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Petit MP, Ouellette N, Bourbeau R. The case for counting multiple causes of death in the COVID-19 era. Int J Epidemiol 2024; 53:dyad149. [PMID: 37930034 DOI: 10.1093/ije/dyad149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Marie-Pier Petit
- Department of Demography, Université de Montréal, Montreal, QC, Canada
| | - Nadine Ouellette
- Department of Demography, Université de Montréal, Montreal, QC, Canada
| | - Robert Bourbeau
- Department of Demography, Université de Montréal, Montreal, QC, Canada
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2
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Han C, Jang H, Oh J. Excess mortality during the Coronavirus disease pandemic in Korea. BMC Public Health 2023; 23:1698. [PMID: 37660007 PMCID: PMC10474701 DOI: 10.1186/s12889-023-16546-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Although the ongoing epidemics of Coronavirus disease 2019 (COVID-19) may have affected the mortality trend of the nation, the national level assessment of excess mortality (changes in overall mortality in the entire population) is still scarce in Korea. Therefore, this study evaluated the excess mortality during the COVID-19 pandemic in Korea using the certified mortality data. METHODS Monthly mortality and population data from January 2013 to June 2022 was obtained from the National Health Insurance Service database and Statistics Korea. A quasi-Poisson interrupted time-series model adjusted for age structure, population, seasonality, and long-term trends was used to estimate the counterfactual projections (expected) of mortality during the COVID-19 pandemic (March 2020 to June 2022). The absolute difference (observed-expected) and ratio (observed / expected) of mortality were calculated. Stratified analysis based on pandemic years (years 2020, 2021, and 2022), sex, and age groups (aged 0-4, 5-19, 20-64, and ≥ 65 years) were conducted. RESULTS An 8.7% increase in mortality was observed during the COVID-19 pandemic [absolute difference: 61,277 persons; ratio (95% confidence interval (CI)): 1.087 (1.066, 1.107)]. The gap between observed and estimated mortality became wider with continuation of the pandemic [ratio (95% CI), year 2020: 1.021 (1.003, 1.040); year 2021: 1.060 (1.039, 1.080), year 2022: 1.244 (1.219, 1.270)]. Although excess mortality across sex was similar, the adult [aged 20-64, ratio (95% CI): 1.059 (1.043, 1.076)] and elderly [aged 65-, ratio (95% CI): 1.098 (1.062, 1.135)] population showed increased excess mortality during the pandemic. CONCLUSIONS Despite Korea's successful quarantine policy response, the continued epidemic has led to an excess mortality. The estimated mortality exceeded the number of deaths from COVID-19 infection. Excess mortality should be monitored to estimate the overall impact of the pandemic on a nation.
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Affiliation(s)
- Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, 266, Munhwa-Ro, Jung-Gu, Daejeon, 35015, Korea.
| | - Hoyeon Jang
- Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Korea
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Fedeli U, Amidei CB, Casotto V, Schievano E, Zoppini G. Excess diabetes-related deaths: The role of comorbidities through different phases of the COVID-19 pandemic. Nutr Metab Cardiovasc Dis 2023; 33:1709-1715. [PMID: 37407311 PMCID: PMC10228157 DOI: 10.1016/j.numecd.2023.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIMS Diabetes confers an excess risk of death to COVID-19 patients. Causes of death are now available for different phases of the pandemic, encompassing different viral variants and COVID-19 vaccination. The aims of the present study were to update multiple causes of death data on diabetes-related mortality during the pandemic and to estimate the impact of common diabetic comorbidities on excess mortality. METHODS AND RESULTS Diabetes-related deaths in 2020-2021 were compared with the 2018-2019 average; furthermore, age-standardized rates observed during the pandemic were compared with expected figures obtained from the 2008-2019 time series through generalized estimating equation models. Changes in diabetes mortality associated with specific comorbidities were also computed. Excess diabetes-related mortality was +26% in 2020 and +18% in 2021, after the initiation of the vaccination campaign. The presence of diabetes and hypertensive diseases was associated with the highest mortality increase, especially in subjects aged 40-79 years, +41% in 2020 and +30% in 2021. CONCLUSION The increase in diabetes-related deaths exceeded that observed for all-cause mortality, and the risk was higher when diabetes was associated with hypertensive diseases. Notably, the excess mortality decreased in 2021, after the implementation of vaccination against COVID-19.
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Affiliation(s)
- Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | | | - Veronica Casotto
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Elena Schievano
- Department of Epidemiology, Azienda Zero, Veneto Region, Padua, Italy
| | - Giacomo Zoppini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Torres MJ, Coste J, Canouï-Poitrine F, Pouchot J, Rachas A, Carcaillon-Bentata L. Impact of the First COVID-19 Pandemic Wave on Hospitalizations and Deaths Caused by Geriatric Syndromes in France: A Nationwide Study. J Gerontol A Biol Sci Med Sci 2023; 78:1612-1626. [PMID: 36702778 DOI: 10.1093/gerona/glad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people's lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. METHODS The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. RESULTS Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from -59% for incontinence to -13% for femoral neck fractures). A dose-response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. CONCLUSIONS In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults' health.
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Affiliation(s)
- Marion J Torres
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Joël Coste
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Antoine Rachas
- Department of Strategy, Studies and Statistics, French National Health Insurance (Cnam), Paris, France
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Fedeli U, Barbiellini Amidei C, Marcon A, Casotto V, Grippo F, Grande E, Gaisl T, Barco S. Mortality Related to Chronic Obstructive Pulmonary Disease during the COVID-19 Pandemic: An Analysis of Multiple Causes of Death through Different Epidemic Waves in Veneto, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912844. [PMID: 36232144 PMCID: PMC9565127 DOI: 10.3390/ijerph191912844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/12/2023]
Abstract
Mortality related to chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic is possibly underestimated by sparse available data. The study aimed to assess the impact of the pandemic on COPD-related mortality by means of time series analyses of causes of death data. We analyzed the death certificates of residents in Veneto (Italy) aged ≥40 years from 2008 to 2020. The age-standardized rates were computed for COPD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple cause of death-MCOD). The annual percent change (APC) in the rates was estimated for the pre-pandemic period. Excess COPD-related mortality in 2020 was estimated by means of Seasonal Autoregressive Integrated Moving Average models. Overall, COPD was mentioned in 7.2% (43,780) of all deaths. From 2008 to 2019, the APC for COPD-related mortality was -4.9% (95% CI -5.5%, -4.2%) in men and -3.1% in women (95% CI -3.8%, -2.5%). In 2020 compared to the 2018-2019 average, the number of deaths from COPD (UCOD) declined by 8%, while COPD-related deaths (MCOD) increased by 14% (95% CI 10-18%), with peaks corresponding to the COVID-19 epidemic waves. Time series analyses confirmed that in 2020, COPD-related mortality increased by 16%. Patients with COPD experienced significant excess mortality during the first year of the pandemic. The decline in COPD mortality as the UCOD is explained by COVID-19 acting as a competing cause, highlighting how an MCOD approach is needed.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | | | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Fedeli U, Casotto V, Schievano E, Bonora E, Zoppini G. Diabetes as a cause of death across different COVID-19 epidemic waves. Diabetes Res Clin Pract 2022; 190:109984. [PMID: 35803315 PMCID: PMC9258691 DOI: 10.1016/j.diabres.2022.109984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this study is to assess the role of diabetes as a cause of death through different epidemic waves of COVID-19. METHODS The annual percentage change in age-standardized rates (APC) was estimated for diabetes as the underlying (UCOD) and as multiple causes of death (MCOD) in 2008-2019. Diabetes-related deaths in 2020 were compared to the 2018-2019 average. SARIMA models were applied to monthly excess in mortality considering seasonality and long-term trends. RESULTS 2018-2019-Age-standardized mortality rates decreased, especially among females (MCOD: APC -2.49, 95%CI -3.01/-1.97%). In 2020, deaths increased by 19% (95%CI 13-25%) for UCOD, and by 27% (95%CI 24-30%) for MCOD. Diabetes and COVID-19 accounted for 74% of such excess. During the first epidemic wave, the increase in observed rates vs predicted by the model was larger in males (March +39%, April +46%) than in females (+30% and +32%). In the second wave, a huge excess of similar magnitude was observed in the two sexes; rates in December exceeded those predicted by more than 100%. CONCLUSIONS The COVID-19 pandemic abruptly interrupted a long-term declining trend in mortality associated to diabetes. MCOD analyses are warranted to fully estimate the impact of epidemic waves on diabetes-related mortality.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | | | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Italy
| | - Enzo Bonora
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Giacomo Zoppini
- Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Grant WB, Boucher BJ. An Exploration of How Solar Radiation Affects the Seasonal Variation of Human Mortality Rates and the Seasonal Variation in Some Other Common Disorders. Nutrients 2022; 14:2519. [PMID: 35745248 PMCID: PMC9228654 DOI: 10.3390/nu14122519] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Many diseases have large seasonal variations in which winter overall mortality rates are about 25% higher than in summer in mid-latitude countries, with cardiovascular diseases and respiratory infections and conditions accounting for most of the variation. Cancers, by contrast, do not usually have pronounced seasonal variations in incidence or mortality rates. This narrative review examines the epidemiological evidence for seasonal variations in blood pressure, cardiovascular disease rates and respiratory viral infections in relation to atmospheric temperature and humidity, and solar UV exposure through vitamin D production and increased blood concentrations of nitric oxide. However, additional mechanisms most likely exist by which solar radiation reduces the risk of seasonally varying diseases. Some studies have been reported with respect to temperature without considering solar UV doses, although studies regarding solar UV doses, such as for respiratory infections, often consider whether temperature can affect the findings. More research is indicated to evaluate the relative effects of temperature and sun exposure on the seasonality of mortality rates for several diseases. Since solar ultraviolet-B (UVB) doses decrease to vanishingly small values at higher latitudes in winter, the use of safe UVB lamps for indoor use in winter may warrant consideration.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
| | - Barbara J. Boucher
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
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