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Hardy ST, Fontil V, Dillon GH, Shimbo D. Achieving Equity in Hypertension: A Review of Current Efforts by the American Heart Association. Hypertension 2024; 81:2218-2227. [PMID: 39229721 DOI: 10.1161/hypertensionaha.124.20533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels.
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Affiliation(s)
- Shakia T Hardy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (S.T.H.)
| | - Valy Fontil
- Institute for Excellence in Health Equity, Grossman School of Medicine, New York University, New York, NY (V.F.)
- Family Health Centers at New York University Langone Health, Brooklyn, NY (V.F.)
| | - Glenn H Dillon
- Division of Research and Grants Administration, American Heart Association, Dallas, TX (G.H.D.)
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY (D.S.)
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2
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Ravaioli F, Brodosi L, Agnelli G, Albanese MG, Baldo C, Baracco B, Lambertini L, Leoni L, Magnani L, Nicastri A, Perazza F, Rossetti C, Sacilotto F, Stecchi M, Sasdelli AS, Pironi L. Malnutrition independently predicts mortality at 18 months in patients hospitalised for severe acute respiratory syndrome corona virus 2 (SARS-coV-2). Clin Nutr ESPEN 2024; 63:736-747. [PMID: 39074610 DOI: 10.1016/j.clnesp.2024.07.022] [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: 03/31/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Abstract
RATIONALE To investigate the association between malnutrition and patient outcome following hospitalisation for Corona Virus Disease 2019 (COVID-19). METHODS In April 2020, 268 adult patients (235 included in the follow-up) hospitalised for COVID-19 infection were evaluated for malnutrition risk and diagnosis using modified Nutritional Risk Screening 2002 and modified Global Leadership Initiative on Malnutrition criteria (GLIM), respectively. An 18-month follow-up was carried out to assess the incidence and the associated risk factors for death and re-hospitalization. RESULTS The outcome was unknown for 33 patients. Death occurred in 39% of the 235 patients included in the follow-up. The risk of death was independently associated with malnutrition risk or diagnosis of malnutrition, whereas the male sex showed a protective association. The Kaplan-Meier survival curves showed that patients with diagnosis of malnutrition had lower survival rate. The re-hospitalization rate was 31% and was negatively associated with BMI≥25, and positively associated with length of hospitalisation for COVID-19 and with cancer comorbidity. CONCLUSIONS In hospitalized patients for SARS-CoV-2 disease, both malnutrition risk (p = 0.050) and diagnosis of malnutrition (p = 0.047 with modified GLIM and C-reactive protein >0.5 mg/dL; p = 0.024 with modified GLIM and C-reactive protein >5 mg/dL) were predictive risk factors for mortality, whereas male sex was associated with lower risk of death. Overweight at time of hospitalization and the length of hospitalisation were respectively protective and risk factor for re-hospitalization after discharge.
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Affiliation(s)
- Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lucia Brodosi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Giulio Agnelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Maria Giuseppina Albanese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Chiara Baldo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Bianca Baracco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lorenza Lambertini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Laura Leoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lucia Magnani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Alba Nicastri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Federica Perazza
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Chiara Rossetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Federica Sacilotto
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Michele Stecchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | | | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
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Sukumaran R, Nair AS, Banerjee M. Ethnic and region-specific genetic risk variants of stroke and its comorbid conditions can define the variations in the burden of stroke and its phenotypic traits. eLife 2024; 13:RP94088. [PMID: 39268810 PMCID: PMC11398864 DOI: 10.7554/elife.94088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Burden of stroke differs by region, which could be attributed to differences in comorbid conditions and ethnicity. Genomewide variation acts as a proxy marker for ethnicity, and comorbid conditions. We present an integrated approach to understand this variation by considering prevalence and mortality rates of stroke and its comorbid risk for 204 countries from 2009 to 2019, and Genome-wide association studies (GWAS) risk variant for all these conditions. Global and regional trend analysis of rates using linear regression, correlation, and proportion analysis, signifies ethnogeographic differences. Interestingly, the comorbid conditions that act as risk drivers for stroke differed by regions, with more of metabolic risk in America and Europe, in contrast to high systolic blood pressure in Asian and African regions. GWAS risk loci of stroke and its comorbid conditions indicate distinct population stratification for each of these conditions, signifying for population-specific risk. Unique and shared genetic risk variants for stroke, and its comorbid and followed up with ethnic-specific variation can help in determining regional risk drivers for stroke. Unique ethnic-specific risk variants and their distinct patterns of linkage disequilibrium further uncover the drivers for phenotypic variation. Therefore, identifying population- and comorbidity-specific risk variants might help in defining the threshold for risk, and aid in developing population-specific prevention strategies for stroke.
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Affiliation(s)
- Rashmi Sukumaran
- Human Molecular Genetics Laboratory, Rajiv Gandhi Centre for BiotechnologyThiruvananthapuramIndia
- Department of Computational Biology and Bioinformatics, University of KeralaThiruvananthapuramIndia
| | - Achuthsankar S Nair
- Department of Computational Biology and Bioinformatics, University of KeralaThiruvananthapuramIndia
| | - Moinak Banerjee
- Human Molecular Genetics Laboratory, Rajiv Gandhi Centre for BiotechnologyThiruvananthapuramIndia
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Chowell G, Islam N. Political Determinants of Health: Has COVID-19 Exposed the Worst of It? Am J Public Health 2024; 114:879-881. [PMID: 39024529 PMCID: PMC11306624 DOI: 10.2105/ajph.2024.307778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Gerardo Chowell
- Gerardo Chowell is with the Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, and the Centre for Research on Pandemics and Society, Oslo Metropolitan University, Oslo, Norway. Nazrul Islam is with the Faculty of Medicine, University of Southampton, Southampton, UK, and the Max Planck Institute for Demographic Research, Rostock, Germany
| | - Nazrul Islam
- Gerardo Chowell is with the Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, and the Centre for Research on Pandemics and Society, Oslo Metropolitan University, Oslo, Norway. Nazrul Islam is with the Faculty of Medicine, University of Southampton, Southampton, UK, and the Max Planck Institute for Demographic Research, Rostock, Germany
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5
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La Porta CAM, Zapperi S. Health and income inequality: a comparative analysis of USA and Italy. Front Public Health 2024; 12:1421509. [PMID: 39171297 PMCID: PMC11335724 DOI: 10.3389/fpubh.2024.1421509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Socio-economic background is often an important determinant for health with low income households having higher exposure to risk factors and diminished access to healthcare and prevention, in a way that is specific to each country. Methods Here, we perform a comparative analysis of the relations between health and income inequality in two developed countries, USA and Italy, using longitudinal and cross-sectional data from surveys. Results and discussion We show that the income class determines the incidence of chronic pathologies, associated risk-factors and psychiatric conditions, but find striking differences in health inequality between the two countries. We then focus our attention on a fraction of very disadvantaged households in the USA whose income in persistently at the bottom of the distribution over a span of 20 years and which is shown to display particularly dire health conditions. Low income people in the USA also display comorbidity patterns that are not found in higher income people, while in Italy income appears to be less relevant for comorbidity. Taken together our findings illustrate how differences in lifestyle and the healthcare systems affect health inequality.
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Affiliation(s)
- Caterina A. M. La Porta
- Center for Complexity and Biosystems and Center for Innovation for Well-Being And Environment, Department of Environmental Science and Policy, University of Milan, Milan, Italy
- UOC Maxillo-Facial Surgery and Dentistry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Zapperi
- Center for Complexity and Biosystems, Department of Physics “Aldo Pontremoli”, University of Milan, Milan, Italy
- CNR—Consiglio Nazionale delle Ricerche, Istituto di Chimica della Materia Condensata e di Tecnologie per l'Energia, Milan, Italy
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Forthun I, Madsen C, Emilsson L, Nilsson A, Kepp KP, Björk J, Vollset SE, Lallukka T, Skrindo Knudsen AK. Excess mortality in Denmark, Finland, Norway and Sweden during the COVID-19 pandemic 2020-2022. Eur J Public Health 2024; 34:737-743. [PMID: 38758188 PMCID: PMC11293825 DOI: 10.1093/eurpub/ckae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020-2022. METHODS Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010-2019 used as reference period. We then compared excess mortality across the countries in 2020-2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. RESULTS While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29-122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14-90), 130 (83-177) and 88 (48-128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. CONCLUSION Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates-arguably the most accurate available for any region in capturing pandemic-related excess deaths-may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Ingeborg Forthun
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Christian Madsen
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Louise Emilsson
- General Practice Research Unit (AFE) and Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Varmland, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Anton Nilsson
- Unit of Epidemiology, Population Studies and Infrastructures (EPI@LUND), Division of Occupational and Environmental Medicine, Epidemiology, Lund University, Lund, Sweden
| | - Kasper P Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
- Epistudia, Bern, Switzerland
| | - Jonas Björk
- Unit of Epidemiology, Population Studies and Infrastructures (EPI@LUND), Division of Occupational and Environmental Medicine, Epidemiology, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Science, School of Medicine, University of Washington, Seattle, WA, USA
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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7
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Kayı İ, Gönen M, Sakarya S, Eryiğit ÖY, Ergönül Ö. Gender-Based Socio-Economic Inequalities in the Pre-Vaccination Era of the COVID-19 Pandemic in Istanbul: A Neighborhood-Level Analysis of Excess Mortality. Healthcare (Basel) 2024; 12:1406. [PMID: 39057549 PMCID: PMC11276765 DOI: 10.3390/healthcare12141406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Worldwide excess mortality (EM) data have the potential to provide a better estimation of the impact of the pandemic. This study aims to investigate and map the inequalities in EM in Istanbul during the pre-vaccination era of the COVID-19 pandemic in 2020 and its association with selected demographic and socio-economic variables at the neighborhood level according to gender. This ecological study was conducted with the EM data of Istanbul. The EM data were obtained from the Istanbul Metropolitan Municipality (IMM) and analyzed according to socio-demographic indicators (gender, age), neighborhood-level indicators (population density, educational attainment) and neighborhood vulnerability (socio-economic and transportation) for the 808 neighborhoods, then presented separately according to gender to examine gender-specific factors. Socio-economic and transportation vulnerability indexes are provided the IMM. The excess mortality rate per 1000 (EMR) in 2020 has been calculated by using the number of deaths in the years 2018-2019. We have mapped EMRs of each neighborhood and used linear regression analysis in three datasets to examine gender specific factors. EMRs in Istanbul showed two peaks one in April and one in November. Male EMRs were higher compared to females in Istanbul during the pre-vaccination era of the pandemic. Higher EMRs were observed in neighborhoods with a higher share of 50+ year old age groups and higher neighborhood socio-economic vulnerability scores. Neighborhood socio-economic vulnerability was significantly associated with EMRs in males but not in females. Unequal distribution of EM between neighborhoods underlines the need for gender-specific pandemic measures to alleviate the burden of the COVID-19 pandemic, especially in socio-economically vulnerable settings. Increased use of area-based indicators with a gender perspective can enhance pandemic measures.
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Affiliation(s)
- İlker Kayı
- Department of Public Health, School of Medicine, Koc University, Istanbul 34010, Türkiye;
- Department of Global Health, Graduate School of Health Sciences, Koc University, Istanbul 34450, Türkiye
| | - Mehmet Gönen
- Department of Industrial Engineering, College of Engineering, Koc University, Istanbul 34450, Türkiye;
- Koc University Is Bank Research Center for Infectious Diseases, Koc University Hospital, Istanbul 34010, Türkiye;
| | - Sibel Sakarya
- Department of Public Health, School of Medicine, Koc University, Istanbul 34010, Türkiye;
- Department of Global Health, Graduate School of Health Sciences, Koc University, Istanbul 34450, Türkiye
| | | | - Önder Ergönül
- Koc University Is Bank Research Center for Infectious Diseases, Koc University Hospital, Istanbul 34010, Türkiye;
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koc University, Istanbul 34450, Turkey
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8
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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial Variation in Excess Mortality Across Europe: A Cross-Sectional Study of 561 Regions in 21 Countries. J Epidemiol Glob Health 2024; 14:470-479. [PMID: 38376764 PMCID: PMC11176282 DOI: 10.1007/s44197-024-00200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. METHODS Statistical and demographic analyses of regional all-cause mortality data provided by the vital statistics systems of 21 European countries for 561 regions in Central and Western Europe. Life expectancy losses at ages 0 and 60 for males and females were estimated. RESULTS We found evidence of a loss in life expectancy in 391 regions, whilst only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years and three regions showed losses greater than 3 years. We highlight geographical clusters of high mortality in Northern Italy, Spain and Poland, whilst clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden. CONCLUSIONS Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France.
| | - Pavel Grigoriev
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | | | - Carlo-Giovanni Camarda
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
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9
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Vandenbroucke JP, Pearce N. Excess Mortality Calculations to Assess the Impact of the COVID-19 Pandemic: Concepts and Methodological Issues. Am J Public Health 2024; 114:593-598. [PMID: 38547492 PMCID: PMC11079831 DOI: 10.2105/ajph.2024.307572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
We discuss some intriguing methodological aspects of excess mortality analyses, which have been widely used to describe the impact of the COVID-19 pandemic. We describe the main ways of presenting excess mortality: as a mortality rate (incidence rate) or as a percentage increase (relative risk or rate ratio). We discuss what should be regarded as the null value of excess mortality (i.e., when countries or regions can be judged as having fared equally well) and when age and sex standardization, adjustment for other determinants of the spread of a pandemic, or both is necessary. We discuss the level of detail by time and place and person that may be necessary. We note that an excess mortality comparison is essentially a difference-in-differences analysis. We conclude that, although one cannot rule out using excess mortality analyses for causal effect estimates, such analyses will remain most fruitful for generating hypotheses about both the efficiency of measures to curtail the pandemic and factors that cannot be influenced. Nevertheless, a judicious use of arguments and counterarguments can then lead to identifying best practices for various situations. (Am J Public Health. 2024;114(6):593-598. https://doi.org/10.2105/AJPH.2024.307572).
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Affiliation(s)
- Jan P Vandenbroucke
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
| | - Neil Pearce
- Jan P. Vandenbroucke and Neil Pearce are with the Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK. Jan P. Vandenbroucke is also with the Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and the Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands
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10
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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021). Nat Commun 2024; 15:4246. [PMID: 38762653 PMCID: PMC11102496 DOI: 10.1038/s41467-024-48689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
Since its emergence in December 2019, the COVID-19 pandemic has resulted in a significant increase in deaths worldwide. This article presents a detailed analysis of the mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce age and sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a forecasting approach based on CP-splines that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). We also estimate that eight regions suffered losses exceeding 20 years of life per 1000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic's impact.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), Aubervilliers, France.
| | - Pavel Grigoriev
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
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11
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Shkolnikov VM, Jdanov DA, Majeed A, Islam N. Making sense of national and international disparities in excess mortality from the COVID-19 pandemic. BMJ Glob Health 2024; 9:e015737. [PMID: 38637122 PMCID: PMC11029358 DOI: 10.1136/bmjgh-2024-015737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
| | - Dmitri A Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Nazrul Islam
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Southampton, Southampton, UK
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12
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Hajdu T, Krekó J, Tóth CG. Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe. Sci Rep 2024; 14:3835. [PMID: 38360870 PMCID: PMC10869827 DOI: 10.1038/s41598-024-54366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/12/2024] [Indexed: 02/17/2024] Open
Abstract
Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021 but returned to the pre-pandemic level in 2022. The 2021 increase was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.
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Affiliation(s)
- Tamás Hajdu
- HUN-REN Centre for Economic and Regional Studies, Budapest, Hungary
| | - Judit Krekó
- HUN-REN Centre for Economic and Regional Studies, Hungary and Budapest Institute for Policy Analysis, Budapest, Hungary
| | - Csaba G Tóth
- HUN-REN Centre for Economic and Regional Studies, Hungary and Corvinus University of Budapest, Budapest, Hungary.
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13
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Sciacchitano S, Carola V, Nicolais G, Sciacchitano S, Napoli C, Mancini R, Rocco M, Coluzzi F. To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty. J Clin Med 2024; 13:721. [PMID: 38337415 PMCID: PMC10856357 DOI: 10.3390/jcm13030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Simona Sciacchitano
- Department of Psychiatry, La Princesa University Hospital, 28006 Madrid, Spain;
| | - Christian Napoli
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Monica Rocco
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Flaminia Coluzzi
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
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14
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Bonnet F, Camarda CG. Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020. PLoS One 2024; 19:e0293752. [PMID: 38241216 PMCID: PMC10798530 DOI: 10.1371/journal.pone.0293752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/18/2023] [Indexed: 01/21/2024] Open
Abstract
The COVID-19 pandemic's uneven impact on subnational regions highlights the importance of understanding its local-level mortality impact. Vital statistics are available for an increasing number of countries for 2020, 2021, and 2022, facilitating the computation of subnational excess mortality and a more comprehensive assessment of its burden. However, this calculation faces two important methodological challenges: it requires appropriate mortality projection models; and small populations imply considerable, though commonly neglected, uncertainty in the estimates. We address both issues using a method to forecast mortality at the subnational level, which incorporates uncertainty in the computation of mortality measures. We illustrate our approach by examining French départements (NUTS 3 regions, or 95 geographical units), and produce sex-specific estimates for 2020. This approach is highly flexible, allowing one to estimate excess mortality during COVID-19 in most demographic scenarios and for past pandemics.
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Affiliation(s)
- Florian Bonnet
- Institut national d’études démographiques (INED), Aubervilliers, France
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15
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Adair T, Houle B, Canudas-Romo V. Effect of the COVID-19 pandemic on life expectancy in Australia, 2020-22. Int J Epidemiol 2023; 52:1735-1744. [PMID: 37743848 PMCID: PMC10749770 DOI: 10.1093/ije/dyad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Australia provides a valuable international case study of life expectancy during the pandemic. In contrast to many other countries, it experienced relatively stringent restrictions and low COVID-19 mortality during 2020-21, followed by relaxation of these restrictions when high vaccination rates were achieved. This study measures Australia's life expectancy trends and the contributions of age group and causes of death, during the pandemic. METHODS Trends in life expectancy at birth in Australia and its states and territories were measured from 2020 to 2022. The contributions of age group and cause of death to these trends were measured using decomposition methods. Life expectancy was compared with other high-income countries. RESULTS Australia's life expectancy fell by more than half a year in 2022, following a sharp increase in 2020 and moderate decline in 2021. For the 3 years 2020 to 2022, life expectancy was 0.13 years (95% confidence interval 0.07-0.19) higher for males and 0.09 years (0.03-0.14) higher for females versus 2017-19. Australia's life expectancy increase in 2020 was larger than that in the vast majority of other high-income countries, but its decline in 2022 was greater than in other countries whose life expectancy rose in the first year of the pandemic. The small negative contribution of COVID-19 deaths to life expectancy in Australia was more than offset by lower non-communicable disease mortality. There were only small differences in life expectancy change between the states with the most stringent restrictions (Victoria and New South Wales) and the rest of Australia. CONCLUSIONS Australia's life expectancy trends during 2020-22 were relatively favourable compared with other high-income countries, with the exception of its sharp decline in 2022 once restrictions were loosened.
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Affiliation(s)
- Tim Adair
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Houle
- School of Demography, Research School of Social Sciences, Australian National University, Canberra, ACT, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Vladimir Canudas-Romo
- School of Demography, Research School of Social Sciences, Australian National University, Canberra, ACT, Australia
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16
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Marinetti I, Jdanov D, Grigoriev P, Klüsener S, Janssen F. Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021. PLoS One 2023; 18:e0295763. [PMID: 38127957 PMCID: PMC10734971 DOI: 10.1371/journal.pone.0295763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
The mortality impact of COVID-19 has mainly been studied at the national level. However, looking at the aggregate impact of the pandemic at the country level masks heterogeneity at the subnational level. Subnational assessments are essential for the formulation of public health policies. This is especially important for federal countries with decentralised healthcare systems, such as Germany. Therefore, we assess geographical variation in the mortality impact of COVID-19 for the 16 German federal states in 2020 and 2021 and the sex differences therein. For this purpose, we adopted an ecological study design, using population-level mortality data by federal state, age, and sex, for 2005-2021 obtained from the German Federal Statistical Office. We quantified the impact of the pandemic using the excess mortality approach. We estimated period life expectancy losses (LE losses), excess premature mortality, and excess deaths by comparing their observed with their expected values. The expected mortality was based on projected age-specific mortality rates using the Lee-Carter methodology. Saxony was the most affected region in 2020 (LE loss 0.77 years, 95% CI 0.74;0.79) while Saarland was the least affected (-0.04, -0.09;0.003). In 2021, the regions with the highest losses were Thuringia (1.58, 1.54;1.62) and Saxony (1.57, 1.53;1.6) and the lowest in Schleswig-Holstein (0.13, 0.07;0.18). Furthermore, in 2021, eastern regions experienced higher LE losses (mean: 1.13, range: 0.85 years) than western territories (mean: 0.5, range: 0.72 years). The regional variation increased between 2020 and 2021, and was higher among males than among females, particularly in 2021. We observed an unequal distribution of the mortality impact of COVID-19 at the subnational level in Germany, particularly in 2021 among the male population. The observed differences between federal states might be partially explained by the heterogeneous spread of the virus in 2020 and by differences in the population's propensity to follow preventive guidelines.
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Affiliation(s)
- Isabella Marinetti
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Dmitri Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
- National Research University Higher School of Economics, Moscow, Russia
| | - Pavel Grigoriev
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Sebastian Klüsener
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
- University of Cologne, Cologne, Germany
- Vytautas Magnus University, Kaunas, Lithuania
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute—KNAW/University of Groningen, The Hague, The Netherlands
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17
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Zhang L, Sun L. Life expectancy inequalities between regions of China 2004-2020: contribution of age- and cause-specific mortality. Front Public Health 2023; 11:1271469. [PMID: 38174074 PMCID: PMC10764032 DOI: 10.3389/fpubh.2023.1271469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background China's rapid economic and social development since the early 2000s has caused significant shifts in its epidemiological transition, potentially leading to health disparities across regions. Objectives This study employs Life Expectancy (LE) to assess health disparities and trends among China's eastern, central, and western regions. It also examines the pace of LE gains relative to empirical trends and investigates age and causes of death mortality improvement contributing to regional LE gaps. Data and methods Using a log-quadratic model, the study estimates LE in China and its regions from 2004 to 2020, using census and death cause surveillance data. It also utilizes the Human Mortality Database (HMD) and the LE gains by LE level approach to analyze China and its regions' LE gains in comparison to empirical trend of developed countries. The study investigates changes in LE gaps due to age and causes of death mortality improvements during two periods, 2004-2012 and 2012-2020, through the LE factor decomposition method. Results From 2000 to 2020, China's LE exhibited faster pace of gains compared to developed countries. While men's LE growth gradually aligns with empirical trends, women experience slightly higher growth rates. Regional LE disparities significantly reduced from 2004 to 2012, with a marginal reduction from 2012 to 2020. In the latter period, the changing LE gap aligns with expected trends in developed countries, with all Chinese regions surpassing empirical estimates. Cardiovascular diseases and malignant neoplasms emerged as the primary contributors to expanding regional LE gaps, with neurological disorders and diabetes playing an increasingly negative role. Conclusion LE disparities in China have consistently decreased, although at a slower pace in recent years, mirroring empirical trends. To further reduce regional LE disparities, targeted efforts should focus on improving mortality rates related to cardiovascular diseases, neoplasms, neurological disorders and diabetes, especially in the western region. Effective health interventions should prioritize equalizing basic public health services nationwide.
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Affiliation(s)
- Leyi Zhang
- School of Insurance, University of International Business and Economics, Beijing, China
- School of Mathematics, Baotou Teachers' College, Baotou, China
| | - Lijuan Sun
- School of Insurance, University of International Business and Economics, Beijing, China
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18
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Ioannidis JPA, Zonta F, Levitt M. Variability in excess deaths across countries with different vulnerability during 2020-2023. Proc Natl Acad Sci U S A 2023; 120:e2309557120. [PMID: 38019858 PMCID: PMC10710037 DOI: 10.1073/pnas.2309557120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Excess deaths provide total impact estimates of major crises, such as the COVID-19 pandemic. We evaluated excess death trajectories across countries with accurate death registration and population age structure data and assessed relationships with vulnerability indicators. Using the Human Mortality Database on 34 countries, excess deaths were calculated for 2020-2023 (to week 29, 2023) using 2017-2019 as reference, with adjustment for 5 age strata. Countries were divided into less and more vulnerable; the latter had per capita nominal GDP < $30,000, Gini > 0.35 for income inequality and/or at least ≥2.5% of their population living in poverty. Excess deaths (as proportion of expected deaths, p%) were inversely correlated with per capita GDP (r = -0.60), correlated with proportion living in poverty (r = 0.66), and modestly correlated with income inequality (r = 0.45). Incidence rate ratio for deaths was 1.062 (95% CI, 1.038-1.087) in more versus less vulnerable countries. Excess deaths started deviating in the two groups after the first wave. Between-country heterogeneity diminished gradually within each group. Less vulnerable countries had mean p% = -0.8% and 0.4% in 0-64 and >65-y-old strata. More vulnerable countries had mean p% = 7.0% and 7.2%, respectively. Lower death rates were seen in children of age 0-14 y during 2020-2023 versus prepandemic years. While the pandemic hit some countries earlier than others, country vulnerability dominated eventually the cumulative impact. Half the analyzed countries witnessed no substantial excess deaths versus prepandemic levels, while the others suffered major death tolls.
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Affiliation(s)
- John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA94305
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA94305
- Department of Biomedical Data Science, Stanford University, Stanford, CA94305
- Department of Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA94305
| | - Francesco Zonta
- Department of Biological Sciences, Xi’an Jiaotong Liverpool University, Suzhou215123, China
| | - Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA94305
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19
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Cao G, Liu J, Liu M, Liang W. Effects of the COVID-19 pandemic on life expectancy at birth at the global, regional, and national levels: A joinpoint time-series analysis. J Glob Health 2023; 13:06042. [PMID: 37862617 PMCID: PMC10588978 DOI: 10.7189/jogh.13.06042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background Current estimates indicate that coronavirus disease 2019 (COVID-19) caused 14.9 million excess deaths in 2020 and 2021. Thus, estimating the change in life expectancy at birth due to the COVID-19 pandemic could aid in understanding its impact and implementing public health initiatives. Methods We collected data on the life expectancy at birth of the combined population between 1990 and 2021 at the global, regional, and national levels from the 2022 Revision of World Population Prospects. In this time series study, we estimated the trend segments, the change of trend years (joinpoints), the annual percentage change (APC) in life expectancy at birth within each trend segment, and the average APC (AAPC) in life expectancy at birth during the full study period using joinpoint regression analysis. Results The global life expectancy at birth decreased from 72.8 years in 2019 to 71.0 years in 2021, with an annual decrease of 1.2% (95% confidence interval (CI) = 1.0, 1.5) during the 2019-2021 period, despite an overall increasing trend during the entire period from 1990 to 2021 (AAPC = 0.3%; 95% CI = 0.3, 0.4). We observed a significantly increasing trend in life expectancy at birth in all regions and nearly 87.7% (207/236) of the world's countries and areas during the entire period (1990-2021). All continental regions except Africa and Oceania experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with an APC of -1.2% (95% CI = -1.5, -0.9) for Asia, -2.1% (95% CI = -2.7, -1.6) for Latin America and the Caribbean, -1.1% (95% CI = -1.6, -0.6) for Northern America, and -1.4% (95% CI = -1.9, -0.9) for Europe. Among all countries and areas, 107 countries and areas (45.3%) experienced a significant decreasing trend in life expectancy at birth in the most recent time segment, with 77 countries and areas (32.6%) experiencing a significant decreasing trend during the 2019-2021 period. Conclusions The world experienced a significant decreasing trend in life expectancy at birth in 2019-2021, with a decrease of 1.8 years; all continental regions except Africa and Oceania and 77 countries and areas experienced a significant decreasing trend in life expectancy at birth. These decreasing trends at global, regional, and national levels during the 2019-2021 period reflected the COVID-19 pandemic's direct and indirect adverse effects on life expectancy at birth.
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Affiliation(s)
- Guiying Cao
- School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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20
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Breuer E, Morris A, Blanke L, Pearsall M, Rodriguez R, Miller BF, Naslund JA, Saxena S, Balsari S, Patel V. A theory of change for community-initiated mental health care in the United States. Glob Ment Health (Camb) 2023; 10:e56. [PMID: 37854428 PMCID: PMC10579655 DOI: 10.1017/gmh.2023.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 10/20/2023] Open
Abstract
Mental health service delivery needs radical reimagination in the United States where unmet needs for care remain large and most metrics on the burden of mental health problems have worsened, despite significant numbers of mental health professionals, spending on service provision and research. The COVID-19 pandemic has exacerbated the need for mental health care. One path to a radical reimagination is "Community Initiated Care (CIC)" which equips and empowers communities to address by providing brief psychosocial interventions by people in community settings. We co-developed a theory of change (ToC) for CIC with 24 stakeholders including representatives from community-based, advocacy, philanthropic and faith-based organizations to understand how CIC could be developed and adapted for specific contexts. We present a ToC which describes ways in which the CIC initiative can promote and strengthen mental health in communities in the United States with respect to community organization and leadership; community care and inclusion and normalizing mental health. We propose 10 strategies as part of CIC and propose a way forward for implementation and evaluation. This CIC model is a local, tailored approach which can expand the role of community members to strengthen our response to mental health needs in the United States.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Angelika Morris
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Miriam Pearsall
- National Academy for State Health Policy (NASHP), Portland, ME, USA
| | | | - Benjamin F. Miller
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shekhar Saxena
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Satchit Balsari
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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21
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Yadav PK, Yadav S. Impact of COVID-19 on subnational variations in life expectancy and life disparity at birth in India: evidence from NFHS and SRS data. Arch Public Health 2023; 81:165. [PMID: 37667348 PMCID: PMC10476359 DOI: 10.1186/s13690-023-01170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Abstract
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.
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Affiliation(s)
- Pawan Kumar Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
- Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, 737102, India.
| | - Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
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22
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Woolf SH. Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021. Am J Public Health 2023; 113:970-980. [PMID: 37262403 PMCID: PMC10413748 DOI: 10.2105/ajph.2023.307310] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives. To document the evolution of the US life expectancy disadvantage and regional variation across the US states. Methods. I obtained life expectancy estimates in 2022 from the United Nations, the Human Mortality Database, and the US Mortality Database, and calculated changes in growth rates, US global position (rank), and state-level trends. Results. Increases in US life expectancy slowed from 1950 to 1954 (0.21 years/annum) and 1955 to 1973 (0.10 years/annum), accelerated from 1974 to 1982 (0.34 years/annum), and progressively deteriorated from 1983 to 2009 (0.15 years/annum), 2010 to 2019 (0.06 years/annum), and 2020 to 2021 (-0.97 years/annum). Other countries experienced faster growth in each phase except 1974 to 1982. During 1933 to 2021, 56 countries on 6 continents surpassed US life expectancy. Growth in US life expectancy was slowest in Midwest and South Central states. Conclusions. The US life expectancy disadvantage began in the 1950s and has steadily worsened over the past 4 decades. Dozens of globally diverse countries have outperformed the United States. Causal factors appear to have been concentrated in the Midwest and South. Public Health Implications. Policies that differentiate the United States from other countries and circumstances associated with the Midwest and South may have contributed. (Am J Public Health. 2023;113(9):970-980. https://doi.org/10.2105/AJPH.2023.307310).
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Affiliation(s)
- Steven H Woolf
- Steven H. Woolf is with the Center on Society and Health and the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
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23
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Tanaka H, Togawa K, Katanoda K. Impact of the COVID-19 pandemic on mortality trends in Japan: a reversal in 2021? A descriptive analysis of national mortality data, 1995-2021. BMJ Open 2023; 13:e071785. [PMID: 37652585 PMCID: PMC10476106 DOI: 10.1136/bmjopen-2023-071785] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic led to an increase in mortality in most countries in 2020, deviating from prior decreasing trends. In Japan, however, mortality was suggested to decrease in 2020. This study investigated long-term mortality trends and cause-specific contributions, focusing on the period of the COVID-19 pandemic in Japan. DESIGN We analysed Japanese age-standardised mortality rates (ASMRs) from 1995 to 2021 using vital statistics. MAIN OUTCOME MEASURES The cause-specific annual ASMR changes were calculated in comparison with the previous year over the abovementioned period. RESULTS There was a general downward trend in overall ASMR for both sexes until 2020 followed by a small increase in 2021. In men, the all-cause ASMR (per 100 000 persons) decreased from 1352.3 to 1328.8 in 2020 (-1.74% from 2019), and increased to 1356.3 in 2021 in men (+2.07% from 2020). In women, the all-cause ASMR decreased from 746.0 to 722.1 in 2020 (-3.20% from 2019), and increased to 737.9 (+2.19% from 2020) in 2021. ASMRs from malignant neoplasms, pneumonia, accidents and suicide (men only) continued to decrease during the COVID-19 pandemic while the trend of cardiovascular mortality increased in 2021. Analysis of ASMR changes revealed that COVID-19, senility, cardiovascular disease and 'other causes not classified as major causes' contributed to the all-cause mortality increase in 2021. CONCLUSIONS In Japan, the decreasing trend in overall mortality continued in 2020 despite the COVID-19 pandemic. However, approximately 2% mortality increase was observed in 2021, which was attributable to COVID-19, senility, cardiovascular disease and 'other causes'. The year 2021 was a turning point of mortality trends in Japan, although continued monitoring is warranted.
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Affiliation(s)
- Hirokazu Tanaka
- Division of Population Data Science, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Kayo Togawa
- Division of Population Data Science, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Kota Katanoda
- Division of Population Data Science, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
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24
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Hong J, Yi S, Yoon T. The impact of the COVID-19 pandemic on life expectancy by the level of area deprivation in South Korea. Front Public Health 2023; 11:1215914. [PMID: 37593728 PMCID: PMC10427859 DOI: 10.3389/fpubh.2023.1215914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Objective Comparative evidence suggests that the impact of COVID-19 on life expectancy has been relatively milder in South Korea. This study aims to examine whether the pandemic has universal or unequal impacts on life expectancy across 250 districts with varying levels of deprivation. Methods Using mortality data from 2012 to 2021 obtained from the Microdata Integrated Service of Statistics Korea, we calculated life expectancy at birth and age 65 for both sexes, by deprivation quintiles, before and during the pandemic. We summarized life expectancy gaps using the slope of the inequality index (SII) and further decomposed the gaps by the contribution of age and cause of death using Arriaga's method. Results Both men and women experienced consistent improvements in life expectancy from 2012 to 2019, but the trend was disrupted during 2020 and 2021, primarily driven by older people. While men in more deprived areas were initially hit harder by the pandemic, the life expectancy gap across deprivation quintiles remained relatively constant and persistent across the study period [SII: -2.48 (CI: -2.70 from -2.27) for 2019 and - 2.84 (CI: -3.06 from -2.63) for 2020]. Middle-aged men from the most deprived areas were the most significant contributors to the life expectancy gap, with liver disease, liver cancer, transport accidents, and intentional injuries being the leading causes, both in the pre and during the pandemic. While these contributors remained largely similar before and during the pandemic, the contribution of transport accidents and liver cancer to the male life expectancy gap slightly decreased during the pandemic, while that of ischemic heart disease and pneumonia slightly increased. A similar increase was also observed for the female life expectancy gap. Conclusion This study found no clear evidence of an increased life expectancy gap during the pandemic in South Korea, unlike in other countries, although access to emergency healthcare services may have been slightly more disturbed in deprived areas. This achievement can provide lessons for other countries. However, the persistent regional gaps in life expectancy observed over the past decade indicate the need for more targeted public health policies to address this issue.
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Affiliation(s)
- Jihyung Hong
- Department of Healthcare Management, Gachon University, Seongnam, Republic of Korea
| | - Sunghyun Yi
- Department of Health Policy and Management, General Graduate School of Gachon University, Seongnam, Republic of Korea
| | - Taeho Yoon
- Department of Preventive and Occupational & Environmental Medicine, College of Medicine, Pusan National University, Yangsan, Republic of Korea
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25
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Moreira I, Ferrer M, Vilagut G, Mortier P, Felez-Nobrega M, Domènech-Abella J, Haro JM, Alonso J. Social inequalities in mental and physical health derived from the COVID-19 pandemic in Spain beyond SARS-CoV-2 infection. Int J Equity Health 2023; 22:136. [PMID: 37488575 PMCID: PMC10367254 DOI: 10.1186/s12939-023-01933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021). METHODS This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender. RESULTS A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions. CONCLUSIONS Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.
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Affiliation(s)
- Isabel Moreira
- Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Universitat Pompeu Fabra - Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Philippe Mortier
- Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Joan Domènech-Abella
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep-Maria Haro
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigación del Hospital de la Princesa, Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Research Institute, Doctor Aiguader 88, office 144, Barcelona, 08003, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Carlini V, Noonan DM, Abdalalem E, Goletti D, Sansone C, Calabrone L, Albini A. The multifaceted nature of IL-10: regulation, role in immunological homeostasis and its relevance to cancer, COVID-19 and post-COVID conditions. Front Immunol 2023; 14:1161067. [PMID: 37359549 PMCID: PMC10287165 DOI: 10.3389/fimmu.2023.1161067] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Interleukin-10 (IL-10) is a pleiotropic cytokine that has a fundamental role in modulating inflammation and in maintaining cell homeostasis. It primarily acts as an anti-inflammatory cytokine, protecting the body from an uncontrolled immune response, mostly through the Jak1/Tyk2 and STAT3 signaling pathway. On the other hand, IL-10 can also have immunostimulating functions under certain conditions. Given the pivotal role of IL-10 in immune modulation, this cytokine could have relevant implications in pathologies characterized by hyperinflammatory state, such as cancer, or infectious diseases as in the case of COVID-19 and Post-COVID-19 syndrome. Recent evidence proposed IL-10 as a predictor of severity and mortality for patients with acute or post-acute SARS-CoV-2 infection. In this context, IL-10 can act as an endogenous danger signal, released by tissues undergoing damage in an attempt to protect the organism from harmful hyperinflammation. Pharmacological strategies aimed to potentiate or restore IL-10 immunomodulatory action may represent novel promising avenues to counteract cytokine storm arising from hyperinflammation and effectively mitigate severe complications. Natural bioactive compounds, derived from terrestrial or marine photosynthetic organisms and able to increase IL-10 expression, could represent a useful prevention strategy to curb inflammation through IL-10 elevation and will be discussed here. However, the multifaceted nature of IL-10 has to be taken into account in the attempts to modulate its levels.
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Affiliation(s)
- Valentina Carlini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), MultiMedica, Milan, Italy
| | - Douglas M. Noonan
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), MultiMedica, Milan, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Eslam Abdalalem
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), MultiMedica, Milan, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Clementina Sansone
- Stazione Zoologica Anton Dohrn, Istituto Nazionale di Biologia, Ecologia e Biotecnologie Marine, Napoli, Italy
| | - Luana Calabrone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), MultiMedica, Milan, Italy
| | - Adriana Albini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology IEO-, Milan, Italy
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27
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Fisman DN. When the role of uncertainty is…uncertain. Proc Natl Acad Sci U S A 2023; 120:e2305856120. [PMID: 37224188 PMCID: PMC10265980 DOI: 10.1073/pnas.2305856120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- David N. Fisman
- Dalla Lana School of Public Health, University of Toronto, TorontoM5T 3M7, ON, Canada
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Huang G, Guo F, Zimmermann KF, Liu L, Taksa L, Cheng Z, Tani M, Franklin M. The effect of the COVID-19 pandemic on life expectancy in 27 countries. Sci Rep 2023; 13:8911. [PMID: 37264048 DOI: 10.1038/s41598-023-35592-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
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.
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Affiliation(s)
- Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Fei Guo
- Department of Management, Macquarie Business School, Macquarie University, Sydney, Australia
| | | | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Lucy Taksa
- Deakin University Business School, Deakin University, Burwood, Australia
| | - Zhiming Cheng
- Department of Management, Macquarie Business School, Macquarie University, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Massimiliano Tani
- School of Business, University of New South Wales, Canberra, Australia
| | - Marika Franklin
- Deakin University Business School, Deakin University, Burwood, Australia
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29
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Islam N, Jdanov DA. Age and sex adjustments are critical when comparing death rates. BMJ 2023; 381:845. [PMID: 37085178 DOI: 10.1136/bmj.p845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Affiliation(s)
- Nazrul Islam
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Dmitri A Jdanov
- Max Planck Institute for Demographic Research, Rostock, Germany
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30
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Moryson W, Kalinowski P, Kotecki P, Stawińska-Witoszyńska B. Changes in the Level of Premature Mortality in the Polish Population Due to Selected Groups of Cardiovascular Diseases before and during the Pandemic of COVID-19. J Clin Med 2023; 12:jcm12082913. [PMID: 37109249 PMCID: PMC10144974 DOI: 10.3390/jcm12082913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND In the years 2020 and 2021, the COVID-19 pandemic disrupted Poland's health care system and caused a high number of excess deaths. After nearly 30 years of continuous dynamic increase in the life expectancy of the Polish population and a decrease in premature mortality that led to a reduction in the health gap between Poland and Western European countries, regrettably, a decline in life expectancy was recorded. For males, the decline amounted to 2.3 years and, for females, to 2.1 years. AIM The aim of this study was to assess changes in the level of premature mortality due to selected cardiovascular diseases in Poland before and during the COVID-19 pandemic. METHOD Time trends of deaths of patients under the age of 65 due to ischemic heart disease, cerebrovascular disease and aortic aneurysm were analyzed by gender and age groups. The joinpoint model was used in determining time trends. RESULTS Premature mortality due to all of the cardiovascular diseases analyzed had been declining steadily by about 5% per year since 2008. However, at the end of the second decade of the 21st century, a significant change in the dynamics of the trend was observed, particularly with regard to deaths from ischemic heart disease, which since 2018 caused premature mortality increases of 10% per year in the female population. In the male population, an increase of nearly 20% per year has been observed since 2019. The changes also affected premature mortality due to cerebrovascular disease. CONCLUSIONS After nearly three decades of significant decline in premature mortality from cardiovascular diseases in Poland, there was a reversal in the trend, in particular as regards ischemic heart disease. The unfavorable changes intensified in the subsequent two years. The simultaneous increase in the number of cardiovascular incidents ending in death and the decline in access to prompt diagnosis and effective treatment may explain the unfavorable changes in the deaths caused by cardiovascular disease and the increase in premature mortality due to cardiovascular disease.
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Affiliation(s)
- Wacław Moryson
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Paweł Kalinowski
- Department of Hygiene and Epidemiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Paweł Kotecki
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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31
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Puig X, Ginebra J. Mapping life expectancy loss in Barcelona in 2020. AM STAT 2023. [DOI: 10.1080/00031305.2023.2197022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Xavier Puig
- Departament of Statistics and O.R., Polytechnic University of Catalonia, Avgda. Diagonal 647, 6a Planta, 08028 Barcelona, Spain
| | - Josep Ginebra
- Departament of Statistics and O.R., Polytechnic University of Catalonia, Avgda. Diagonal 647, 6a Planta, 08028 Barcelona, Spain
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Viejo Casas A, Gómez-Revuelta M, Merino Garay U, Ruiz Guerrero F, Ruiz Núñez M, Fernández Solla P, Garrastazu López R, López Caro JC, García Rumayor E, Boada Antón L, Juncal Ruiz M, Ortiz-García de la Foz V, Vázquez-Bourgon J. Long-term mental health impact of COVID-19 on primary care health workers in northern Spain: Results from a two-phase longitudinal study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023; 16:1-10. [PMID: 36644525 PMCID: PMC9827670 DOI: 10.1016/j.rpsm.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
Background COVID-19 pandemic has affected the mental health of the general population, and in particular of health professionals. Primary care personnel are at greater risk due to being highly exposed to the disease and working regularly in direct contact with patients suffering COVID-19. However, there is not sufficient evidence on the long-term psychological impact these professionals may suffer. We aimed to explore the long-term psychological impact of COVID-19 on primary care professionals. Methods We applied a two-phase design; a self-reported psychopathology screening (PHQ-9, GAD-7, ISI and IES-R) in phase-1, and a specialised psychiatric evaluation (MINI, HDRS and STAI) in phase-2 to confirm phase-1 results. Evaluations were carried at the beginning of the pandemic (May-June 2020) (n = 410) and one year later (n = 339). Chi-square, ANOVA and logistic regression tests were used for statistical analyses. Results Primary care professionals presented high rates of depression, anxiety and psychological distress, measured by PHQ-9, GAD-7 and IES-R respectively, during the pandemic. Depressive symptoms' severity (PHQ-9: 7.5 vs 8.4, p = 0.013) increased after one year of COVID-19 pandemic. After one year nearly 40% of subjects presented depression. Being women, having suffered COVID-19 or a relative with COVID-19, and being a front-line professional were risk factors for presenting depression and anxiety. Conclusion Primary Care professionals in Cantabria present a poor mental health during COVID-19 pandemic, which has even worsened at long-term, presenting a greater psychopathology severity one year after. Thus, it is critical implementing prevention and early-treatment programmes to help these essential professionals to cope with the pandemic.
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Affiliation(s)
- Ana Viejo Casas
- Pisueña-Cayón Primary Care Centre, Sarón, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Seville, Spain
| | | | - Francisco Ruiz Guerrero
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | | | - Patricia Fernández Solla
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | | | | | - Elsa García Rumayor
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Laura Boada Antón
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Juncal Ruiz
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Seville, Spain
- Department of Psychiatry, Hospital Sierrallana, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Víctor Ortiz-García de la Foz
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Seville, Spain
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Klepach AN, Luk’yanenko RF. Healthcare in Russia: Macroeconomic Parameters and Structural Issues. STUDIES ON RUSSIAN ECONOMIC DEVELOPMENT 2023; 34:207-220. [PMID: 37122341 PMCID: PMC10116466 DOI: 10.1134/s1075700723020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 05/02/2023]
Abstract
The epidemiological crisis of 2020-2021 has revealed a number of imbalances and "bottlenecks" that have developed in the Russian healthcare system over the past 20 years as a result of a policy of limiting development to breakthroughs in individual areas accompanied by optimization of the sector. It became evident that one of the most acute problems is interregional disparity in terms of personnel and resource availability in the healthcare system, which determines the system's ability to respond to challenges and shocks. Solving these problems requires a comprehensive approach: simply increasing the sector's financing is not sufficient and must be accompanied by structural changes, in particular, modifying the education system and training new highly qualified personnel, creating an effective system of territorial distribution of personnel, and radically increasing the availability of high-end equipment, i.e., a transition to a new model of healthcare.
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Affiliation(s)
- A. N. Klepach
- Institute of Economic Forecasting, Russian Academy of Sciences, 117418 Moscow, Russia
| | - R. F. Luk’yanenko
- Vnesheconombank Research and Expert Review Institute, 107996 Moscow, Russia
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34
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Malcolm C, King E, France E, Kyle RG, Kumar S, Dick S, Wilson P, Aucott L, Turner SW, Hoddinott P. Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals. PLoS One 2022; 17:e0278777. [PMID: 36525432 PMCID: PMC9757586 DOI: 10.1371/journal.pone.0278777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children. METHODS A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied. RESULTS Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child's safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so. CONCLUSIONS The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.
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Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Richard G Kyle
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simita Kumar
- Screening and Immunisation, Public Health Scotland, Edinburgh, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna Aucott
- Centre for Randomised Healthcare Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- NHS Grampian, Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
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35
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Schöley J, Aburto JM, Kashnitsky I, Kniffka MS, Zhang L, Jaadla H, Dowd JB, Kashyap R. Life expectancy changes since COVID-19. Nat Hum Behav 2022; 6:1649-1659. [PMID: 36253520 PMCID: PMC9755047 DOI: 10.1038/s41562-022-01450-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Jonas Schöley
- Max Planck Institute for Demographic Research, Rostock, Germany.
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Maxi S Kniffka
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Luyin Zhang
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
| | - Hannaliis Jaadla
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
- Cambridge Group for the History of Population and Social Structure, Department of Geography, University of Cambridge, Cambridge, UK
| | - Jennifer B Dowd
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
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Demombynes G, de Walque D, Gubbins P, Urdinola P, Veillard J. 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. BMJ Open 2022; 12:e061589. [PMID: 36351719 PMCID: PMC9659715 DOI: 10.1136/bmjopen-2022-061589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
| | - Damien de Walque
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Paul Gubbins
- Human Development Global Practice, World Bank, Santiago, Chile
| | - Piedad Urdinola
- School of Economics, Universidad Nacional de Colombia - Sede Bogotá, Bogota, Bogota, Colombia
| | - Jeremy Veillard
- Human Development Global Practice, World Bank Group, Bogota, Colombia
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Scherbov S, Gietel-Basten S, Ediev D, Shulgin S, Sanderson W. COVID-19 and excess mortality in Russia: Regional estimates of life expectancy losses in 2020 and excess deaths in 2021. PLoS One 2022; 17:e0275967. [PMID: 36322565 PMCID: PMC9629588 DOI: 10.1371/journal.pone.0275967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
Accurately counting the human cost of the COVID-19 at both the national and regional level is a policy priority. The Russian Federation currently reports one of the higher COVID-19 mortality rates in the world; but estimates of mortality differ significantly. Using a statistical method accounting for changes in the population age structure, we present the first national and regional estimates of excess mortality for 2021; calculations of excess mortality by age, gender, and urban/rural status for 2020; and mean remaining years of life expectancy lost at the regional level. We estimate that there were 351,158 excess deaths in 2020 and 678,022 in 2021 in the Russian Federation; and, in 2020, around 2.0 years of life expectancy lost. While the Russian Federation exhibits very high levels of excess mortality compared to other countries, there is a wide degree of regional variation: in 2021, excess deaths expressed as a percentage of expected deaths at the regional level range from 27% to 52%. Life expectancy loss is generally greater for males; while excess mortality is greater in urban areas. For Russia as whole, an average person who died due to the pandemic in 2020 would have otherwise lived for a further 14 more years (and as high as 18 years in some regions), disproving the widely held view that excess mortality during the pandemic period was concentrated among those with few years of life remaining-especially for females. At a regional level, less densely populated, more remote regions, rural regions appear to have fared better regarding excess mortality and life expectancy loss-however, a part of this differential could be owing to measurement issues. The calculations demonstrate more clearly the true degree of the human cost of the pandemic in the Russian Federation.
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Affiliation(s)
- Sergei Scherbov
- Population and Just Societies Program, International Institute of Applied Systems and Analysis, Laxenburg, Austria
| | - Stuart Gietel-Basten
- Division of Social Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR, China
- Department of Humanities and Social Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Dalkhat Ediev
- Population and Just Societies Program, International Institute of Applied Systems and Analysis, Laxenburg, Austria
- North-Caucasian State Academy, Institute for Applied Mathematics and Information Technologies, Cherkessk, Russia
| | - Sergey Shulgin
- International Laboratory of Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
| | - Warren Sanderson
- Population and Just Societies Program, International Institute of Applied Systems and Analysis, Laxenburg, Austria
- Department of Economics, Stony Brook University, Stony Brook, NY, United States of America
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Bartoll-Roca X, Palència L, Calvo MJ, Pérez K. Trends and inequalities in (healthy) life expectancy by neighbourhood during the COVID-19 epidemic in Barcelona. GACETA SANITARIA 2022; 37:102267. [PMID: 36347169 PMCID: PMC9576221 DOI: 10.1016/j.gaceta.2022.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the trend in life expectancy (LE), healthy life expectancy (HLE) and socio-economic inequalities by neighbourhood in Barcelona from the pre-pandemic period (2018-2019) to the pandemic period (2020-2021). METHOD LE and HLE at birth were computed using the municipal register of inhabitants and quality of life (EuroQol) from the Barcelona Health Survey of 2016. Inequalities were assessed with the gap between quantiles of neighbourhood income. RESULTS In 2020, there was a reduction in LE among men (-1.98 years) and women (-2.44) and in HLE among men (-1.44). Socio-economic inequalities in LE and HLE between neighbourhoods widened since 2019 to 2021 (LE: from 3.92 to 4.86 years for men, and from 1.30 to 3.60 for women; HLE: from 6.88 to 7.70 years for men, and from 7.85 to 9.31 for women). CONCLUSIONS The pandemic has substantially reduced LE and HLE, with larger effects among low-income neighbourhoods, especially among women.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.
| | - Laia Palència
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - María Jesús Calvo
- Oficina Municipal de Dades, Ajuntament de Barcelona, Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Bibliometric Analysis of Global Research Activity on Premature Mortality. Healthcare (Basel) 2022; 10:healthcare10101941. [PMID: 36292388 PMCID: PMC9601940 DOI: 10.3390/healthcare10101941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Premature mortality is defined as death that occurs before the average age of death for a particular population. Although premature mortality is a public health problem globally, the literature indicates no bibliometric studies that have made a holistic evaluation of the publications on this issue. This study aims to explore the characteristics of the publications on premature mortality in terms of the number of publications, citations, countries, collaboration, and the author’s productivity and to further identify the trending keyword and relevant research topics. All the articles related to premature mortality data were retrieved from the Web of Science (WOS) database using the search terms “premature death,” “premature mortality,” or “years of life loss.” The retrieved articles were downloaded in a BibTeX format file. A Bibliometrix package from R software was used to perform bibliometric analyses. A total of 1060 original research articles and reviews have been published since 1971, with a total of 5499 contributing authors. The number of publications has increased substantially in the past decade. The annual percentage growth rate of publications is 5.08%. The United States is the leading country in this area of research with the highest number of publications (n = 280), the highest total citation (17,378), and the most activity in collaboration. Our thematic map suggests that the cluster for cardiovascular disease became the main research domain in this field, while the cluster for air pollution is an important topic for future research. Additionally, neurodegeneration is another cluster of research that should be developed further and connected with premature mortality. These bibliometric findings hopefully will help scholars better understand the global overview of premature mortality and provide information for potential collaborators, with the information promising attractive areas for future research.
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Ebeling M, Acosta E, Caswell H, Meyer AC, Modig K. Years of life lost during the Covid-19 pandemic in Sweden considering variation in life expectancy by level of geriatric care. Eur J Epidemiol 2022; 37:1025-1034. [PMID: 36127511 PMCID: PMC9488891 DOI: 10.1007/s10654-022-00915-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Visit: Nobelsväg 13, Box 210, 171 77, Stockholm, Sweden.
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany.
| | - Enrique Acosta
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hal Caswell
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Visit: Nobelsväg 13, Box 210, 171 77, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Visit: Nobelsväg 13, Box 210, 171 77, Stockholm, Sweden
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Disability-adjusted life years (DALYs) based COVID-19 health impact assessment: A systematic review protocol. PLoS One 2022; 17:e0274468. [PMID: 36094922 PMCID: PMC9467350 DOI: 10.1371/journal.pone.0274468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background COVID-19 is a highly contagious infectious disease that emerged in 2019. This disease is causing devastating health, socio-economic, and economic crises. More specifically COVID-19 is affecting both the quality and length of human life. The overall health impact of this disease is measured by the disability-adjusted life years which is the sum of the life years lost due to disability (the effect on the health quality) and the years life lost due to premature death (effect on the length of life). The purpose of this review is to summarise DALYs-based health impact publications and produce compiled and informative literature that can aid the health regulators to make evidence-based decisions on mitigating COVID-19. Methods The review will be conducted using the PRISMA 2020 guidelines. The DALYs-based original observational and cross-sectional studies will be collected for assessing the health impact of COVID-19. Both the life quality and length impacts of COVID-19 will be reviewed. The life quality impact of COVID-19 will be measured using the life years lost due to disability (pre-recovery illness, pre-death illness, and post-acute consequences), and its impact on the length of life will be measured with years of life lost due to premature death (shortening of life expectancy). The combined health impact of COVID-19 on the quality and length of life will be measured in disability-adjusted life years. Discussion The impacts of COVID-19 on the two health outcomes (quality and length of life) will indicate the level of COVID-19 health burden. The increase or decrease of COVID-19 health impact might be due to the sample size differences of different studies and the omission of years lost due to post-acute consequences in some studies. After having a summarized systematic review health decision-makers will apply an impact-based response to COVID-19. Trail registration Systematic review registration: This protocol is pre-registered in PROSPERO with the registration number CRD42022324931.
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42
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Hanney SR, Straus SE, Holmes BJ. Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges. Health Res Policy Syst 2022; 20:99. [PMID: 36088365 PMCID: PMC9464102 DOI: 10.1186/s12961-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, United Kingdom.
| | - Sharon E Straus
- St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bev J Holmes
- Michael Smith Health Research BC, Vancouver, BC, Canada
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Aburto JM, Tilstra AM, Floridi G, Dowd JB. Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality. Proc Natl Acad Sci U S A 2022; 119:e2205813119. [PMID: 35998219 PMCID: PMC9436308 DOI: 10.1073/pnas.2205813119] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.
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Affiliation(s)
- José Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark; Odense 5000, Denmark
| | - Andrea M. Tilstra
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
- University of Colorado Population Center, Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302
| | - Ginevra Floridi
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
| | - Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Department of Sociology, and Nuffield College, University of Oxford, Oxford, OX1 1JD, United Kingdom
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Schallner N, Lieberum J, Kalbhenn J, Bürkle H, Daumann F. Intensive care unit resources and patient-centred outcomes in severe COVID-19: a prospective single-centre economic evaluation. Anaesthesia 2022; 77:1336-1345. [PMID: 36039476 PMCID: PMC9538123 DOI: 10.1111/anae.15844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/12/2022]
Abstract
During the COVID-19 pandemic, ICU bed shortages sparked a discussion about resource allocation. We aimed to analyse the value of ICU treatment of COVID-19 from a patient-centred health economic perspective. We prospectively included 49 patients with severe COVID-19 and calculated direct medical treatment costs. Quality of life was converted into aggregated quality-adjusted life years using the statistical remaining life expectancy. Costs for non-treatment as the comparator were estimated using the value of statistical life year approach. We used multivariable linear or logistic regression to identify predictors of treatment costs, quality of life and survival. Mean (SD) direct medical treatment costs were higher in patients in ICU with COVID-19 compared with those without (£60,866 (£42,533) vs. £8282 (£14,870), respectively; p < 0.001). This was not solely attributable to prolonged ICU length of stay, as costs per day were also higher (£3115 (£1374) vs. £1490 (£713), respectively; p < 0.001), independent of overall disease severity. We observed a beneficial cost-utility value of £7511 per quality-adjusted life-year gained, even with a more pessimistic assumption towards the remaining life expectancy. Extracorporeal membrane oxygenation therapy provided no additional quality-adjusted life-year benefit. Compared with non-treatment (costs per lost life year, £106,085), ICU treatment (costs per quality-adjusted life-year, £7511) was economically preferable, even with a pessimistic interpretation of patient preferences for survival (sensitivity analysis of the value of statistical life year, £48,848). Length of ICU stay was a positive and extracorporeal membrane oxygenation a negative predictor for quality of life, whereas costs per day were a positive predictor for mortality. These data suggest that despite high costs, ICU treatment for severe COVID-19 may be cost-effective for quality-adjusted life-years gained.
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Affiliation(s)
- N Schallner
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J Lieberum
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - H Bürkle
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - F Daumann
- Institute of Health Economics and Sports Economics, Institute of Sports Science, University of Jena, Germany
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Yumaguzin VV, Vinnik MV. Forecast of Population Size and Demographic Burden in Russia up to 2100. STUDIES ON RUSSIAN ECONOMIC DEVELOPMENT 2022; 33:422-431. [PMID: 35911058 PMCID: PMC9321309 DOI: 10.1134/s1075700722040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
The article presents basic approaches to substantiating the hypotheses of fertility, mortality, and migration in Russia in the long term. The main results of the multivariate demographic development of Russia until 2100, which combines 30 different combinations of demographic processes, are analyzed. It is shown that the population will decline under most scenarios, including the most probable medium scenario – up to 137.5 million people by the end of the century. In the short term until the early 2030s, all options show an increase in the demographic load, and in the longer term it alternatively decreases and increases with different intensity time and again. The most favorable scenarios with high fertility and life expectancy and low migration growth put the greatest pressure on the working-age population due to the higher number of births and the elderly in these scenarios.
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Schwandt H, Currie J, von Wachter T, Kowarski J, Chapman D, Woolf SH. Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021. JAMA 2022; 328:360-366. [PMID: 35797033 PMCID: PMC9264223 DOI: 10.1001/jama.2022.10952] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/09/2022] [Indexed: 01/09/2023]
Abstract
Importance The COVID-19 pandemic caused a large decrease in US life expectancy in 2020, but whether a similar decrease occurred in 2021 and whether the relationship between income and life expectancy intensified during the pandemic are unclear. Objective To measure changes in life expectancy in 2020 and 2021 and the relationship between income and life expectancy by race and ethnicity. Design, Setting, and Participants Retrospective ecological analysis of deaths in California in 2015 to 2021 to calculate state- and census tract-level life expectancy. Tracts were grouped by median household income (MHI), obtained from the American Community Survey, and the slope of the life expectancy-income gradient was compared by year and by racial and ethnic composition. Exposures California in 2015 to 2019 (before the COVID-19 pandemic) and 2020 to 2021 (during the COVID-19 pandemic). Main Outcomes and Measures Life expectancy at birth. Results California experienced 1 988 606 deaths during 2015 to 2021, including 654 887 in 2020 to 2021. State life expectancy declined from 81.40 years in 2019 to 79.20 years in 2020 and 78.37 years in 2021. MHI data were available for 7962 of 8057 census tracts (98.8%; n = 1 899 065 deaths). Mean MHI ranged from $21 279 to $232 261 between the lowest and highest percentiles. The slope of the relationship between life expectancy and MHI increased significantly, from 0.075 (95% CI, 0.07-0.08) years per percentile in 2019 to 0.103 (95% CI, 0.098-0.108; P < .001) years per percentile in 2020 and 0.107 (95% CI, 0.102-0.112; P < .001) years per percentile in 2021. The gap in life expectancy between the richest and poorest percentiles increased from 11.52 years in 2019 to 14.67 years in 2020 and 15.51 years in 2021. Among Hispanic and non-Hispanic Asian, Black, and White populations, life expectancy declined 5.74 years among the Hispanic population, 3.04 years among the non-Hispanic Asian population, 3.84 years among the non-Hispanic Black population, and 1.90 years among the non-Hispanic White population between 2019 and 2021. The income-life expectancy gradient in these groups increased significantly between 2019 and 2020 (0.038 [95% CI, 0.030-0.045; P < .001] years per percentile among Hispanic individuals; 0.024 [95% CI: 0.005-0.044; P = .02] years per percentile among Asian individuals; 0.015 [95% CI, 0.010-0.020; P < .001] years per percentile among Black individuals; and 0.011 [95% CI, 0.007-0.015; P < .001] years per percentile among White individuals) and between 2019 and 2021 (0.033 [95% CI, 0.026-0.040; P < .001] years per percentile among Hispanic individuals; 0.024 [95% CI, 0.010-0.038; P = .002] years among Asian individuals; 0.024 [95% CI, 0.011-0.037; P = .003] years per percentile among Black individuals; and 0.013 [95% CI, 0.008-0.018; P < .001] years per percentile among White individuals). The increase in the gradient was significantly greater among Hispanic vs White populations in 2020 and 2021 (P < .001 in both years) and among Black vs White populations in 2021 (P = .04). Conclusions and Relevance This retrospective analysis of census tract-level income and mortality data in California from 2015 to 2021 demonstrated a decrease in life expectancy in both 2020 and 2021 and an increase in the life expectancy gap by income level relative to the prepandemic period that disproportionately affected some racial and ethnic minority populations. Inferences at the individual level are limited by the ecological nature of the study, and the generalizability of the findings outside of California are unknown.
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Affiliation(s)
- Hannes Schwandt
- School of Education and Social Policy, Northwestern University, Evanston, Illinois
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
| | - Janet Currie
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
- Department of Economics, Princeton University, Princeton, New Jersey
| | - Till von Wachter
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
- Department of Economics, University of California, Los Angeles
- California Policy Lab, University of California, Los Angeles
| | - Jonathan Kowarski
- Department of Economics, University of California, Los Angeles
- California Policy Lab, University of California, Los Angeles
| | - Derek Chapman
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond
| | - Steven H. Woolf
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond
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Raikhel AV, Blau K, Alberty K, Redinger JW. An Interactive COVID-19 Vaccine Hesitancy Workshop for Internal Medicine Residents and Medical Students. Cureus 2022; 14:e27079. [PMID: 36000126 PMCID: PMC9391063 DOI: 10.7759/cureus.27079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Since being first identified in December 2019, SARS-CoV-2 has resulted in millions of illnesses and deaths worldwide. Despite the safety and availability of effective vaccines that offer protection from severe COVID-19 disease, a sizable minority of the United States population has reported COVID-19 vaccine hesitancy and remains unvaccinated. Methods We developed an interactive workshop for internal medicine residents and medical students in which a framework is utilized to aid the subtyping of COVID-19 vaccine hesitancy. Learners then interactively apply this framework through vaccine counseling in a role-playing exercise. Results The workshop increased confidence in the learner's ability to determine the COVID-19 vaccine hesitancy subtype after participation in the workshop (53% preworkshop, 81% postworkshop, p=0.01). The workshop also increased reported confidence in tailoring COVID-19 vaccine counseling after participation in the workshop (60% preworkshop, 90% postworkshop, p=0.005). These gains were also seen when participant learners were compared with nonparticipant learners for both subtyping confidence (81% postworkshop, 26% nonparticipant, p<0.0001) and confidence in providing tailored counseling (90% postworkshop, 60% nonparticipant, p=0.004). Conclusion The implementation of our workshop correlated with an increase in the reported trainee confidence related to COVID-19 vaccine counseling. This offers a promising early step in developing educational programs that build trainee skills in this domain. More work is needed to establish robust curricula to support learners in reaching patients who express COVID-19 vaccine hesitancy.
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Pires SM, Redondo HG, Espenhain L, Jakobsen LS, Legarth R, Meaidi M, Koch A, Tribler S, Martin-Bertelsen T, Ethelberg S. Disability adjusted life years associated with COVID-19 in Denmark in the first year of the pandemic. BMC Public Health 2022; 22:1315. [PMID: 35804310 PMCID: PMC9270752 DOI: 10.1186/s12889-022-13694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background Burden of disease studies measure the public health impact of a disease in a society. The aim of this study was to quantify the direct burden of COVID-19 in the first 12 months of the epidemic in Denmark. Methods We collected national surveillance data on positive individuals for SARS-CoV-2 with RT-PCR, hospitalization data, and COVID-19 mortality reported in the period between 26th of February, 2020 to 25th of February, 2021. We calculated disability adjusted life years (DALYs) based on the European Burden of Disease Network consensus COVID-19 model, which considers mild, severe, critical health states, and premature death. We conducted sensitivity analyses for two different death-registration scenarios, within 30 and 60 days after first positive test, respectively. Results We estimated that of the 211,823 individuals who tested positive to SARS-CoV-2 by RT-PCR in the one-year period, 124,163 (59%; 95% uncertainty interval (UI) 112,782–133,857) had at least mild symptoms of disease. The total estimated disease burden was 30,180 DALYs (95% UI 30,126; 30,242), corresponding to 520 DALYs/100,000. The disease burden was higher in the age groups above 70 years of age, particularly in men. Years of life lost (YLL) contributed with more than 99% of total DALYs. The results of the scenario analysis showed that defining COVID-19-related fatalities as deaths registered up to 30 days after the first positive test led to a lower YLL estimate than when using a 60-days window. Conclusion COVID-19 led to a substantial public health impact in Denmark in the first full year of the epidemic. Our estimates suggest that it was the the sixth most frequent cause of YLL in Denmark in 2020. This impact will be higher when including the post-acute consequences of COVID-19 and indirect health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13694-9.
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Affiliation(s)
- Sara M Pires
- Risk Benefit Research Group, National Food Institute, Technical University of Denmark, Lyngby, Denmark.
| | - Hernan G Redondo
- Risk Benefit Research Group, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Laura Espenhain
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen S, Denmark
| | - Lea S Jakobsen
- Risk Benefit Research Group, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Rebecca Legarth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen S, Denmark
| | - Marianna Meaidi
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Anders Koch
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen S, Denmark.,Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Siri Tribler
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen S, Denmark
| | - Tomas Martin-Bertelsen
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen S, Denmark.,Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
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Alkhameys S, Barrett R. Impact of the COVID-19 pandemic on England's national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019-February 2021). Curr Med Res Opin 2022; 38:1081-1092. [PMID: 35582854 DOI: 10.1080/03007995.2022.2078100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Direct-acting oral anticoagulants (DOACs) were developed as an alternative to warfarin to treat and prevent thromboembolism, including stroke prevention in non-valvular atrial fibrillation patients. The COVID-19 pandemic could increase the risk of stroke and/or the risk of bleeding in patients due to nonadherence or sub/supra-optimal dosing. OBJECTIVE To investigate DOAC prescription trends in England's community settings during the complete first wave of COVID-19 pandemic. METHODS Descriptive and interrupted time series (ITS) analyses were conducted to examine the prescription patterns of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin for primary care patients in the English Prescribing Dataset from January 2019 to February 2021, with March 2020 as the cut-off point. RESULTS A 19% increase in mean DOAC's accompanied with 20% warfarin prescriptions decline was observed. ITS modelling showed an increase in DOAC prescription volume in March 2020 (+7 million items, p = 0.008). The pre-existing upward trend in DOAC prescriptions slowed during the period (-427,000 items, p = 0.007). Apixaban was the most frequently used DOAC and had the largest step-change in March 2020 (+5 million items, p = 0.010). The mean monthly combined cost of DOACs and warfarin was higher during the period. DOAC prescription trends were consistent across England's regions. Conclusion: The overall oral anticoagulants use in this period was lower than expected, indicating a medical needs gap, possibly due to adherence issues. The potential clinical and logistical consequences warrant further study to identify contributing factors and mitigate avoidable risks.
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Affiliation(s)
| | - Ravina Barrett
- Senior Lecturer in Pharmacy Practice, School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
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Uusküla A, Jürgenson T, Pisarev H, Kolde R, Meister T, Tisler A, Suija K, Kalda R, Piirsoo M, Fischer K. Long-term mortality following SARS-CoV-2 infection: A national cohort study from Estonia. THE LANCET REGIONAL HEALTH. EUROPE 2022; 18:100394. [PMID: 35505834 PMCID: PMC9051903 DOI: 10.1016/j.lanepe.2022.100394] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND The objective of this study was to describe 12-month mortality following SARS-CoV-2 infection compared with a reference population with no history of SARS-CoV-2. METHODS Nationwide cohort study using electronic health care data on SARS-CoV-2 RNA positive cases (n= 66,287) and reference group subjects (n=254,969) with linkage to SARS-CoV-2 testing and death records. FINDINGS People infected with SARS-COV-2 had more than three times the risk of dying over the following year compared with those who remained uninfected (aHR 3·1, 95%CI 2·9-3·3). Short-term mortality (up to 5 weeks post-infection) was significantly higher among COVID-19 group (1623·0/10 000) than in the reference group (118/10 000). For COVID-19 cases aged 60 years or older, increased mortality persisted until the end of the first year after infection, and was related to increased risk for cardiovascular (aHR 2·1, 95%CI 1·8-2·3), cancer (aHR 1·5, 95%CI 1·2-1·9), respiratory system diseases (aHR 1·9, 95%CI 1·2-3·0), and other causes of death (aHR 1·8, 95%CI 1·4-2·2). INTERPRETATION Increased risk of death from SARS-CoV-2 is not limited to the acute illness: SARS-CoV-2 infection carries a substantially increased mortality in the following 12 months. This excess death mainly occurs in older people and is driven by broad array of causes of death. FUNDING Research was carried out with the support of Estonian Research Council (grants PRG1197, PRG198), European Regional Development Fund (RITA 1/02-120) and European Social Fund via IT Academy program.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Corresponding author at: Anneli Uusküla PhD, Department of Family Medicine and Public Health, University of Tartu, Tartu 50411, Estonia, +372 737 4195.
| | - Tuuli Jürgenson
- Institute of Mathematics and Statistics, University of Tartu, Estonia
- Institute of Genomics, University of Tartu, Estonia
| | - Heti Pisarev
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Estonia
| | - Tatjana Meister
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anna Tisler
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kadri Suija
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Marko Piirsoo
- Institute of Technology, University of Tartu, Estonia
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