminal stage) could be observed in deceased ECMO patients. In-hospital mortality was high (Overall: 72.5%, ECMO: 80.0%, ns). Regardless of ECMO therapy half of the study population deceased within 30 days after hospital admission. Despite being younger and with less comorbidities ECMO therapy did not improve survival in severely ill COVID-19 patients. Undulating CRP levels, a massive increase of bilirubin level and a high use of cytokine-adsorption were associated with worse outcomes. In conclusion, ECMO support might be helpful in selected severe cases of COVID-19.
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Affiliation(s)
- Assem Aweimer
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany.
| | - Lea Petschulat
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Birger Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Roland Köditz
- Department of Endocrinology and Diabetes, BG University Hospital Bergmannsheil, Ruhr University of Bochum, Bochum, Germany
| | - Johannes Finkeldei
- Department of Endocrinology and Diabetes, BG University Hospital Bergmannsheil, Ruhr University of Bochum, Bochum, Germany
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Medical Hospital I, Katholisches Klinikum Bochum, St Josef Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Thomas Breuer
- Department of Internal Medicine, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Christian Draese
- Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Ulrich H Frey
- Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Tim Rahmel
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Michael Adamzik
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Dirk Buchwald
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Brechmann
- Gastroenterology and Hepatology, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Ingolf Hosbach
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Jürgen Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Aydan Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
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Haider N, Hasan MN, Guitian J, Khan RA, McCoy D, Ntoumi F, Dar O, Ansumana R, Uddin MJ, Zumla A, Kock RA. The disproportionate case-fatality ratio of COVID-19 between countries with the highest vaccination rates and the rest of the world. IJID REGIONS 2023; 6:159-166. [PMID: 36721772 PMCID: PMC9881127 DOI: 10.1016/j.ijregi.2023.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
Objectives The global reported cumulative case-fatality ratios (rCFRs) and excess mortality rates of the 20 countries with the highest coronavirus disease 2019 (COVID-19) vaccination rates, the rest of the world and Sub-Saharan Africa (SSA) were compared before and after the commencement of vaccination programmes. Methods A time series model was used to understand the trend of rCFR over time, and a generalized linear mixed model was used to understand the effect of vaccination on rCFR. Results By 31 December 2022, an average of 260.3 doses of COVID-19 vaccine per 100 population had been administered in the top 20 vaccinated countries, compared with 152.1 doses in the rest of the world and 51.2 doses in SSA. The mean rCFR of COVID-19 had decreased by 69.0% in the top 20 vaccinated countries, 26.5% in the rest of the world and 7.6% in SSA. Excess mortality had decreased by 48.7% in the top 20 vaccinated countries, compared with 62.5% in the rest of the world and 60.7% in SSA. In a generalized linear mixed model, the reported number of vaccine doses administered (/100 population) (odds ratio 0.64) was associated with a steeper reduction in COVID-19 rCFR. Conclusions Vaccine equity and faster roll-out across the world is critically important in reducing COVID-19 transmission and CFR.
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Affiliation(s)
- Najmul Haider
- The Royal Veterinary College, University of London, Hatfield, UK
- School of Life Sciences, Keele University, Keele, UK
- Corresponding authors. Address: School of Life Sciences, Keele University, Keele ST5 5BG, UK.
| | - Mohammad Nayeem Hasan
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Javier Guitian
- The Royal Veterinary College, University of London, Hatfield, UK
| | - Rumi A. Khan
- Division of Pulmonary Critical Care Medicine, Dell Medical School at University of Texas, Austin, Texas, USA
| | - David McCoy
- Institute of Population Health Sciences, Barts and London Medical and Dental School, Queen Mary University of London, London, UK
| | - Francine Ntoumi
- Congolese Foundation for Medical Research, Brazzaville, Republic of Congo
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Osman Dar
- Chatham House Centre for Global Health Security, Royal Institute of International Affairs, London, UK
| | - Rashid Ansumana
- School of Community Health Science, Njala University, Bo, Sierra Leone
| | - Md. Jamal Uddin
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
- Department of General Educational and Development, Daffodil International University, Dhaka, Bangladesh
- Corresponding authors. Address: School of Life Sciences, Keele University, Keele ST5 5BG, UK.
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK
- NIHR-BRC, University College London Hospitals, London, UK
| | - Richard A. Kock
- The Royal Veterinary College, University of London, Hatfield, UK
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Nguyen KQ, Nguyen LMA, Taylor-Robinson AW. Global "flu-ization" of COVID-19: A perspective from Vietnam. Front Public Health 2022; 10:987467. [PMID: 36262220 PMCID: PMC9574250 DOI: 10.3389/fpubh.2022.987467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Le My Anh Nguyen
- College of Health Sciences, VinUniversity, Hanoi, Vietnam,Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Andrew W. Taylor-Robinson
- College of Health Sciences, VinUniversity, Hanoi, Vietnam,Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,*Correspondence: Andrew W. Taylor-Robinson
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ROMEO I, SKURZAK S. How to tell our grandchildren the tale of cardiac arrest during COVID-19. Minerva Anestesiol 2022; 88:541-543. [DOI: 10.23736/s0375-9393.22.16674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pashkevich A, Burghardt TE. Let Us Not Forget the Victims of COVID-19 Pandemics Who Did Not Die With the Coronavirus. Front Public Health 2022; 10:900100. [PMID: 35615045 PMCID: PMC9124853 DOI: 10.3389/fpubh.2022.900100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anton Pashkevich
- Faculty of Civil Engineering, Politechnika Krakowska, Kraków, Poland
- *Correspondence: Anton Pashkevich
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Domingo L, Comas M, Jansana A, Louro J, Tizón-Marcos H, Cos ML, Roquer J, Chillarón JJ, Cirera I, Pascual-Guàrdia S, Sala M, Castells X. Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain. J Clin Med 2022; 11:1752. [PMID: 35407360 PMCID: PMC8999691 DOI: 10.3390/jcm11071752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 01/18/2023] Open
Abstract
Few studies have assessed the impact of the COVID-19 pandemic on non-COVID diseases and healthcare quality. We aimed to evaluate changes in rates of hospitalisations, complications, in-hospital mortality, and readmissions among patients with non-COVID diseases during a one-year period after the pandemic onset. From March 2018 to February 2021 a retrospective observational study of hospital admissions in a university hospital in Spain was conducted. Non-COVID hospitalisations admitted through the emergency department were compared between the pre-COVID period (n = 28,622) and the COVID period (n = 11,904). We assessed rate ratios (RaR), comparing the weekly number of admissions and risk ratios (RR) to examine rates of complications, in-hospital mortality, readmissions, and severity. Statistical significance was set at p < 0.05. The weekly admission rate dropped by 20.8% during the complete lockdown. We observed significant reductions in admissions related to diseases of the respiratory system and circulatory system. Admissions for endocrine and metabolic diseases increased. The complication rates increased (RR = 1.21, 95% CI: 1.05;1.4), while in-hospital mortality rates held steady during the COVID period (RR = 1.09, 95% CI: 0.98;1.2). Hospital efforts to maintain quality and safety standards despite disruptions translated into a moderate increase in complications but not in in-hospital mortality. Reduced hospitalisations for conditions requiring timely treatment may have significant public health consequences.
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Affiliation(s)
- Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar-IMIM, 08003 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Lourdes Cos
- Department of Internal Medicine, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain;
| | - Jaume Roquer
- Neurology Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain;
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, 08003 Barcelona, Spain; (I.C.); (S.P.-G.)
| | - Juan José Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar-IMIM, 08003 Barcelona, Spain;
| | - Isabel Cirera
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, 08003 Barcelona, Spain; (I.C.); (S.P.-G.)
- Emergency Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain
| | - Sergi Pascual-Guàrdia
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, 08003 Barcelona, Spain; (I.C.); (S.P.-G.)
- Pneumology Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (M.C.); (A.J.); (J.L.); (M.S.); (X.C.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), RICAPPS, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Walkowiak MP, Walkowiak D. Underestimation in Reporting Excess COVID-19 Death Data in Poland during the First Three Pandemic Waves. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063692. [PMID: 35329378 PMCID: PMC8954142 DOI: 10.3390/ijerph19063692] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
The issue whether official Polish COVID-19 death statistics correctly reflect the actual number of deaths is a contentious issue in public discourse and an important policy-wise question in Poland although it has not been the subject of thorough research so far. There had been clearly elevated excess mortality—5100 (death rate of 2.3 per 10,000) during the first wave, 77,500 (21.0 per 10,000) during the second one, and 48,900 (13.5 per 10,000) in the third. This study finds that during the second and the third pandemic wave, our data on excess mortality will match very well the somewhat belatedly officially reported COVID-19 deaths if we assume that only 60% of cases were officially detected. Based on principal component analysis of death timing, except for the age bracket below 40, where COVID-19 deaths calculated on the basis of our model explain 55% of excess mortality, for the remaining age groups, combined COVID-19 deaths explain 95% of excess mortality. Based on the share of excess mortality attributable to COVID-19 during the second wave, this infection in Poland caused the death of 73,300 people and not of 37,600 as officially reported. The third wave caused 46,200 deaths instead of the reported 34,700. The first wave was, indeed, as officially reported, very mild, and the number of excess deaths was too low to be used to calculate COVID-19 deaths directly. However, assuming that the detection rate remained comparable to the average in subsequent waves, we can set the number of deaths at 3500 instead of the reported 2100.
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Affiliation(s)
- Marcin Piotr Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, 60-356 Poznan, Poland;
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 60-356 Poznan, Poland
- Correspondence: ; Tel./Fax: +48-61-658-44-93
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Guimarães RM, Oliveira MPRPBD, Dutra VGP. Excess mortality according to group of causes in the first year of the COVID-19 pandemic in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220029. [DOI: 10.1590/1980-549720220029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/05/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective: To estimate excess mortality by cause of death in Brazil and states in 2020. Methods: We estimated the expected number of deaths considering a linear trend analysis with the number of deaths between 2015 and 2019 for each group of causes and each federative unit. We calculated standardized mortality ratios (SMR) and 95% confidence intervals for each SMR assuming a Poisson distribution. We performed the analyses in the R program, version 4.1.3. Results: We observed a 19% excess in deaths in 2020 (SMR=1.19; 95%CI=1.18–1.20). The Infectious and Parasitic Diseases group stood out among the defined causes (SMR=4.80; 95%CI 4.78–4.82). The ill-defined causes showed great magnitude in this period (SMR=6.08; 95%CI 6.06–6.10). Some groups had lower-than-expected deaths: respiratory diseases (10% lower than expected) and external causes (4% lower than expected). In addition to the global analysis of the country, we identified significant heterogeneity among the federative units. States with the highest SMR are concentrated in the northern region, and those with the lowest SMR are concentrated in the southern and southeastern regions. Conclusion: Excess mortality occurs during the COVID-19 pandemic. This excess results not only from COVID-19 itself, but also from the social response and the management of the health system in responding to a myriad of causes that already had a trend pattern before it.
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Jambarsang S, Taheri Soodejani M. The impact of COVID-19 Vaccination in Iranian elderly: 7 percent of all-cause deaths reduced by vaccinating 2 percent of population; letter to editor. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2022; 15:188-189. [PMID: 35845308 PMCID: PMC9275733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sara Jambarsang
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Moslem Taheri Soodejani
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Guimarães RM, Oliveira MPRPBD, Dutra VGP. Excesso de mortalidade segundo grupo de causas no primeiro ano de pandemia de COVID-19 no Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220029.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Estimar o excesso de mortalidade segundo causa de óbito no Brasil e estados em 2020. Métodos: O número de óbitos esperado foi estimado considerando análise de tendência linear com o número de mortes entre os anos de 2015 e 2019, para cada grupo de causas e cada unidade da federação. Calculamos as razões de mortalidade padronizadas, e os intervalos com 95% de confiança para cada SMR foram calculados assumindo uma distribuição Poisson. As análises foram realizadas no programa R, versão 4.1.3. Resultados: Observamos um excesso de 19% nos óbitos em 2020 (SMR=1,19; IC=1,18–1,20). O grupo de Doenças Infecciosas e Parasitárias obteve maior destaque entre as causas definidas (SMR=4,80; IC95% 4,78–4,82). As causas mal definidas apresentaram grande magnitude neste período (SMR=6,08; IC95% 6,06–6,10). Há, ainda, grupos que apresentaram número de óbitos abaixo do esperado: doenças do aparelho respiratório (10% abaixo do esperado) e causas externas (4% abaixo do esperado). Além da análise global para o país, identificamos grande heterogeneidade entre as unidades da federação. Os estados com maiores SMR estão concentrados na região norte, e os que possuem menores SMR estão concentrados nas regiões sul e sudeste. Conclusões: Há um excesso de mortalidade ocorrendo durante a pandemia de COVID-19. Este excesso é resultado não apenas da COVID-19 em si, mas da resposta social e da gestão do sistema de saúde em responder a uma miríade de causas que já possuíam um ritmo de tendência anterior a ela.
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Raknes G, Strøm MS, Sulo G, Øverland S, Roelants M, Juliusson PB. Lockdown and non-COVID-19 deaths: cause-specific mortality during the first wave of the 2020 pandemic in Norway: a population-based register study. BMJ Open 2021; 11:e050525. [PMID: 34907049 PMCID: PMC8671852 DOI: 10.1136/bmjopen-2021-050525] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the potential impact of the first wave of COVID-19 pandemic on all cause and cause-specific mortality in Norway. DESIGN Population-based register study. SETTING The Norwegian cause of Death Registry and the National Population Register of Norway. PARTICIPANTS All recorded deaths in Norway from March to May from 2010 to 2020. MAIN OUTCOME MEASURES Rate (per 100 000) of all-cause mortality and causes of death in the European Shortlist for Causes of Death from March to May 2020. The rates were age standardised and adjusted to a 100% register coverage and compared with a 95% prediction interval (PI) from linear regression based on corresponding rates for 2010-2019. RESULTS 113 710 deaths were included, of which 10 226 were from 2020. We did not observe any deviation from predicted total mortality. There were fewer than predicted deaths from chronic lower respiratory diseases excluding asthma (11.4, 95% PI 11.8 to 15.2) and from other non-ischaemic, non-rheumatic heart diseases (13.9, 95% PI 14.5 to 20.2). The death rates were higher than predicted for Alzheimer's disease (7.3, 95% PI 5.5 to 7.3) and diabetes mellitus (4.1, 95% PI 2.1 to 3.4). CONCLUSIONS There was no significant difference in the frequency of the major causes of death in the first wave of the 2020 COVID-19 pandemic in Norway compared with corresponding periods 2010-2019. There was an increase in diabetes mellitus and Alzheimer's deaths. Reduced mortality due to some heart and lung conditions may be linked to infection control measures.
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Affiliation(s)
- Guttorm Raknes
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Raknes Research, Bergen, Norway
| | - Marianne Sørlie Strøm
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Institute of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Gerhard Sulo
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Simon Øverland
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Petur Benedikt Juliusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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