Reduction in life expectancy in Brazil after COVID-19

Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020

Global population health during the COVID-19 pandemic is poorly understood because of weak mortality monitoring in low- and middle-income countries. High-quality survey data on 765,180 individuals, representative of one-fourth of India's population, uncover patterns missed by incomplete vital statistics and disease surveillance. Compared to 2019, life expectancy at birth was 2.6 years lower and mortality was 17% higher in 2020, implying 1.19 million excess deaths in 2020. Life expectancy declines in India were larger and had a younger age profile than in high-income countries. Increases in mortality were greater than expected based on observed seroprevalence and international infection fatality rates, most prominently among the youngest and older age groups. In contrast to global patterns, females in India experienced a life expectancy decline that was 1 year larger than losses for males. Marginalized social groups experienced greater declines than the most privileged social group. These findings uncover large and unequal mortality impacts during the pandemic in the world's most populous country.

Giving meaning to internalized violence throughout life by older adults living in rural areas

OBJECTIVES

to understand the meanings of violence internalized throughout life by older adults living in rural areas.

METHODS

a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.

RESULTS

it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.

FINAL CONSIDERATIONS

older adults living in rural areas internalized the violence suffered in a unique way, and this scenario's specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.

Presidential election results in 2018-2022 and its association with excess mortality during the 2020-2021 COVID-19 pandemic in Brazilian municipalities

We evaluated the hypothesis of an association between excess mortality and political partisanship in Brazil using municipal death certificates registered in the Brazilian Ministry of Health database and first-round electoral results of Presidential elections in 2018 and 2022. Considering the former Brazilian President's stance of discrediting and neglecting the severity of the pandemic, we expect a possible relationship between excessive mortality rates during the COVID-19 health crisis and the number of municipal votes for Bolsonaro. Our results showed that, in both elections, the first-round percentage of municipal votes for Bolsonaro was positively associated with the peaks of excess deaths across Brazilian municipalities in 2020 and 2021. Despite the excess mortality during the pandemic, the political loyalty to Bolsonaro remained the same during the electoral period of 2022. A possible explanation for this is linked to the Brazilian political scenario, which presents an environment of tribal politics and affective polarization.

Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030

BACKGROUND

Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030.

METHODS

We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030.

RESULTS

The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential.

CONCLUSION

Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.

[Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020]

This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Country-based modelling of COVID-19 case fatality rate: A multiple regression analysis

BACKGROUND

The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection. The determinants of mortality on a global scale cannot be fully understood due to lack of information.

AIM

To identify key factors that may explain the variability in case lethality across countries.

METHODS

We identified 21 Potential risk factors for coronavirus disease 2019 (COVID-19) case fatality rate for all the countries with available data. We examined univariate relationships of each variable with case fatality rate (CFR), and all independent variables to identify candidate variables for our final multiple model. Multiple regression analysis technique was used to assess the strength of relationship.

RESULTS

The mean of COVID-19 mortality was 1.52 ± 1.72%. There was a statistically significant inverse correlation between health expenditure, and number of computed tomography scanners per 1 million with CFR, and significant direct correlation was found between literacy, and air pollution with CFR. This final model can predict approximately 97% of the changes in CFR.

CONCLUSION

The current study recommends some new predictors explaining affect mortality rate. Thus, it could help decision-makers develop health policies to fight COVID-19.

Socioeconomic, Disease Burden, Physical Functioning, Psychosocial, and Environmental Factors Associated With Mortality Among Older Adults: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil)

OBJECTIVES

There is little nationally representative information about factors associated with longevity among older Brazilians.

METHODS

Baseline survey data from the Brazilian longitudinal Study of Aging (ELSI-Brazil) were linked to vital statistics systems. Mortality rates and life expectancy estimates were calculated and compared to official sources. Cox Proportional Hazards models and Population Attributable Fractions (PAFs) identified significant predictors of mortality. Results: Calculated mortality rates and life expectancy estimates were similar to official statistics for most ages with higher risk of death among older ages, as expected. High School completion, being partnered, and female sex were negatively associated with mortality, while being underweight, previous diagnosis of a chronic condition, having any functional limitations, poor self-rated health, low grip strength, and smoking were all associated with higher mortality risk. Discussion: The ELSI-Brazil study has potential to identify factors associated with longevity and to inform programs and policies designed to enhance healthy aging among older adults in Brazil.

Statistical modeling and estimating number of healthy life years lost and healthy life expectancy in India, 2000-2019

Objective

In this study, our objective is to propose various models to estimate healthy life year lost (HLYL) and healthy life expectancy (HLE) in India.

Methods

The HLYL and HLE were estimated and further these estimates were compared with the direct life table method and the World Health Organization (WHO) method. From the mortality perspective, we have developed a log-logistic model for estimating the parameter (bx), which is characterized by HLYL. The results were compared with other models, such as the Gompertz and Weibull model. Here, we have also obtained the HLE by subtracting HLYL from the total life expectancy.

Results

The result shows an increasing trend of HLYL among the male, female, and the total population in India.

Conclusion

From the log-logistic model, the HLYL was estimated as 8.79 years, 8.36 years, and 9.38 years for the total, male, and female populations, respectively, in India during 2019.

Temporal Analysis of COVID-19 Epidemiological Indicators in a Low-Income Brazilian Context: A Retrospective Analysis in Paraiba State

Northeast Brazil is a region with great international tourist potential. Among the states that make up this region, Paraíba stands out due to the presence of vulnerable groups and factors that contribute to adverse outcomes of COVID-19. Therefore, the aim of this study was to analyze the epidemiological data on the incidence, mortality, and case fatality of COVID-19 in Paraíba. An ecological, population-based study was performed, with data extracted from the Brazilian Ministry of Health database. All cases and deaths from COVID-19 from March 2020 to December 2022 were included. The time series was built by applying the Prais-Winsten regression model, and the daily percent change was calculated to analyze the trends. The highest case fatality of the entire period was in April 2020 (7.8%), but in March 2021, the state broke the dismal record of 1248 deaths and the highest mortality rate (30.5 deaths per 100,000 inhabitants). Stationary mortality and case fatality were better in 2022; however, in February 2022, the mortality rate was at levels similar to the same month of the previous year. These results illustrate that COVID-19 is evolving and needs to be constantly monitored.

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

Impact of COVID-19 on subnational variations in life expectancy and life disparity at birth in India: evidence from NFHS and SRS data

BACKGROUND

Measuring life expectancy and life disparity can assist in comprehending how the COVID-19 pandemic has affected the mortality estimates in the Indian population. The present study aims to study the life expectancy and life disparity at birth at the national and subnational levels before and during the COVID-19 pandemic using the NFHS and SRS data.

METHODS

The measures Life expectancy at birth ([Formula: see text]) and Life disparity at birth ([Formula: see text]) were computed for the non-pandemic and pandemic years from NFHS (2015-16), SRS (2015) and NFHS (2019-21), SRS (2020) respectively at the national and Subnational level in India. Using NFHS data for the 36 states and SRS data for the 22 states, the study calculates [Formula: see text] and [Formula: see text] by total, male and female population.

RESULTS

The [Formula: see text] for male and female decline from 64.3 years and 69.2 years in 2015-16 to 62.9 years and 68.9 years in 2019-21. The [Formula: see text] shows a drop of approximately 1.4 years for males and 0.3 years for females in the pandemic year 2019-21 when compared to the non-pandemic year 2015-16. At the subnational level [Formula: see text] shows a decline for 22 states in person, 23 states in males and 21 states in females in the pandemic year 2019-21 as compared to the non-pandemic years 2015-16. The [Formula: see text] shows a increase for 21 states in person, 24 states in females and 17 states in males in the pandemic year than non-pandemic year. The findings shows a significant losses in [Formula: see text] and gains in [Formula: see text] for males than females in the pandemic year as compared to the non-pandemic year at the subnational level in India.

CONCLUSIONS

COVID-19 pandemic has decreased [Formula: see text] and increased [Formula: see text] in the pandemic year 2019-21 at the national and subnational level in India. COVID-19 had a significant impact on the age pattern of mortality for many states and male, female population and delayed the mortality transition in India.

Big data evidence of the impact of COVID-19 hospitalizations on mortality rates of non-COVID-19 critically ill patients

The COVID-19 virus caused a global pandemic leading to a swift policy response. While this response was designed to prevent the spread of the virus and support those with COVID-19, there is growing evidence regarding measurable impacts on non-COVID-19 patients. The paper uses a large dataset from administrative records of the Brazilian public health system (SUS) to estimate pandemic spillover effects in critically ill health care delivery, i.e. the additional mortality risk that COVID-19 ICU hospitalizations generate on non-COVID-19 patients receiving intensive care. The data contain the universe of ICU hospitalizations in SUS from February 26, 2020 to December 31, 2021. Spillover estimates are obtained from high-dimensional fixed effects regression models that control for a number of unobservable confounders. Our findings indicate that, on average, the pandemic increased the mortality risk of non-COVID-19 ICU patients by 1.296 percentage points, 95% CI 1.145-1.448. The spillover mortality risk is larger for non-COVID patients receiving intensive care due to diseases of the respiratory system, diseases of the skin and subcutaneous tissue, and infectious and parasitic diseases. As of July 2023, the WHO reports more than 6.9 million global deaths due to COVID-19 infection. However, our estimates of spillover effects suggest that the pandemic's total death toll is much higher.

Impacts of the COVID-19 pandemic on life expectancy at birth in Asia

OBJECTIVE

To investigate the impact of the COVID-19 pandemic on life expectancy at birth (e0) for 51 Asian countries and territories from January 1, 2020 to December 31, 2021.

METHOD

Based on age-sex-specific mortality used for estimating the changes in e0 for years 2019, 2020, and 2021 from the 2022 revision of the World Population Prospects, we employed Arriaga's discrete method to decompose changes in e0 into both absolute and relative contributions of changes in age-specific death rate, and further obtained the age-sex-specific contribution to changes in e0 by country/territory and period (i.e., 2019-2020 and 2020-2021) for Asia.

FINDINGS

The COVID-19 pandemic reduced 1.66 years in e0 of the Asian population from 2019 to 2021, slightly lower than the world average of 1.74 years. South Asia had a high loss of 3.01 years, whereas Eastern Asia had almost no changes. Oman, Lebanon, India, Armenia, Azerbaijan, Indonesia, and the Philippines experienced a high loss of above 2.5 years in e0. Despite significant national and territorial variations, the decline of e0 in Asia was mostly from the age group of 60-79 years, followed by age groups of 80 + and 45-59 years; and age groups of children contributed little (i.e., 0-4 and 5-14 years old). Males suffered more losses than females in this pandemic. Asian nations saw less loss in e0 in the second year of the pandemic, i.e., 2020-2021, than in the first year, i.e., 2019-2020, but this recovery trend was not observed in Southern Asia and South-Eastern Asia. Countries from Central Asia and Western Asia, such as Kazakhstan, Armenia, Azerbaijan, Lebanon, and Oman, had extraordinarily more losses in e0 in the first year at ages around 70.

CONCLUSION

The COVID-19 pandemic had significantly affected e0 of Asian populations, and most contribution to the reduction of e0 came from the three older age groups, 60-79 years, 80 + years, and 45-59 years, with great variations across countries/territories. Our findings could have important implications for development of more resilient public health systems in Asian societies with better policy interventions for vulnerable demographic groups.

Complexity of the COVID-19 pandemic in Maringá

While extensive literature exists on the COVID-19 pandemic at regional and national levels, understanding its dynamics and consequences at the city level remains limited. This study investigates the pandemic in Maringá, a medium-sized city in Brazil's South Region, using data obtained by actively monitoring the disease from March 2020 to June 2022. Despite prompt and robust interventions, COVID-19 cases increased exponentially during the early spread of COVID-19, with a reproduction number lower than that observed during the initial outbreak in Wuhan. Our research demonstrates the remarkable impact of non-pharmaceutical interventions on both mobility and pandemic indicators, particularly during the onset and the most severe phases of the emergency. However, our results suggest that the city's measures were primarily reactive rather than proactive. Maringá faced six waves of cases, with the third and fourth waves being the deadliest, responsible for over two-thirds of all deaths and overwhelming the local healthcare system. Excess mortality during this period exceeded deaths attributed to COVID-19, indicating that the burdened healthcare system may have contributed to increased mortality from other causes. By the end of the fourth wave, nearly three-quarters of the city's population had received two vaccine doses, significantly decreasing deaths despite the surge caused by the Omicron variant. Finally, we compare these findings with the national context and other similarly sized cities, highlighting substantial heterogeneities in the spread and impact of the disease.

Excess mortality associated with the COVID-19 pandemic during the 2020 and 2021 waves in Antananarivo, Madagascar

INTRODUCTION

COVID-19-associated mortality remains difficult to estimate in sub-Saharan Africa because of the lack of comprehensive systems of death registration. Based on death registers referring to the capital city of Madagascar, we sought to estimate the excess mortality during the COVID-19 pandemic and calculate the loss of life expectancy.

METHODS

Death records between 2016 and 2021 were used to estimate weekly excess mortality during the pandemic period. To infer its synchrony with circulation of SARS-CoV-2, a cross-wavelet analysis was performed. Life expectancy loss due to the COVID-19 pandemic was calculated by projecting mortality rates using the Lee and Carter model and extrapolating the prepandemic trends (1990-2019). Differences in life expectancy at birth were disaggregated by cause of death.

RESULTS

Peaks of excess mortality in 2020-21 were associated with waves of COVID-19. Estimates of all-cause excess mortality were 38.5 and 64.9 per 100 000 inhabitants in 2020 and 2021, respectively, with excess mortality reaching ≥50% over 6 weeks. In 2021, we quantified a drop of 0.8 and 1.0 years in the life expectancy for men and women, respectively attributable to increased risks of death beyond the age of 60 years.

CONCLUSION

We observed high excess mortality during the pandemic period, in particular around the peaks of SARS-CoV-2 circulation in Antananarivo. Our study highlights the need to implement death registration systems in low-income countries to document true toll of a pandemic.

Social determinants of health in Brazil during the COVID-19 pandemic: strengths and limitations of emergency responses

Economic crises often expose the most vulnerable to higher health risks and tend to exacerbate existing inequalities. The Social Determinants of Health (SDoH) framework illustrates many layers of inequalities that would affect outcomes of the COVID-19 pandemic. The impacts of emergency policy responses considering the SDoH framework are important for all sectors in policymaking. However, its assessment in Global South countries is limited, due to high informality rates and data availability. We address this gap using a unique dataset that allows for the analysis of occupational categories before and after the COVID-19 pandemic in Brazil, incorporating the emergency assistance provided in 2020. Results show that, although labor earnings fell 4% for the self-employed at each death from COVID-19, increasing unemployment and inactivity among the typically most vulnerable, those effects were offset by emergency policies, reducing poverty. Groups often considered less vulnerable, such as formal employees, had an increase. The policy responses to this shock served then as a leveler of previous SDoH, despite ignoring the health-risk gradient there is along the income distribution. A poverty rebound that ensued after the sudden discontinuation of those policies is a lesson for future crises, and on how SDoH inequalities should be addressed.

The effect of the COVID-19 pandemic on life expectancy in 27 countries

The expected year-on-year intrinsic mortality variations/changes are largely overlooked in the existing research when estimating the effect of the COVID-19 pandemic on mortality patterns. To fill this gap, this study provides a new assessment of the loss of life expectancy caused by COVID-19 in 27 countries considering both the actual and the expected changes in life expectancy between 2019 and 2020. Life expectancy in 2020 and the expected life expectancy in the absence of COVID-19 are estimated using the Lee-Carter model and data primarily from the Human Mortality Database. The results show that life expectancy in 21 of the 27 countries was expected to increase in 2020 had COVID-19 not occurred. By considering the expected mortality changes between 2019 and 2020, the study shows that, on average, the loss of life expectancy among the 27 countries in 2020 amounted to 1.33 year (95% CI 1.29-1.37) at age 15 and 0.91 years (95% CI 0.88-0.94) at age 65. Our results suggest that if the year-on-year intrinsic variations/changes in mortality were considered, the effects of COVID-19 on mortality are more profound than previously understood. This is particularly prominent for countries experiencing greater life expectancy increase in recent years.

Probabilistic survival modeling in health research: an assessment using cohort data from hospitalized patients with COVID-19 in a Latin American city

Probabilistic survival methods have been used in health research to analyze risk factors and adverse health outcomes associated with COVID-19. The aim of this study was to employ a probabilistic model selected among three distributions (exponential, Weibull, and lognormal) to investigate the time from hospitalization to death and determine the mortality risks among hospitalized patients with COVID-19. A retrospective cohort study was conducted for patients hospitalized due to COVID-19 within 30 days in Londrina, Brazil, between January 2021 and February 2022, registered in the database for severe acute respiratory infections (SIVEP-Gripe). Graphical and Akaike Information Criterion (AIC) methods were used to compare the efficiency of the three probabilistic models. The results from the final model were presented as hazard and event time ratios. Our study comprised of 7,684 individuals, with an overall case fatality rate of 32.78%. Data suggested that older age, male sex, severe comorbidity score, intensive care unit admission, and invasive ventilation significantly increased risks for in-hospital mortality. Our study highlights the conditions that confer higher risks for adverse clinical outcomes attributed to COVID-19. The step-by-step process for selecting appropriate probabilistic models may be extended to other investigations in health research to provide more reliable evidence on this topic.

Spatial-temporal distribution of incidence, mortality, and case-fatality ratios of coronavirus disease 2019 and its social determinants in Brazilian municipalities

The COVID-19 pandemic caused impact on public health worldwide. Brazil gained prominence during the pandemic due to the magnitude of disease. This study aimed to evaluate the spatial-temporal dynamics of incidence, mortality, and case fatality of COVID-19 and its associations with social determinants in Brazilian municipalities and epidemiological week. We modeled incidence, mortality, and case fatality rates using spatial-temporal Bayesian model. "Bolsa Família Programme" (BOLSAFAM) and "proportional mortality ratio" (PMR) were inversely associated with the standardized incidence ratio (SIR), while "health insurance coverage" (HEALTHINSUR) and "Gini index" were directly associated with the SIR. BOLSAFAM and PMR were inversely associated with the standardized mortality ratio (SMR) and standardized case fatality ratio (SCFR). The highest proportion of excess risk for SIR and the SMR started in the North, expanding to the Midwest, Southeast, and South regions. The highest proportion of excess risk for the SCFR outcome was observed in some municipalities in the North region and in the other Brazilian regions. The COVID-19 incidence and mortality in municipalities that most benefited from the cash transfer programme and with better social development decreased. The municipalities with a higher proportion of non-whites had a higher risk of becoming ill and dying from the disease.

Longitudinal Evaluation of Antibody Persistence in Mother-Infant Dyads After Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Pregnancy

BACKGROUND

There are limited data on how coronavirus disease 2019 (COVID-19) severity, timing of infection, and subsequent vaccination impact transplacental transfer and persistence of maternal and infant antibodies.

METHODS

In a longitudinal cohort of pregnant women with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, maternal/infant sera were collected at enrollment, delivery/birth, and 6 months. Anti-SARS-CoV-2 spike immunoglobulin (Ig)G, IgM, and IgA were measured by enzyme-linked immunosorbent assay.

RESULTS

Two-hundred fifty-six pregnant women and 135 infants were enrolled; 148 maternal and 122 neonatal specimens were collected at delivery/birth; 45 maternal and 48 infant specimens were collected at 6 months. Sixty-eight percent of women produced all anti-SARS-CoV-2 isotypes at delivery (IgG, IgM, IgA); 96% had at least 1 isotype. Symptomatic disease and vaccination before delivery were associated with higher maternal IgG at labor and delivery. Detectable IgG in infants dropped from 78% at birth to 52% at 6 months. In the multivariate analysis evaluating factors associated with detectable IgG in infants at delivery, significant predictors were 3rd trimester infection (odds ratio [OR] = 4.0), mild/moderate disease (OR = 4.8), severe/critical disease (OR = 6.3), and maternal vaccination before delivery (OR = 18.8). No factors were significant in the multivariate analysis at 6 months postpartum.

CONCLUSIONS

Vaccination in pregnancy post-COVID-19 recovery is a strategy for boosting antibodies in mother-infant dyads.

A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

[Social vulnerability, survival, and hospital lethality by COVID-19 in patients aged 50 years and over: retrospective cohort of cases in Brazil in 2020 and 2021]

The outcome of SARS-CoV-2 infection is not only associated with age and comorbidities but is also aggravated by social vulnerability. This study aims to analyze - according to social vulnerability - survival and hospital lethality by COVID-19 in the first 100 days from symptoms to death in individuals aged 50 years or older hospitalized in Brazil. This is a retrospective cohort from Epidemiological Week 11 of 2020 to week 33 of 2021. The Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) provided clinical and epidemiological data. The Geographic Index of the Socioeconomic Context for Health and Social Studies (GeoSES) measured social vulnerability. The Kaplan-Meier curve and the adjusted proportional risk model by Cox were used for survival, with hazard ratio (HR) and 95% confidence intervals (95%CI). Among the 410,504 cases, overall lethality was of 42.2% in general and 51.4% in the most vulnerable. We found a higher lethality according to worse socioeconomic status in all categories by age group; the double is registered for 50-59 years. The adjusted Cox model showed a 32% increase in risk of death (HR = 1.32; 95%CI: 1.24-1.42). Moreover, men, older adults, black or indigenous adults, with multiple comorbidities, and subjected to invasive ventilation, have a higher risk of death after hospitalization. Intersectoral policy measures need to be targeted to alleviate the effects of the COVID-19 pandemic aggravated by social vulnerability.

SARS-CoV-2 Genomic Surveillance in Brazil: A Systematic Review with Scientometric Analysis

Several studies have monitored the SARS-CoV-2 variants in Brazil throughout the pandemic. Here, we systematically reviewed and conducted a scientometric analysis of the SARS-CoV-2 genomic surveillance studies using Brazilian samples. A Pubmed database search on October 2022 returned 492 articles, of which 106 were included. Ninety-six different strains were reported, with variant of concern (VOC) gamma (n = 35,398), VOC delta (n = 15,780), and the variant of interest zeta (n = 1983) being the most common. The top three states with the most samples in the published articles were São Paulo, Rio de Janeiro, and Minas Gerais. Whereas the first year of the pandemic presented primary circulation of B.1.1.28 and B.1.1.33 variants, consecutive replacements were observed between them and VOI zeta, VOC gamma, VOC delta, and VOC omicron. VOI mu, VOI lambda, VOC alpha, and VOC beta were also detected but failed to reach significant circulation. Co-infection, re-infection, and vaccine breakthrough reports were found. Article co-citation differed from the co-authorship structure. Despite the limitations, we expect to give an overview of Brazil's genomic surveillance studies and contribute to future research execution.

Life expectancy changes since COVID-19

The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in western Europe experienced bounce backs from life expectancy losses of 2020, eastern Europe and the United States witnessed sustained and substantial life expectancy deficits. Life expectancy deficits during fall/winter 2021 among people ages 60+ and <60 were negatively correlated with measures of vaccination uptake across countries (r60+ = -0.86; two-tailed P < 0.001; 95% confidence interval, -0.94 to -0.69; r<60 = -0.74; two-tailed P < 0.001; 95% confidence interval, -0.88 to -0.46). In contrast to 2020, the age profile of excess mortality in 2021 was younger, with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.

[Life expectancy and Covid: Setting the record straight]

Life expectancy (LE) is an objective and highly reliable marker for events affecting demography. Analysing LE changes during the Covid pandemic shows widely different situations in a sample of 29 countries, highlighting comparatively efficient management in most Western European countries, in contrast to catastrophic results in Eastern Europe and in the United States. Loss of LE is also inversely correlated with vaccination uptake, confirming the efficacy of vaccines at the population level.

Is life expectancy higher in countries and territories with publicly funded health care? Global analysis of health care access and the social determinants of health

Background

To better understand factors influencing life expectancy, this paper examines how the availability of publicly funded health care in a country and multiple social determinants of health impact longevity of life.

Methods

In this descriptive statistical analysis, data regarding publicly funded health care, life expectancy, and social determinants of health were obtained for 196 countries and 4 territories. Social determinants included 10 indicators detailing country-level information to represent 5 key categories: economic stability, education, health & health care, neighbourhood & built environment, and social & community context. Analyses consisted of: 1) comparison of mean life expectancy among countries and territories with- and without- publicly funded health care; 2) correlations in life expectancy across social determinants by health care access and level of burden; and 3) correlations in life expectancy within social determinants for health care access by level of burden.

Results

Overall, life expectancy in countries and territories with- publicly funded health care (Mean (m) = 76.7 years) was significantly longer compared to countries and territories without- publicly funded health care (m = 66.8 years, P < 0.0001). For each social determinant, we observed longer life expectancy continued to be associated with publicly funded health care access across stratum (P < 0.0001), but difference in years of life expectancy existed both by burden of social determinant, as well as access to health care within quartiles of burden (Publicly funded care (yes): 68.12-80.88 years, (no): 62.39-77.33 years, all P < 0.05). Both social determinants as well as the availability of publicly funded health care were individually and simultaneously associated with mean longevity of life between countries and territories worldwide.

Conclusions

These findings demonstrate how, if made widely available, publicly funded health care could extend longevity of life. If combined with programs to reduce the burden of social determinants, a substantial impact can be made to promote more equitable distribution of life expectancies across the world. Ultimately, both access to publicly funded care and reducing inequalities in social determinants are needed in order to promote longer and healthier aging in populations worldwide.

Are COVID-19 age-mortality curves for 2020 flatter in developing countries? Evidence from a cross-sectional observational study of population-level official death counts and excess deaths estimates

OBJECTIVES

Previous studies have found a pattern of flatter COVID-19 age-mortality curves among low-income and middle-income countries (LMICs) using only official COVID-19 death counts. This study examines this question by comparing the age gradient of COVID-19 mortality in a broad set of countries using both official COVID-19 death counts and excess mortality estimates for 2020.

DESIGN

This observational study uses official COVID-19 death counts for 76 countries and excess death estimates for 42 countries. A standardised population analysis was conducted to assess the extent to which variation across countries in the age distribution of COVID-19 deaths was driven by variation in the population age distribution.

SETTING AND PRIMARY OUTCOMES

Officially reported COVID-19 deaths and excess deaths for 2020 for all countries where such data were available in the COVerAGE database and the short-term mortality fluctuations harmonised data series, respectively.

RESULTS

A higher share of pandemic-related deaths in 2020 occurred at younger ages in middle-income countries compared with high-income countries. People under age 65 years constituted on average (1) 10% of official deaths and 11 % of excess deaths in high-income countries, (2) 34% of official deaths and 33% of excess deaths in upper-middle-income countries, and (3) 54% of official deaths in LMICs. These contrasting profiles are due only in part to differences in population age structure.

CONCLUSIONS

These findings are driven by some combination of variation in age patterns of infection rates and infection fatality rates. They indicate that COVID-19 is not just a danger to older people in developing countries, where a large share of victims are people of working age, who are caregivers and breadwinners for their families.

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Objective

This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed.

Methodology

Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances.

Results

In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence.

Conclusion

The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.

Years of life lost during the Covid-19 pandemic in Sweden considering variation in life expectancy by level of geriatric care

The Covid-19 pandemic has not affected the population evenly. This must be acknowledged when it comes to understanding the Covid-19 death toll and answering the question of how many life years have been lost. We use level of geriatric care to account for variation in remaining life expectancy among individuals that died during 2020. Based on a linkage of administrative registers, we estimate remaining life expectancy stratified by age, sex, and care status using an incidence-based multistate model and analyze the number of years of life lost (YLL) during 2020 in Sweden. Our results show that remaining life expectancy between individuals with and without care differs substantially. More than half of all Covid-19 deaths had a remaining life expectancy lower than 4 years. Yet, in a 1-year perspective, Covid-19 did not seem to replace other causes of death. Not considering the differences in remaining life expectancy in the affected populations overestimated YLL by 40% for women and 30% for men, or around 2 years per death. While the unadjusted YLL from Covid-19 amounted to an average of 7.5 years for women and 8.6 years for men, the corresponding YLL adjusted for care status were 5.4 and 6.6, respectively. The total number of YLL to Covid-19 in 2020 is comparable to YLL from ischemic heart disease in 2019 and 2020. Our results urge the use of subgroup specific mortality when counting the burden of Covid-19. YLL are considerably reduced when the varying susceptibility for death is considered, but even if most lifespans were cut in the last years of life, the YLL are still substantial.

Machine learning and comorbidity network analysis for hospitalized patients with COVID-19 in a city in Southern Brazil

The large amount of data generated during the COVID-19 pandemic requires advanced tools for the long-term prediction of risk factors associated with COVID-19 mortality with higher accuracy. Machine learning (ML) methods directly address this topic and are essential tools to guide public health interventions. Here, we used ML to investigate the importance of demographic and clinical variables on COVID-19 mortality. We also analyzed how comorbidity networks are structured according to age groups. We conducted a retrospective study of COVID-19 mortality with hospitalized patients from Londrina, Parana, Brazil, registered in the database for severe acute respiratory infections (SIVEP-Gripe), from January 2021 to February 2022. We tested four ML models to predict the COVID-19 outcome: Logistic Regression, Support Vector Machine, Random Forest, and XGBoost. We also constructed a comorbidity network to investigate the impact of co-occurring comorbidities on COVID-19 mortality. Our study comprised 8358 hospitalized patients, of whom 2792 (33.40%) died. The XGBoost model achieved excellent performance (ROC-AUC = 0.90). Both permutation method and SHAP values highlighted the importance of age, ventilatory support status, and intensive care unit admission as key features in predicting COVID-19 outcomes. The comorbidity networks for old deceased patients are denser than those for young patients. In addition, the co-occurrence of heart disease and diabetes may be the most important combination to predict COVID-19 mortality, regardless of age and sex. This work presents a valuable combination of machine learning and comorbidity network analysis to predict COVID-19 outcomes. Reliable evidence on this topic is crucial for guiding the post-pandemic response and assisting in COVID-19 care planning and provision.

Unequal impact of the COVID-19 pandemic in 2020 on life expectancy across urban areas in Chile: a cross-sectional demographic study

OBJECTIVES

To quantify the impact of the COVID-19 pandemic on life expectancy in Chile categorised by rural and urban areas, and to correlate life expectancy changes with socioeconomic factors at the municipal level.

DESIGN

Retrospective cross-sectional demographic analysis using aggregated national all-cause death data stratified by year, sex and municipality during the period 2010-2020.

SETTING AND POPULATION

Chilean population by age, sex and municipality from 2002 to 2020.

MAIN OUTCOME MEASURES

Stratified mortality rates using a Bayesian methodology. These were based on vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for males and females and analysed previous mortality trends since 2010.

RESULTS

Life expectancy declined for both males and females in 2020 compared with 2019. Urban areas were the most affected, with males losing 1.89 years and females 1.33 years. The strength of the decline in life expectancy correlated positively with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities.

CONCLUSIONS

Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.

Ratiometric fluorescence immunoassay of SARS-CoV-2 nucleocapsid protein via Si-FITC nanoprobe-based inner filter effect

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has necessitated rapid, easy-to-use, and accurate diagnostic methods to monitor the virus infection. Herein, a ratiometric fluorescence enzyme-linked immunosorbent assay (ELISA) was developed using Si-fluorescein isothiocyanate nanoparticles (FITC NPs) for detecting SARS-CoV-2 nucleocapsid (N) protein. Si-FITC NPs were prepared by a one-pot hydrothermal method using 3-aminopropyl triethoxysilane (APTES)-FITC as the Si source. This method did not need post-modification and avoided the reduction in quantum yield and stability. The p-nitrophenyl (pNP) produced by the alkaline phosphatase (ALP)-mediated hydrolysis of p-nitrophenyl phosphate (pNPP) could quench Si fluorescence in Si-FITC NPs via the inner filter effect. In ELISA, an immunocomplex was formed by the recognition of capture antibody/N protein/reporter antibody. ALP-linked secondary antibody bound to the reporter antibody and induced pNPP hydrolysis to specifically quench Si fluorescence in Si-FITC NPs. The change in fluorescence intensity ratio could be used for detecting N protein, with a wide linearity range (0.01-10.0 and 50-300 ng/mL) and low detection limit (0.002 ng/mL). The concentration of spiked SARS-CoV-2 N protein could be determined accurately in human serum. Moreover, this proposed method can accurately distinguish coronavirus disease 2019 (COVID-19) and non-COVID-19 patient samples. Therefore, this simple, sensitive, and accurate method can be applied for the early diagnosis of SARS-CoV-2 virus infection.

Electronic Supplementary Material

Supplementary material (characterization of Si-FITC NPs (FTIR spectrum, XRD spectra, and synchronous fluorescence spectra); condition optimization of ALP response (fluorescence intensity ratio change); mechanism investigation of ALP response (fluorescence lifetime decay curves and UV-vis absorption spectra); detection of N protein using commercial ELISA Kit; analytical performance of assays for ALP detection or SARS-CoV-2 N protein detection; and determination results of SARS-CoV-2 N protein in human serum) is available in the online version of this article at 10.1007/s12274-022-4740-5.

Correlation between human development index and its components with COVID-19 indices: a global level ecologic study

Background

Given that COVID-19 continues to spread worldwide, attempts to restrain the virus and to prevent the effects that critically ill patients with COVID-19 have on healthcare systems, has become a public health priority. This ecological study aimed to investigate the correlation between the Human Development Index (HDI) and the epidemiological indicators of COVID-19, including the cumulative incidence rate of cases, the cumulative incidence rate of death, performed COVID-19 tests per million, recovery rate, and case fatality rate.

Methods

In this ecological study, a data set was provided, which included the epidemiologic indices of COVID-19, HDI, and its components for each country. Correlation coefficients were used to determine linear correlation. Also, the scatter plots of the HDI for the studied countries based on the epidemiologic indices of COVID-19 were drawn.

Results

This study showed that HDI and its components had positive correlation with a cumulative incidence rate of cases, the cumulative incidence rate of death, and performed COVID-19 tests (p < 0.001). HDI and two of its components, including literacy and Gross National Income (GNI) components had negative correlation with case fatality rate (CFR). Also, HDI and two of its components, including literacy and life expectancy components had negative correlation with recovery rate.

Conclusion

Our study showed that the HDI and its components can affect the epidemiological status of COVID-19. As HDI increased, the cumulative incidence rate of cases, cumulative incidence rate of death, and COVID-19 tests increased as well. As HDI increased, CFR and recovery rate decreased as well. Although the HDI is higher in high-income countries, these countries may have also better reporting and surveillance systems.

Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil

BACKGROUND

Physical distancing associated with the COVID-19 pandemic may lead to suboptimal maternal mental health, social support after birth, and infant feeding practices.

RESEARCH AIMS

To compare breastfeeding prevalence in participants who were pregnant at a time when strict physical distancing measures were imposed in Fortaleza, the capital of Ceará state, Brazil, with the pre-pandemic breastfeeding levels, and to assess the association of breastfeeding prevalence with maternal common mental disorders, and sociodemographic and health predictors.

METHOD

A cross-sectional prospective two-group comparison design using two population-based surveys was carried out in Fortaleza before and after the pandemic. Participants (n = 351) who had a live birth in Fortaleza in July or August 2020, and participants (n = 222) who had a child younger than 12 months in 2017 were surveyed. Crude and adjusted multinomial logistic regressions with robust variance were used to estimate risk ratios and 95% confidence intervals (CI).

RESULTS

Similar prevalence of exclusive breastfeeding were observed in 2021 (8.1%) and 2017 (8.5%; p = .790). An increase in predominant (2.2% vs. 13.4%; p < .001) and a decrease in complementary breastfeeding (64.0% vs. 48.4%; p = .037) was observed in 2021, compared to 2017. The prevalence of maternal common mental disorders also increased in 2021 (17.6% vs. 32.5%, p < .001). No statistically significant associations were found between breastfeeding patterns, maternal common mental disorders, and other predictors in 2017 or 2021.

CONCLUSIONS

Participants who delivered during the COVID-19 pandemic delayed solid foods introduction and breastfed predominantly longer than participants during the pre-pandemic period. While common mental disorders significantly increased, they were not associated with differences in breastfeeding.

Masculinidades y salud de los hombres en la Región de las Américas

Objetivo.

Describir los resultados en salud de los hombres a partir del análisis sobre la interrelación de estos con las masculinidades, que permitirá la identificación de acciones para mejorar los resultados de salud de hombres, mujeres y niños.

Métodos.

Actualización y expansión de los hallazgos del informe Masculinidades y Salud en las Américas publicado por la Organización Panamericana de la Salud en el 2019, el cual se realizó a partir de una búsqueda intencionada y actualizada de datos secundarios sobre la salud masculina y otras investigaciones que abordan la temática.

Resultados.

La salud de los hombres y de las mujeres es distinta, no solo por los factores biológicos, sino también por la construcción y las desigualdades de género, y la intersección de los determinantes sociales. Existen importantes diferencias en los patrones de mortalidad y morbilidad por sexo a lo largo del curso de vida, incluida la sobremortalidad de los hombres por causas prevenibles como las muertes violentas, los accidentes viales y el consumo de alcohol y otras drogas (cocaína, cannabis y anfetaminas, entre otras). Varias de las causas de la mortalidad y la morbilidad se encuentran vinculadas con la expresión del modelo hegemónico de masculinidad y esto representa un riesgo para la salud integral de los hombres y para las personas cercanas.

Conclusiones.

Proponemos que se deben políticas coordinadas e intersectoriales con perspectiva de género relacional e interseccional que incluyan a los hombres para generar acciones de salud en todas las políticas para la diversidad de hombres con consecuencias positivas también para niños, adolescentes y mujeres.

Quantifying political influence on COVID-19 fatality in Brazil

The COVID-19 pandemic was severely aggravated in Brazil due to its politicization by the country’s federal government. However, the impact of diffuse political forces on the fatality of an epidemic is notoriously difficult to quantify. Here we introduce a method to measure this effect in the Brazilian case, based on the inhomogeneous distribution throughout the national territory of political support for the federal government. This political support is quantified by the voting rates in the last general election in Brazil. This data is correlated with the fatality rates by COVID-19 in each Brazilian state as the number of deaths grows over time. We show that the correlation between fatality rate and political support grows as the government’s misinformation campaign is developed. This led to the dominance of such political factor for the pandemic impact in Brazil in 2021. Once this dominance is established, this correlation allows for an estimation of the total number of deaths due to political influence as 350±70 thousand up to the end of 2021, corresponding to (57±11)% of the total number of deaths.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina

OBJECTIVE

To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020.

METHODS

Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used.

RESULTS

A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario.

CONCLUSION

The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.

Privacy and Health Practices in the Digital Age

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy is being frequently dismissed as outdated, costly and ultimately egotistical. This paper aims to review the theoretical framework on privacy in order to overcome the often simplistic debate between the primacy of individual or collective interests. As a result, it is argued that although privacy can be understood as freedom of personal choice in matters of sharing intimacy, it is foundational to both community belonging and to social and political organizations at large. Ethical decisions on the use of data analytics technologies in health practices should also take into account the social effects of violating privacy.

[Changes in the pattern of COVID-19 hospitalizations and deaths after substantial vaccination of the elderly in Manaus, Amazonas State, Brazil]

The impact of COVID-19 vaccination in the elderly has received relatively little attention, particularly in a scenario predominated by the gamma variant. The aim of this study was to assess vaccination coverage and its relationship to changes in the pattern of COVID-19 hospitalizations and deaths in the elderly in Manaus, Amazonas State, Brazil. This was an ecological study with Brazilian Ministry of Health data on hospitalizations and deaths, assessing vaccination coverage based on a two-dose regimen, in addition to two vaccination regimens associated with a significant protective effect, one partial (35 days or more after the first dose of the Oxford/AstraZeneca vaccine) and the other complete (14 days or more after the second dose of the Sinovac-CoronaVac vaccine). Based on the date of initial symptoms, patterns of COVID-19 hospitalizations and deaths were assessed comparatively in elderly 60-69 years and 70 years or more in two groups of Epidemiological Weeks (EW) in 2020 (unvaccinated) and 2021 (vaccinated). Hospitalization and death rates were estimated with Poisson regression. In the groups 60-69 and 70 years or more, vaccination coverage rates were 41.8% and 54.8%, as well as 53.5% and 90.1%, in the EW groups 18-20/2021 and 21-23/2021, respectively. Both EW groups in 2021 showed a substantial change in the patterns of COVID-19 hospitalizations and deaths, with an increase in the risk of hospitalization and death in unvaccinated younger individuals and an important reduction in vaccinated elderly, especially those 60-69 years of age, besides overall reductions of 62% (95%CI: 52-69) and 63% (95%CI: 43-75) in hospitalization and death rates, respectively. Our results emphasize the importance of mass vaccination, especially during an epidemic such as in Manaus, marked by high circulation of the gamma variant.

Effect of COVID-19 Epidemic on Life Expectancy and Years of Life Lost in Iran: A Secondary Data Analysis

Background

The COVID-19 pandemic has caused a significant number of deaths in many countries around the world. This study provides an estimate of the effect of the COVID-19 epidemic on life expectancy and years of life lost (YLL) in Iran.

Methods

This study is a secondary data analysis carried out in 2020. Mortality data from COVID-19 were obtained from the Ministry of Health and Medical Education. Since the calculation of mortality rates requires the number of people at risk of death, this data was obtained from the Statistics Center of Iran and was used after a detailed evaluation. The effect of COVID-19 on mortality is evaluated using the techniques of a multi-decrement life table and the corresponding single-reduction life table. The YLL is calculated using the standard method provided by the World Health Organization.

Results

Analysis of mortality data showed that deaths due to COVID-19 could reduce life expectancy at birth by 1.4 years in 2020. Therefore, life expectancy at birth declined from 75.1 years to 73.7 years. Furthermore, the deaths due to COVID-19 from the outbreak to early February 2021 have caused about 800,000 years of YLL, which is almost as much as the YLL caused by cancers and tumors.

Conclusion

A decrease in life expectancy at birth by more than one year in countries with a life expectancy of over 70 years, such as Iran, can delay the increase in life expectancy for several years.

Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.

Coronavirus disease-related in-hospital mortality: a cohort study in a private healthcare network in Brazil

COVID-19-related in-hospital mortality has been reported at 30.7–47.3% in Brazil, however studies assessing exclusively private hospitals are lacking. This is important because of significant differences existing between the Brazilian private and public healthcare systems. We aimed to determine the COVID-19-related in-hospital mortality and associated risk factors in a Brazilian private network from March/2020 to March/2021. Data were extracted from institutional database and analyzed using Cox regression model. Length of hospitalization and death-related factors were modeled based on available independent variables. In total, 38,937 COVID-19 patients were hospitalized of whom 3058 (7.8%) died. Admission to the intensive care unit occurred in 62.5% of cases, and 11.5% and 3.8% required mechanical ventilation (MV) and renal replacement therapy (RRT), respectively. In the adjusted model, age ≥ 61 years-old, comorbidities, and the need for MV and/or RRT were significantly associated with increased mortality (p < 0.05). Obesity and hypertension were associated with the need for MV and RRT (p < 0.05).

The 90 plus: longevity and COVID-19 survival

The world population is getting older and studies aiming to enhance our comprehension of the underlying mechanisms responsible for health span are of utmost interest for longevity and as a measure for health care. In this review, we summarized previous genetic association studies (GWAS) and next-generation sequencing (NGS) of elderly cohorts. We also present the updated hypothesis for the aging process, together with the factors associated with healthy aging. We discuss the relevance of studying older individuals and build databanks to characterize the presence and resistance against late-onset disorders. The identification of about 2 million novel variants in our cohort of more than 1000 elderly Brazilians illustrates the importance of studying highly admixed populations of non-European ancestry. Finally, the ascertainment of nonagenarians and particularly of centenarians who were recovered from COVID-19 or remained asymptomatic opens new avenues of research aiming to enhance our comprehension of biological mechanisms associated with resistance against pathogens.

Proposing Causal Sequence of Death by Neural Machine Translation in Public Health Informatics

Each year there are nearly 57 million deaths worldwide, with over 2.7 million in the United States. Timely, accurate and complete death reporting is critical for public health, especially during the COVID-19 pandemic, as institutions and government agencies rely on death reports to formulate responses to communicable diseases. Unfortunately, determining the causes of death is challenging even for experienced physicians. The novel coronavirus and its variants may further complicate the task, as physicians and experts are still investigating COVID-related complications. To assist physicians in accurately reporting causes of death, an advanced Artificial Intelligence (AI) approach is presented to determine a chronically ordered sequence of conditions that lead to death (named as the causal sequence of death), based on decedent’s last hospital discharge record. The key design is to learn the causal relationship among clinical codes and to identify death-related conditions. There exist three challenges: different clinical coding systems, medical domain knowledge constraint, and data interoperability. First, we apply neural machine translation models with various attention mechanisms to generate sequences of causes of death. We use the BLEU (BiLingual Evaluation Understudy) score with three accuracy metrics to evaluate the quality of generated sequences. Second, we incorporate expert-verified medical domain knowledge as constraints when generating the causal sequences of death. Lastly, we develop a Fast Healthcare Interoperability Resources (FHIR) interface that demonstrates the usability of this work in clinical practice. Our results match the state-of-art reporting and can assist physicians and experts in public health crisis such as the COVID-19 pandemic.

Global and National Declines in Life Expectancy: An End-of-2021 Assessment

Timely, high-quality mortality data have allowed for assessments of the impact of the novel coronavirus disease 2019 (COVID-19) on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by 0.92 years between 2019 and 2020 and by another 0.72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed on rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the acquired immunodeficiency syndrome (AIDS) pandemic.

Deciphering Multifactorial Correlations of COVID-19 Incidence and Mortality in the Brazilian Amazon Basin

Amazonas suffered greatly during the COVID-19 pandemic. The mortality and fatality rates soared and scarcity of oxygen and healthcare supplies led the health system and funerary services to collapse. Thus, we analyzed the trends of incidence, mortality, and lethality indicators of COVID-19 and the dynamics of their main determinants in the state of Amazonas from March 2020 to June 2021. This is a time-series ecological study. We calculated the lethality, mortality, and incidence rates with official and public data from the Health Department. We used the Prais-Winsten regression and trends were classified as stationary, increasing, or decreasing. The effective reproduction number (Rt) was also estimated. Differences were considered significant when p < 0.05. We extracted 396,772 cases of and 13,420 deaths from COVID-19; 66% of deaths were in people aged over 60; 57% were men. Cardiovascular diseases were the most common comorbidity (28.84%), followed by diabetes (25.35%). Rural areas reported 53% of the total cases and 31% of the total deaths. The impact of COVID-19 in the Amazon is not limited to the direct effects of the pandemic itself; it may present characteristics of a syndemic due to the interaction of COVID-19 with pre-existing illnesses, endemic diseases, and social vulnerabilities.