Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data

Healthcare provider recommendations for COVID-19 vaccination: Prevalence, disparities, and correlates

OBJECTIVE

We assessed healthcare provider recommendations for COVID-19 vaccination, disparities across sociodemographic factors, and associations with health care coverage, social norms, COVID-19 vaccine hesitancy, and Fox News preference.

METHODS

We utilized random sample survey data of Arkansas residents (N = 2201) collected in October 2022 to identify adults with a personal provider who make up the analytical sample of this study (n = 1804).

RESULTS

Over a third (37.2 %; n = 607) of the weighted sample did not receive a recommendation. Adjusted odds of receiving a recommendation were positively associated with health care coverage (aOR=1.66; 95 % CI [1.05, 2.64]) and negatively associated with perceiving "very few" (aOR=0.48; 95 % CI [0.33, 0.72]) or "some but not many" (aOR=0.57; 95 % CI [0.41, 0.80]) rather than "nearly all" people close to them to be vaccinated. Adjusted odds of receiving a recommendation were negatively associated with being very hesitant (vs. not at all hesitant) (aOR=0.65; 95 % CI [0.47, 0.88]).

CONCLUSION

Provider recommendations for COVID-19 vaccination were not provided for a large portion of Arkansas adults, were inconsistently provided across sociodemographic groups, and were associated with health care coverage, social norms, and vaccine hesitancy.

PRACTICE IMPLICATIONS

Intervening on disparities in COVID-19 vaccination may require addressing disparities in provider recommendations.

Erosion of the Latino Health Advantage in the US

This JAMA Forum discusses the epidemiological and theoretical explanations regarding the erosion of the Latino health advantage in the US and proposes policies to promote Latino immigrant health.

Unequal loss: Disparities in relational closeness to a COVID-19 death among U.S. older adults

BACKGROUND

COVID-19 mortality occurred unevenly across U.S. demographic subgroups, leaving some communities harder hit than others. Black and Hispanic/Latino older adults are among those disproportionately affected by COVID-19 mortality, and in turn, COVID-19 bereavement. Because disparities in COVID-19 mortality may extend to COVID-19 bereavement, it is important to understand the incidence of COVID-19 bereavement among older adults at various degrees of relational closeness (e.g., spouse vs. household member vs. friend).

METHODS

We used the National Social Health and Aging Project (NSHAP) COVID Study to evaluate disparities in loss of a social network member to COVID-19 among U.S. older adults by race/ethnicity, language, and relational closeness. Multiple logistic regression was used to estimate the likelihood of experiencing a COVID-19 death in one's social network.

RESULTS

None of the English-speaking, non-Hispanic White respondents reported the loss of a household member or spouse to COVID-19. English-speaking, non-Hispanic Black and English-speaking, Hispanic older adults were overrepresented in reporting a death at every degree of relational closeness. However, close COVID-19 bereavement was most prevalent among Spanish-speaking older adults of any race. Although Spanish speakers comprised only 4.8% of the sample, half of the respondents who lost a spouse to COVID-19 were Spanish speakers. Language and ethnoracial group disparities persisted after controlling for age, sex, marital status, and education.

CONCLUSIONS

Known ethnoracial disparities in COVID-19 mortality extend to COVID-19 bereavement among older adults. Because bereavement impacts health, Black, Latino, and Spanish-speaking communities need greater protection and investment to prevent disparities in bereavement from exacerbating disparities in later-life mental and physical health.

Influence of COVID-19 pandemic in India on coronary artery disease clinical presentation, angiography, interventions and in-hospital outcomes: a single centre prospective registry-based observational study

OBJECTIVE

The study examined the influence of the COVID-19 pandemic in India on variation in clinical features, management and in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI).

DESIGN

Prospective registry-based observational study.

SETTING

A tertiary care hospital in India participant in the American College of Cardiology CathPCI Registry.

PARTICIPANTS

7089 successive patients who underwent PCI from April 2018 to March 2023 were enrolled (men 5627, women 1462). Details of risk factors, clinical presentation, coronary angiography, coronary interventions, clinical management and in-hospital outcomes were recorded. Annual data were classified into specific COVID-19 periods according to Government of India guidelines as pre-COVID-19 (April 2018 to March 2019, n=1563; April 2019 to March 2020, n=1594), COVID-19 (April 2020 to March 2020, n=1206; April 2021 to March 2022, n=1223) and post-COVID-19 (April 2022 to March 2023, n=1503).

RESULTS

Compared with the patients in pre-COVID-19 and post-COVID-19 periods, during the first COVID-19 year, patients had more hypertension, non-ST elevation myocardial infarction (NSTEMI), lower left ventricular ejection fraction (LVEF) and multivessel coronary artery disease (CAD). In the second COVID-19 year, patients had more STEMI, lower LVEF, multivessel CAD, primary PCI, multiple stents and more vasopressor and mechanical support. There were 99 (1.4%) in-hospital deaths which in the successive years were 1.2%, 1.4%, 0.8%, 2.4% and 1.3%, respectively (p=0.019). Compared with the baseline year, deaths were slightly lower in the first COVID-19-year (age-sex adjusted OR 0.68, 95% CI 0.31 to 1.47) but significantly more in the second COVID-19-year (OR 1.97, 95% CI 1.10 to 3.54). This variation attenuated following adjustment for clinical presentation, extent of CAD, in-hospital treatment and duration of hospitalisation.

CONCLUSIONS

In-hospital mortality among patients with CAD undergoing PCI was significantly higher in the second year of the COVID-19 pandemic in India and could be one of the reasons for excess deaths in the country. These patients had more severe CAD, lower LVEF, and more vasopressor and mechanical support and duration of hospitalisation.

Projecting the long-term effects of the COVID-19 pandemic on U.S. population structure

The immediate, direct effects of the COVID-19 pandemic on the United States population are substantial. Millions of people were affected by the pandemic: many died, others did not give birth, and still others could not migrate. Research that has examined these individual phenomena is important, but fragmented. The disruption of mortality, fertility, and migration jointly affected U.S. population counts and, consequently, future population structure. We use data from the United Nations World Population Prospects and the cohort component projection method to isolate the effect of the pandemic on U.S. population estimates until 2060. If the pandemic had not occurred, we project that the population of the U.S. would have 2.1 million (0.63%) more people in 2025, and 1.7 million (0.44%) more people in 2060. Pandemic-induced migration changes are projected to have a larger long-term effect on future population size than mortality, despite comparable short-term effects.

Changing impact of COVID-19 on life expectancy 2019-2023 and its decomposition: Findings from 27 countries

Background

The World Health Organization declared COVID-19 no longer a global health emergency on 5th May 2023; however, the impact of COVID-19 on life expectancy throughout the pandemic period is not clear. This study aimed to quantify and decompose the changes in life expectancy during 2019-2023 and corresponding age and gender disparities in 27 countries.

Methods

Data were sourced from the Human Mortality Database, the World Population Prospects 2022 and the United Kingdom's Office for National Statistics. Life expectancy was estimated using the abridged life table method, while differentials of life expectancies were decomposed using the age-decomposition algorithm.

Results

There was an overall reduction in life expectancy at age 5 among the 27 countries in 2020. Life expectancy rebounded in Western, Northern and Southern Europe in 2021 but further decreased in the United States, Chile and Eastern Europe in the same year. In 2022 and after, lost life expectancy years in the United States, Chile and Eastern Europe were slowly regained; however, as of 7th May 2023, life expectancy in 22 of the 27 countries had not fully recovered to its pre-pandemic level. The reduced life expectancy in 2020 was mainly driven by reduced life expectancy at age 65+, while that in subsequent years was mainly driven by reduced life expectancy at age 45-74. Women experienced a lower reduction in life expectancy at most ages but a greater reduction at age 85+.

Conclusions

The pandemic has caused substantial short-term mortality variations during 2019-2023 in the 27 countries studied. Although most of the 27 countries experienced increased life expectancy after 2022, life expectancy in 22 countries still has not entirely regained its pre-pandemic level by May 2023. Threats of COVID-19 are more prominent for older adults and men, but special attention is needed for women aged 85+ years.

Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic

Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.

Life-expectancy changes from 2019 to 22: A case study of Japan using provisional death count

Many countries struggled with suppressing the incidence of COVID-19 caused by SARS-CoV-2 Omicron variant (B.1.1.529). As the epidemic size of COVID-19 in 2022 became bigger than earlier years in Japan, the present study aimed to estimate life expectancy at birth at the end of 2022, using provisional death datasets in Aichi and Fukui prefectures. We collected monthly death count from 2019 to the end of 2022, computing the period life table. While the life expectancy at birth in Aichi, 2019 was 84.6 years, it was very slightly extended to 84.7 years in 2020 and 2021, followed by a shortening for nearly 0.4 years in 2022. In Fukui, monotonous extension pattern was seen, i.e., 85.5 years in 2019, 85.6 in 2020, followed by 85.8 and 86.2 years in 2021 and 2022, respectively. Although decades-long trend of extending life expectancy at birth was partly discontinued from 2020 due to the pandemic at the national level, we have shown that the pandemic impact was still small in Japan by the end of 2022. First Omicron wave occurred shortly after primary series vaccination, and even real time booster program was underway during that wave. Different demographic consequences between Aichi and Fukui are explained by differential epidemic sizes prior to vaccination.

The pandemic and social experience: For whom did discrimination and social isolation increase?

OBJECTIVE

The objective of this study was to examine whether experiences of discrimination have increased during the pandemic, particularly among negatively stigmatized racial/ethnic groups, and whether such experiences have exacerbated feelings of social isolation.

METHOD

Discrimination and social isolation were assessed before and during the pandemic in a sample of 263 Black and White young adults attending a large, predominantly White 4-year research university in the Southeastern region of the United States (52% Black, 48% White, 53% female, mean age = 19.2).

RESULTS

Increases in discrimination were evident among Black but not White participants. Black participants also reported greater increases in social isolation than White participants, and changes in discrimination partially mediated the emergent racial disparity in social isolation.

CONCLUSIONS

Findings are consistent with theoretical perspectives on discrimination during times of stress and suggest the need for broader attention to the impact of the pandemic on unfair treatment of stigmatized groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

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.

Latino Mortality Paradox Found (Again): COVID-19 Mortality a Tale of Two Years

Objectives: This study examines the resiliency of the Latino Mortality paradox during the COVID-19 pandemic. Methods: Data from the Centers for Disease Control and Prevention are used to compute the ratio of Latino-to-white all-causes death rates for adults aged 45 and older, nationally and among 13 U.S. states with Latino populations greater than one million. Results: Nationally, the Latino mortality paradox persisted in 2020 and 2021. However, there was significant variation across states. We document three distinct patterns of COVID-19 mortality across 13 U.S. states: 1) the disappearance of the Latino mortality paradox, 2) the persistence of the Latino mortality paradox, and 3) the disappearance in 2020 and reemergence in 2021 of the Latino mortality paradox. Discussion: COVID-19 Mortality has disproportionately affected mid- and late-life Latinos, although the disparities relative to whites have narrowed. We discuss the dynamics influencing the waning and waxing of the Latino mortality paradox.

Profiles of COVID-19 Impact on Informal Caregivers of Older Mexican Americans

Objectives: This manuscript is a descriptive exploratory study of the impact of the COVID-19 pandemic for caregivers of very old Mexican Americans. Methods: Using data from Wave 10 of the Hispanic Established Population for the Epidemiological Study of Elderly (2021), we examined the characteristics of caregivers of very old Mexican Americans by their perceived level of impact from the pandemic. We examined sociodemographic characteristics, COVID-19 testing and vaccination, stress and depression, and health of caregivers and care recipients. Results: Caregivers who reported the most impact were more likely to report financial and emotional stress. They reported more depressive symptoms and high levels of distress related to neuropsychological behavior symptoms of their care recipient. Discussion: High levels of depressive symptoms, financial stress, and neuropsychological behavior symptoms illustrate that the concerns of caregivers before the pandemic were heightened during the pandemic.

Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina

Introduction

The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina.

Methods

We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives.

Results

Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19.

Discussion

Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.

Is Lymphadenectomy Reasonable for Elderly Intrahepatic Cholangiocarcinoma Patients?

BACKGROUND

In this study, we aimed to determine the impact of lymphadenectomy (LND) on clinical outcomes in ICC patients aged ≥ 70 years.

METHODS

Four hundred and three eligible patients diagnosed with ICC who underwent hepatectomy between 2004 and 2019 were enrolled in the Surveillance, Epidemiology, and End Results database. The impact of LND on perioperative mortality and overall survival (OS) as well as the optimal total number of lymph nodes examined (TNLE) was estimated.

RESULTS

One hundred thirty-nine pairs of patients were matched by propensity score matching. Perioperative mortality was comparable between the LND and non-LND (nLND) groups (0.7% vs. 2.9%, P = 0.367). The median OS in the LND group was significantly longer (44 vs. 32 months, P = 0.045) and LND was identified as an independent protective factor for OS by multivariate analysis (HR 0.65, 95% CI 0.46-0.92, P = 0.014). Patients with the following characteristics were potential beneficiaries of LND: white, female, no/moderate fibrosis, tumor size > 5 cm, solitary tumor, and localized invasion (all P < 0.05). TNLE ≥ 6 had the greatest discriminatory power for identifying lymph node metastasis (area under the curve, 0.704, Youden index, 0.365, P = 0.002). Patients with pathologically confirmed lymph node metastasis are likely to benefit from adjuvant therapy (40 months vs. 4 months, P = 0.052).

CONCLUSIONS

Advanced age (≥ 70 years) was not a contraindication for LND, which facilitates accurate nodal staging and guides postoperative management. Appropriately selected elderly populations could benefit from LND.

Emerging infectious diseases, focus on infection prevention, environmental survival and germicide susceptibility: SARS-CoV-2, Mpox, and Candida auris

BACKGROUND

New and emerging infectious diseases continue to represent a public health threat. Emerging infectious disease threats include pathogens increasing in range (eg, Mpox), zoonotic microbes jumping species lines to cause sustained infections in humans via person-to-person transmission (SARS-CoV-2) and multidrug-resistant pathogens (eg, Candida auris).

MATERIALS AND METHODS

We searched the published English literature and reviewed the selected articles on SARS-CoV-2, Mpox, and Candida auris with a focus on environmental survival, contamination of the patient's hospital environment, susceptibility of the pathogen to antiseptics and disinfectants and infection prevention recommendations.

RESULTS

All three pathogens (ie, SARS-CoV-2, Mpox, and Candida auris) can survive on surfaces for minutes to hours and for Mpox and C auris for days. Currently available antiseptics (eg, 70%-90% alcohol hand hygiene products) are active against SARS-CoV-2, Mpox and C auris. The U.S Environmental Protection Agency provides separate lists of surface disinfectants active against SARS-CoV-2, Mpox, and C auris.

DISCUSSION

The risk of environment-to-patient transmission of SARS-CoV-2, Mpox and Candida auris, is very low, low-moderate and high, respectively. In the absence of appropriate patient isolation and use of personal protection equipment, the risk of patient-to-health care provider transmission of SARS-CoV-2, Mpox, and C auris is high, moderate and low, respectively.

CONCLUSIONS

Appropriate patient isolation, use of personal protective equipment by health care personnel, hand hygiene, and surface disinfection can protect patients and health care personnel from acquiring SARS-CoV-2, Mpox, and C auris from infected patients.

Effects of the COVID-19 pandemic on life expectancy at birth at the global, regional, and national levels: A joinpoint time-series analysis

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.

Age and sex differences in cause-specific excess mortality and years of life lost associated with COVID-19 infection in the Swedish population

BACKGROUND

Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic.

METHODS

In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017-19 in the whole Swedish population.

RESULTS

COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65-110 years and women aged 75-110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020.

CONCLUSIONS

Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.

Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference

BACKGROUND

Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them.

OBJECTIVES

This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP).

METHODS

Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note.

RESULTS

Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or "other" race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference.

CONCLUSION

Participants self-identifying as Black or "other" race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities.

Why the United States needs a multifaceted definition of health

How health is conceived and operationalized is an unrecognized contributor to poor health outcomes in the United States. The United States lacks an explicit definition of health, yielding a de facto, implicit biomedical definition in research and in health care that contrasts with how many people define health for themselves. This biomedical conceptualization has led to the development of lifesaving drugs, vaccines, and procedures, but has also resulted in critical underinvestment in people across their lives, beginning in early childhood, in behavioral, environmental, and social determinants. This underinvestment across the entire lifespan in people's health traps the United States in a vicious cycle of chronic disease and unsustainable health care costs. A movement towards holistic definitions of health represents an escape by defining health in more meaningful terms that reflect people's early development, agency, functioning, adaptive capacity, well-being, and lifelong development-that is, the capability for every person to thrive. Adopting and implementing a multifaceted, holistic health definition by federal research and health agencies could transform and humanize health in the United States and advance health equity.

Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021

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).

Life-expectancy changes during the COVID-19 pandemic from 2019-2021: estimates from Japan, a country with low pandemic impact

Background

The COVID-19 pandemic had a low impact on Japan in 2020, but the size of the epidemic increased considerably there in 2021. This study made a statistical analysis of life expectancy changes up to the end of 2021 in Japan.

Objective

We aimed to estimate changes in life expectancy from 2019 to 2021 associated with the COVID-19 pandemic. To do so, we decomposed the life expectancy changes from 2020-2021 into age-specific and cause of death-specific contributions.

Methods

We used the absolute number of deaths by age and prefecture in Japan to calculate life expectancy from 2019-21 at both national and prefectural levels, and also examined the correlation between life expectancy gap and annual number of COVID-19 cases, total person-days spent in intensive care, and documented deaths due to COVID-19. We used the Arriaga decomposition method to decompose national life expectancy changes from 2020 to 2021 into age and cause of death components.

Results

From 2019-2020, Japan's national level life expectancy across the entire population was extended by 0.24 years. From 2020-2021, it shortened by 0.15 years. The life expectancy shortened more among women (0.15 years) than men (0.12 years). There was significant heterogeneity in life expectancy changes from 2020-2021 by prefecture. It ranged from the maximum shortening of 0.57 years in Tottori prefecture to the maximum extension of 0.23 years in Fukui. The regression analysis revealed the negative correlation between the life expectancy change and burden of COVID-19 at prefectural level. The decomposition of life expectancy changes at birth from 2020-2021 showed that losses in life expectancy were largely attributable to the mortality of the population over 70 years old. Changes in life expectancy among infants and working-age adults mostly contributed to lengthening overall life expectancy. Among leading major causes of death, deaths due to neoplastic tumor and cardiovascular diseases contributed to shortening life expectancy, whereas respiratory diseases did not.

Conclusion

The decades-long increasing trend in life expectancy was suspended by the COVID-19 pandemic. However, life expectancy changes from 2019-2020 and 2020-2021 were small in Japan. This may be attributable to the small epidemiological impact of COVID-19 during this time period, but nonetheless, the negative impact of COVID-19 on life expectancy was indicated in the present study. The chance of death accelerated in older people in 2021, but a smaller number of deaths than usual among infants and working age adults contributed to extended life expectancy, and the change in the cause of death structure under the COVID-19 pandemic also significantly contributed to shortening life expectancy.

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

OBJECTIVE

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

METHOD

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

FINDINGS

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

CONCLUSION

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

COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States

Racial/ethnic and age disparities in COVID-19 and all-cause mortality during 2020 are well documented, but less is known about their evolution over time. We examine changes in age-specific mortality across five pandemic periods in the United States from March 2020 to December 2022 among four racial/ethnic groups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) for ages 35+. We fit Gompertz models to all-cause and COVID-19 death rates by 5-year age groups and construct age-specific racial/ethnic mortality ratios across an Initial peak (Mar-Aug 2020), Winter peak (Nov 2020-Feb 2021), Delta peak (Aug-Oct 2021), Omicron peak (Nov 2021-Feb 2022), and Endemic period (Mar-Dec 2022). We then compare to all-cause patterns observed in 2019. The steep age gradients in COVID-19 mortality in the Initial and Winter peak shifted during the Delta peak, with substantial increases in mortality at working ages, before gradually returning to an older age pattern in the subsequent periods. We find a disproportionate COVID-19 mortality burden on racial and ethnic minority populations early in the pandemic, which led to an increase in all-cause mortality disparities and a temporary elimination of the Hispanic mortality advantage at certain age groups. Mortality disparities narrowed over time, with racial/ethnic all-cause inequalities during the Endemic period generally returning to pre-pandemic levels. Black and Hispanic populations, however, faced a younger age gradient in all-cause mortality in the Endemic period relative to 2019, with younger Hispanic and Black adults in a slightly disadvantageous position and older Black adults in a slightly advantageous position, relative to before the pandemic.

Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022

Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the COVID-19 pandemic's mortality impact. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating factors, and inform response efforts. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,179,024 excess deaths occurred during the first 2 years of the pandemic (first: 634,830; second: 544,194). Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic's rural impact grows.

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

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

Missing Americans: Early death in the United States-1933-2021

We assessed how many US deaths would have been averted each year, 1933-2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as "missing Americans." The United States had lower mortality rates than peer countries in the 1930s-1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White.

Combined effect of early diagnosis and treatment on the case fatality risk of COVID-19 in Japan, 2020

Japanese government initially enforced restrictions on outpatient attendances among febrile individuals suspected of having COVID-19, asking everyone to remain at home for at least 4 days from the onset of fever. This restriction was cancelled on 8 May 2020, and a new antiviral, remdesivir, was approved from 7 May 2020. To investigate how this policy change influenced the prognosis of people with COVID-19, we estimated the case fatality risk as a function of the date of illness onset from April to June 2020. We used an interrupted time-series analysis model with an intervention date of 8 May 2020, and estimated time-dependent case fatality risk by age group. The case fatality risk showed a decreasing trend in all groups, and models were favored accounting for an abrupt causal effect, i.e., immediate decline in fatality risk. The trend was estimated at - 1.1% (95% CI [confidence interval]: - 3.9, 3.0) among people aged 60-69 years, - 7.2% (95% CI - 11.2, - 2.4) among those aged 70-79 years, - 7.4% (95% CI - 14.2, 0.2) among those aged 80-89 years, and - 10.3% (95% CI - 21.1, 2.7) among those aged 90 and over. Early diagnosis and treatment greatly contributed to reducing the case fatality risk.

Identifying age- and sex-specific COVID-19 mortality trends over time in six countries

OBJECTIVES

The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries.

METHODS

We focus on five European countries and the United States. Using standardized and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, and demographic characteristics and seasonality patterns.

RESULTS

Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analyzed but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared with women, men have higher COVID-19 mortality rates at most ages and in most seasons.

CONCLUSION

There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having targeted those ages specifically.

Assessing the impact of one million COVID-19 deaths in America: economic and life expectancy losses

Between February 2020 and May 2022, one million Americans have died of COVID-19. To determine the contribution of those deaths to all-cause mortality in terms of life expectancy reductions and the resulting economic welfare losses, we calculated their combined impact on national income growth and the added value of lives lost. We estimated that US life expectancy at birth dropped by 3.08 years due to the million COVID-19 deaths. Economic welfare losses estimated in terms of national income growth supplemented by the value of lives lost, was in the order of US$3.57 trillion. US$2.20 trillion of these losses were in in the non-Hispanic White population (56.50%), US$698.24 billion (19.54%) in the Hispanic population, and US$579.93 billion (16.23%) in the non-Hispanic Black population. The scale of life expectancy and welfare losses underscores the pressing need to invest in health in the US to prevent further economic shocks from future pandemic threats.

Language Access and Orofacial Pain

Clear and effective communication is vital to quality patient care. More than 66 million Americans (21.5%) speak a language other than English at home, with more than 25 million (8.2%) speaking English "less than very well." Addressing language differences in the orofacial pain setting is of utmost importance to care quality, treatment outcomes, and overall health equity. In the case presented, language-related communication challenges affect the diagnosis and management of a patient with orofacial pain. This case highlights the significance of language discordance in the clinical setting and demonstrates the need for greater language access in the orofacial pain field.

Non-Arteritic Ischemic Optic Neuropathy Following COVID-19 Vaccination in Korea: A Case Series

BACKGROUND

To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea.

METHODS

This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION.

RESULTS

The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43-77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1-41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit.

CONCLUSION

Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.

Nurses and COVID-19 response in Botswana

INTRODUCTION

The advent of the COVID-19 pandemic necessitated the Botswana Presidential Task Force, in collaboration with the Ministry of Health and Wellness (MoHW), to devise strategies to utilize the already overburdened health personnel to combat the spread of the coronavirus. This descriptive case study aimed to describe nurses' role during COVID-19 in Botswana.

DESIGN AND METHODS

A case study analysis was used to describe nurses' roles during COVID-19. Data were collected through observing events in various health facilities and various media platforms that described how nurses had to position themselves to combat the pandemic. Content analysis was done by coding and developing categories that put like content together and generate thematic areas.

RESULTS

Nurses from different sectors were redeployed to assist in setting up different units at the COVID-19 makeshift hospital, taking away from the already understaffed section of health care workers resulting in the overburden and work overload. Furthermore, nurses continued with their regular day-to-day nursing care duties in various healthcare settings, albeit under a severe shortage due to the national response to COVID-19.

CONCLUSION

Adaptations and experiential strategies enabled the distribution of the nursing workforce to cover all locations to curb the spread of COVID-19 despite the challenges encountered. Recommendations and lessons learned on how to prepare for future pandemics are also discussed.

CLINICAL RELEVANCE

Due to their large numbers, nurses formed the backbone of the Botswana COVID-19 response strategy. Therefore, policy-makers should be responsive to the nurses' perspectives when developing strategic policies on how to deal with pandemics based on their experiences.

The Covid-19 pandemic and the expansion of the mortality gap between the United States and its European peers

The mortality gap between the United States and other high-income nations substantially expanded during the first two decades of the 21st century. International comparisons of Covid-19 mortality suggest this gap might have grown during the Covid-19 pandemic. Applying population-weighted average mortality rates of the five largest West European countries to the US population reveals that this mortality gap increased the number of US deaths by 34.8% in 2021, causing 892,491 "excess deaths" that year. Controlling for population size, the annual number of excess deaths has nearly doubled between 2019 and 2021 (+84.9%). Diverging trends in Covid-19 mortality contributed to this increase in excess deaths, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. In 2021, the number of excess deaths involving Covid-19 in the United States reached 223,266 deaths, representing 25.0% of all excess deaths that year. However, 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 is due to other causes of deaths. While the contribution of Covid-19 to excess mortality might be transient, divergent trends in mortality from other causes persistently separates the United States from West European countries. Excess mortality is particularly high between ages 15 and 64. In 2021, nearly half of all US deaths in this age range are excess deaths (48.0%).

A large-scale machine learning study of sociodemographic factors contributing to COVID-19 severity

Understanding sociodemographic factors behind COVID-19 severity relates to significant methodological difficulties, such as differences in testing policies and epidemics phase, as well as a large number of predictors that can potentially contribute to severity. To account for these difficulties, we assemble 115 predictors for more than 3,000 US counties and employ a well-defined COVID-19 severity measure derived from epidemiological dynamics modeling. We then use a number of advanced feature selection techniques from machine learning to determine which of these predictors significantly impact the disease severity. We obtain a surprisingly simple result, where only two variables are clearly and robustly selected-population density and proportion of African Americans. Possible causes behind this result are discussed. We argue that the approach may be useful whenever significant determinants of disease progression over diverse geographic regions should be selected from a large number of potentially important factors.

Service delivery at Title X sites in Texas during the COVID-19 pandemic

CONTEXT

The important role of Title X sites in supporting publicly funded reproductive healthcare was elevated during the COVID-19 pandemic, as many people experienced economic uncertainty and changed their fertility preferences. In this study, we assessed changes in service delivery during the first year of the COVID-19 pandemic at Title X-supported sites in Texas, a large state with a high uninsured rate and a diverse Title X network.

METHODS

Using surveys of Title X-funded organizations in Texas from April and November 2020, we examined the percentage of organizations reporting service modifications. With administrative data on 507,947 client encounters between March 2019 and March 2021, we assessed change in client volume at the onset of the pandemic and evaluated the association between regional COVID-19 case rates and the provision of key Title X services.

RESULTS

In April 2020, most organizations (78%) limited in-person operations while implementing telehealth (74%) and contactless contraception (67%). Network-wide encounter volume declined by 26% at pandemic onset (incidence rate ratio [IRR] = 0.74, 95% confidence interval [CI] = 0.65, 0.84). Health departments experienced the steepest declines in encounter volume (IRR = 0.43, 95% CI = 0.36-0.50). Weekly encounters, particularly for long-acting reversible method placement/removal and sexually transmitted infection testing, decreased as COVID-19 rates increased.

CONCLUSIONS

Investment in public health infrastructure, including providing robust support to health departments as well as rebuilding and expanding the Title X network, is essential to safeguarding access to publicly funded reproductive healthcare during and after the pandemic.

Enhancing the Utility of the Health and Retirement Study (HRS) to Identify Drivers of Rising Mortality Rates in the United States

A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights rising rates of working-age mortality in the United States, portending troubling population health trends for this group as they age. The Health and Retirement Study (HRS) is an invaluable resource for researchers studying health and aging dynamics among Americans ages 50 and above and has strong potential to be used by researchers to provide insights about the drivers of rising U.S. mortality rates. This paper assesses the strengths and limitations of HRS data for identifying drivers of rising mortality rates in the U.S. and provides recommendations to enhance the utility of the HRS in this regard. Among our many recommendations, we encourage the HRS to prioritize the following: link cause of death information to respondents; reduce the age of eligibility for inclusion in the sample; increase the rural sample size; enhance the existing HRS Contextual Data Resource by incorporating longitudinal measures of structural determinants of health; develop additional data linkages to capture residential settings and characteristics across the life course; and add measures that capture drug use, gun ownership, and social media use.

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Excess mortality is the difference between expected and observed mortality in a given period and has emerged as a leading measure of the overall impact of the Covid-19 pandemic that is not biased by differences in testing or cause-of-death assignment. Spatially and temporally granular estimates of excess mortality are needed to understand which areas have been most impacted by the pandemic, evaluate exacerbating and mitigating factors, and inform response efforts, including allocating resources to affected communities. We estimated all-cause excess mortality for the United States from March 2020 through February 2022 by county and month using a Bayesian hierarchical model trained on data from 2015 to 2019. An estimated 1,159,580 excess deaths occurred during the first two years of the pandemic (first: 620,872; second: 538,708). Overall, excess mortality decreased in large metropolitan counties, but increased in nonmetro counties, between the first and second years of the pandemic. Despite the initial concentration of mortality in large metropolitan Northeast counties, beginning in February 2021, nonmetro South counties had the highest cumulative relative excess mortality. These results highlight the need for investments in rural health as the pandemic's disproportionate impact on rural areas continues to grow.

Is austerity a cause of slower improvements in mortality in high-income countries? A panel analysis

BACKGROUND

The rate of improvement in mortality slowed across many high-income countries after 2010. Following the 2007-08 financial crisis, macroeconomic policy was dominated by austerity as countries attempted to address perceived problems of growing state debt and government budget deficits. This study estimates the impact of austerity on mortality trends for 37 high-income countries between 2000 and 2019.

METHODS

We fitted a suite of fixed-effects panel regression models to mortality data (period life expectancy, age-standardised mortality rates (ASMRs), age-stratified mortality rates and lifespan variation). Austerity was measured using the Alesina-Ardagna Fiscal Index (AAFI), Cyclically-Adjusted Primary Balance (CAPB), real indexed Government Expenditure, and Public Social Spending as a % of GDP. Sensitivity analyses varied the lag times, and confined the panel to economic downturns and to non-oil-dominated economies.

RESULTS

Slower improvements, or deteriorations, in life expectancy and mortality trends were seen in the majority of countries, with the worst trends in England & Wales, Estonia, Iceland, Scotland, Slovenia, and the USA, with generally worse trends for females than males. Austerity was implemented across all countries for at least some time when measured by AAFI and CAPB, and for many countries across all four measures (and particularly after 2010). Austerity adversely impacted life expectancy, ASMR, age-specific mortality and lifespan variation trends when measured with Government Expenditure, Public Social Spending and CAPB, but not with AAFI. However, when the dataset was restricted to periods of economic downturn and in economies not dominated hydrocarbon production, all measures of austerity were found to reduce the rate of mortality improvement.

INTERPRETATION

Stalled mortality trends and austerity are widespread phenomena across high-income countries. Austerity is likely to be a cause of stalled mortality trends. Governments should consider alternative economic policy approaches if these harmful population health impacts are to be avoided.

Heterogeneity in Disparities in Life Expectancy Across US Metropolitan Areas

BACKGROUND

Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking.

METHODS

Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States.

RESULTS

We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups.

CONCLUSIONS

Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.

Understanding the impact of lockdowns on short-term excess mortality in Australia

During 2020 and 2021, Australia implemented relatively stringent government restrictions yet had few COVID-19 deaths. This provides an opportunity to understand the effects of lockdowns and quarantining restrictions on short-term mortality and to help provide evidence in understanding how such public health policies can impact on health. Our analysis is based on preliminary mortality data collected by the Australian Bureau of Statistics. Rates were estimated by disease and over time and compared with mortality statistics in the period 2015-2019. Comparing deaths in 2020-2021 with 2015-2019 show the annual mortality rate (per 100 000 people) fell by 5.9% from 528.4 in 2015-2019 to 497.0 in 2020-2021. Declines in mortality are across many disease categories including respiratory diseases (down 9.4 deaths per 100 000), cancer (down 7.5 deaths per 100 000) and heart disease (down 8.4 deaths per 100 000). During 2020 and 2021, Australian age-standardised mortality rates fell by 6%. This drop was similar for men and women, and was driven by a reduction in both communicable and non-communicable causes of death. Such evidence can help inform public health policies designed to both control COVID-19 and other infectious diseases.

Exploring changes in temporary abstinence in increasing and higher risk drinkers in England and Dry January participation in users of the Try Dry app in the UK between 2020 and 2021

BACKGROUND

We looked at changes in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and changes in prevalence of use of the official app accompanying Dry January between 2020 vs 2021, following the onset of the COVID-19 pandemic. We also explored potential shifts in the sociodemographic composition of both groups.

METHODS

We analysed data from: i) 1863 increasing and higher risk drinkers (defined as ≥ 8 on the AUDIT) responding to a nationally representative survey of adults in England in January and February 2020 and 2021, and ii) 104,598 users of the 'Try Dry' app, the official aid to those participating in Dry January 2020 and 2021 in the UK. We used logistic regression to examine shifts in the prevalence of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence and explored whether there were shifts in the characteristics of this group in terms of AUDIT score, number of last year reduction attempts, smoking status, living alone, living with children, reducing alcohol consumption due to future health motives, age, sex, and occupational social grade between 2020 and 2021. We used t-tests and chi-squared tests to compare the prevalence of users of the 'Try Dry' app in 2020 and 2021 and examine whether the two groups differed in terms of age and sex.

RESULTS

The proportion of increasing and higher risk drinkers reporting a reduction attempt motivated by temporary abstinence increased from 4% in 2020 to 8% in 2021 (OR = 2.07, 95% CI = 1.38-3.11, p < .001) with no changes detected in sociodemographic composition. The number of Try Dry app users in 2021 increased by 34.8% relative to 2020. App users in 2021 were two years older on average [p < .001, d = .02], with a 2% increase in the proportion of female app users [p < .001, vs. < .01].

CONCLUSIONS

Higher participation in Dry January 2021 relative to 2020 indicates increased engagement with a period of temporary abstinence following the COVID-19 related lockdowns in England and the UK, which is positive in the wider context of increasing alcohol consumption throughout the pandemic.

Multiscale dimensions of county-level disparities in opioid use disorder rates among older Medicare beneficiaries

Background

Opioid use disorder (OUD) among older adults (age ≥ 65) is a growing yet underexplored public health concern and previous research has mainly assumed that the spatial process underlying geographic patterns of population health outcomes is constant across space. This study is among the first to apply a local modeling perspective to examine the geographic disparity in county-level OUD rates among older Medicare beneficiaries and the spatial non-stationarity in the relationships between determinants and OUD rates.

Methods

Data are from a variety of national sources including the Centers for Medicare & Medicaid Services beneficiary-level data from 2020 aggregated to the county-level and county-equivalents, and the 2016-2020 American Community Survey (ACS) 5-year estimates for 3,108 contiguous US counties. We use multiscale geographically weighted regression to investigate three dimensions of spatial process, namely "level of influence" (the percentage of older Medicare beneficiaries affected by a certain determinant), "scalability" (the spatial process of a determinant as global, regional, or local), and "specificity" (the determinant that has the strongest association with the OUD rate).

Results

The results indicate great spatial heterogeneity in the distribution of OUD rates. Beneficiaries' characteristics, including the average age, racial/ethnic composition, and the average hierarchical condition categories (HCC) score, play important roles in shaping OUD rates as they are identified as primary influencers (impacting more than 50% of the population) and the most dominant determinants in US counties. Moreover, the percentage of non-Hispanic white beneficiaries, average number of mental health conditions, and the average HCC score demonstrate spatial non-stationarity in their associations with the OUD rates, suggesting that these variables are more important in some counties than others.

Conclusions

Our findings highlight the importance of a local perspective in addressing the geographic disparity in OUD rates among older adults. Interventions that aim to reduce OUD rates in US counties may adopt a place-based approach, which could consider the local needs and differential scales of spatial process.

Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality

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.

All Public Health is Local: Lessons From Eagle County During the First 2 Years of the Coronavirus Disease-2019 Pandemic

BACKGROUND

During the coronavirus disease-2019 (COVID-19) pandemic cumulative United States COVID-19 deaths per capita were higher than all other large, high-income nations, but with substantial variation across the country.

OBJECTIVE

The aim was to detail the public health response during the pandemic in Eagle County, Colorado.

RESEARCH DESIGN AND MEASURES

Observational study using pre-COVID-19 county public health metrics. Pandemic actions were recorded from a narrative summary of daily phone consultations by a county-wide taskforce and interviews. Outcomes obtained from local, state, and nationally reported databases.

METHODS

Eagle County began with a life expectancy of 85.9, low all-cause age-adjusted death rates equal for both White and Latinx populations, a high household median income, and other prepandemic advantages. It also launched an innovative, independent county-wide taskforce lead by experienced mid-level managers. The taskforce implemented rapid communication of decision consequences, made immediate course corrections without traditional organizational approvals or contradictory political pressures.

RESULTS

Eagle County was first in Colorado to obtain Personal Protective Equipment and to establish a drive-through testing facility. The COVID-19 case fatality rate was 0.34%. The sole intensive care unit never reached maximum capacity. By March 2022, Eagle County had administered at least 1 vaccine dose to 100% of the population and 83% were fully vaccinated.

CONCLUSIONS

It is not possible to directly attribute superior outcomes to either the baseline characteristics of Eagle County or its innovative taskforce design and deployment. Rather this report highlights the potential impact that improving the baseline health status of US citizens and permitting novel problem-solving approaches by local public health officials might have for the next pandemic.

Promoting Health Equity in the Latinx Community, Locally and Globally

It is imperative that nurses are equipped to promote the health and well-being of diverse populations in United States, including the growing Latinx community, which experiences significant health disparities. This article summarizes the values, programs, and impact of the Duke University School of Nursing Latinx Engagement Health Equity Model. Collaborative partnerships with diverse community partners addressing Latinx populations across the life span were developed, spanning the education, research, and service missions of the university. Programs were rooted in cultural values and were delivered through diverse interprofessional teams and with support from the university. Programs included local and global immersion programs, volunteer work, courses in Medical Spanish, community engaged research projects, and leadership in coalitions. These models have resulted in favorable outcomes for learners, faculty and staff, and the Latinx community more broadly and can serve as a model for strategies to promote health equity at schools of nursing.

Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021

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.