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Ferreira DP, Bolognani CV, Santana LA, Fernandes SES, de Moraes MSF, Fernandes LAS, de Oliveira DQ, de Santana RB, Gottems LBD, Amorim FF. Impact of the COVID-19 Pandemic on Elective and Emergency Surgeries, and Postoperative Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study. Risk Manag Healthc Policy 2024; 17:1701-1712. [PMID: 38946840 PMCID: PMC11214554 DOI: 10.2147/rmhp.s459307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic. Patients and Methods Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality. Results There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2). Conclusion Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.
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Affiliation(s)
| | - Claudia Vicari Bolognani
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Levy Aniceto Santana
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Sergio Eduardo Soares Fernandes
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | | | | | | | | | - Leila Bernarda Donato Gottems
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
| | - Fabio Ferreira Amorim
- Graduation Program in Health Sciences, University of Brasília (Unb), Brasília, Brazil
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Brazil
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Lima EECD, Costa LCCD, Souza RF, Rocha CODE, Ichihara MYT. Presidential election results in 2018-2022 and its association with excess mortality during the 2020-2021 COVID-19 pandemic in Brazilian municipalities. CAD SAUDE PUBLICA 2024; 40:e00194723. [PMID: 38896596 PMCID: PMC11178372 DOI: 10.1590/0102-311xen194723] [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: 08/16/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 06/21/2024] Open
Abstract
We evaluated the hypothesis of an association between excess mortality and political partisanship in Brazil using municipal death certificates registered in the Brazilian Ministry of Health database and first-round electoral results of Presidential elections in 2018 and 2022. Considering the former Brazilian President's stance of discrediting and neglecting the severity of the pandemic, we expect a possible relationship between excessive mortality rates during the COVID-19 health crisis and the number of municipal votes for Bolsonaro. Our results showed that, in both elections, the first-round percentage of municipal votes for Bolsonaro was positively associated with the peaks of excess deaths across Brazilian municipalities in 2020 and 2021. Despite the excess mortality during the pandemic, the political loyalty to Bolsonaro remained the same during the electoral period of 2022. A possible explanation for this is linked to the Brazilian political scenario, which presents an environment of tribal politics and affective polarization.
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Affiliation(s)
| | | | - Rafael F Souza
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brasil
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Szwarcwald CL, Almeida WS, Boccolini CS, Soares Filho AM, Malta DC. The unequal impact of the pandemic at subnational levels and educational attainment-related inequalities in COVID-19 mortality, Brazil, 2020-2021. Public Health 2024; 231:39-46. [PMID: 38615470 DOI: 10.1016/j.puhe.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We estimated COVID-19 mortality indicators in 2020-2021 to show the epidemic's impact at subnational levels and to analyze educational attainment-related inequalities in COVID-19 mortality in Brazil. STUDY DESIGN This was an ecological study with secondary mortality information. METHODS Crude and age-standardized COVID-19 mortality rates were calculated by gender, major regions, and states. The COVID-19 proportional mortality (percentage) was estimated by gender and age in each region. Measures of education-related inequalities in COVID-19 mortality were calculated per state, in each of which the COVID-19 maternal mortality rate (MMR) was estimated by the number of COVID-19 maternal deaths per 100,000 live births (LBs). RESULTS The analysis of mortality rates at subnational levels showed critical regional differences. The North region proved to be the most affected by the pandemic, followed by the Center-West, with age-standardized COVID-19 mortality rates above 2 per 1000 inhabitants. The peak of COVID-19 mortality occurred in mid-March/April 2021 in all regions. Great inequality by educational level was found, with the illiterate population being the most negatively impacted in all states. The proportional mortality showed that males and females aged 50-69 years were the most affected. The MMR reached critical values (>100/100,000 LB) in several states of the North, Northeast, Southeast, and Center-West regions. CONCLUSIONS This study highlights stark regional and educational disparities in COVID-19 mortality in Brazil. Exacerbated by the pandemic, these inequalities reveal potential areas for intervention to reduce disparities. The results also revealed high MMRs in certain states, underscoring pre-existing healthcare access challenges that worsened during the pandemic.
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Affiliation(s)
- C L Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - W S Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C S Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A M Soares Filho
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - D C Malta
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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4
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Gonzaga MR, Queiroz BL, Freire FHMA, Monteiro-da-Silva JHC, Lima EEC, Silva-Júnior WP, Diógenes VHD, Flores-Ortiz R, da Costa LCC, Pinto-Junior EP, Ichihara MY, Teixeira CSS, Alves FJO, Rocha AS, Ferreira AJF, Barreto ML, Katikireddi SV, Dundas R, Leyland AH. Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030. Popul Health Metr 2024; 22:9. [PMID: 38802870 PMCID: PMC11129360 DOI: 10.1186/s12963-024-00329-x] [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: 10/25/2022] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. METHODS We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. RESULTS The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. CONCLUSION Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.
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Affiliation(s)
- Marcos R Gonzaga
- Graduate Program in Demography, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil.
| | - Bernardo L Queiroz
- Graduate Program in Demography, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Flávio H M A Freire
- Graduate Program in Demography, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | | | - Everton E C Lima
- Graduate Program in Demography, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Walter P Silva-Júnior
- Graduate Program in Demography, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Victor H D Diógenes
- Graduate Program in Demography, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Renzo Flores-Ortiz
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | | | - Elzo P Pinto-Junior
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | - Camila S S Teixeira
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | - Flávia J O Alves
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | - Aline S Rocha
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
- School of Nutrition, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Andrêa J F Ferreira
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para a Saúde (Center of Data and Knowledge Integration for Health) - CIDACS/ Gonçalo Moniz Institute - Fiocruz/Bahia, Salvador, Brazil
| | | | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences, Unit University of Glasgow, Glasgow, Scotland
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences, Unit University of Glasgow, Glasgow, Scotland
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De Padua Durante AC, Lacaza R, Lapitan P, Kochhar N, Tan ES, Thomas M. Mixed effects modelling of excess mortality and COVID-19 lockdowns in Thailand. Sci Rep 2024; 14:8240. [PMID: 38589527 PMCID: PMC11001903 DOI: 10.1038/s41598-024-58358-3] [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: 02/24/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
Accurate mortality data are critical for understanding the impact of COVID-19 and learning lessons from crisis responses. But published statistics risk misrepresenting deaths due to limited testing, underreporting, and lack of subnational data, especially in developing countries. Thailand experienced four COVID-19 waves between January 2020 and December 2021, and used a color-coded, province-level system for lockdowns. To account for deaths directly and indirectly caused by COVID-19, this paper uses mixed effects modelling to estimate counterfactual deaths for 2020-2021 and construct a monthly time series of provincial excess mortality. A fixed effects negative binomial and mixed effects Poisson model both substantiate other studies' estimates of excess deaths using subnational data for the first time. Then, panel regression methods are used to characterize the correlations among restrictions, mobility, and excess mortality. The regressions show that mobility reductions modestly curbed mortality immediately upon imposition, suggesting that aversion of non-COVID deaths was a major aspect of the lockdowns' effect in Thailand. However, the estimates are imprecise. An auto-regressive distributed lag model suggests that the effect of lockdowns was through reduced mobility, but the effectiveness appears to have varied over the course of the pandemic.
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Affiliation(s)
| | - Rutcher Lacaza
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Pamela Lapitan
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Nishtha Kochhar
- Department of Economics, Georgetown University, Washington, USA
| | - Elaine S Tan
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines
| | - Milan Thomas
- Economic Research and Development Impact Department, Asian Development Bank, Mandaluyong, Philippines.
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Fernandez-Naranjo RP, Vasconez-Gonzalez J, Izquierdo-Condoy JS, Landazuri S, Castillo D, Ortiz-Prado E. A proposed analytical approach to estimate excess daily mortality rates in Ecuador. Front Public Health 2024; 12:1250343. [PMID: 38525341 PMCID: PMC10957652 DOI: 10.3389/fpubh.2024.1250343] [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: 06/30/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background The COVID-19 pandemic has proved deadly all over the globe; however, one of the most lethal outbreaks occurred in Ecuador. Aims This study aims to highlight the pandemic's impact on the most affected countries worldwide in terms of excess deaths per capita and per day. Methods An ecological study of all-cause mortality recorded in Ecuador was performed. To calculate the excess deaths relative to the historical average for the same dates in 2017, 2018, and 2019, we developed a bootstrap method based on the central tendency measure of mean. A Poisson fitting analysis was used to identify trends on officially recorded all-cause deaths and COVID-19 deaths. A bootstrapping technique was used to emulate the sampling distribution of our expected deaths estimator μ ⌢ d e a t h s by simulating the data generation and model fitting processes daily since the first confirmed case. Results In Ecuador, during 2020, 115,070 deaths were reported and 42,453 were cataloged as excess mortality when compared to 2017-2019 period. Ecuador is the country with the highest recorded excess mortality in the world within the shortest timespan. In one single day, Ecuador recorded 1,120 deaths (6/100,000), which represents an additional 408% of the expected fatalities. Conclusion Adjusting for population size and time, the hardest-hit country due to the COVID-19 pandemic was Ecuador. The mortality excess rate shows that the SARS-CoV-2 virus spread rapidly in Ecuador, especially in the coastal region. Our results and the proposed new methodology could help to address the real situation of the number of deaths during the initial phase of pandemics.
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Affiliation(s)
| | | | | | | | | | - Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador
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Valdivia-Carrera CA, Ho-Palma AC, Munguia-Mercado A, Gonzalez-Pizarro K, Ibacache-Quiroga C, Dinamarca A, Stehlík M, Rusiñol M, Girones R, Lopez-Urbina MT, Basaldua Galarza A, Gonzales-Gustavson E. Surveillance of SARS-CoV-2, rotavirus, norovirus genogroup II, and human adenovirus in wastewater as an epidemiological tool to anticipate outbreaks of COVID-19 and acute gastroenteritis in a city without a wastewater treatment plant in the Peruvian Highlands. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167161. [PMID: 37730068 DOI: 10.1016/j.scitotenv.2023.167161] [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: 04/24/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has demonstrated that Wastewater Based Epidemiology is a fast and economical alternative for monitoring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the community level in high-income countries. In the present study, wastewater from a city in the Peruvian Highlands, which lacks a wastewater treatment plant, was monitored for one year to assess the relationship between the concentration of SARS-CoV-2 and the reported cases of COVID-19 in the community. Additionally, we compared the relationship between rotavirus (RV), norovirus genogroup II (NoV GGII), and human adenovirus (HAdV) with the number of reported cases of acute gastroenteritis. Before commencing the analysis of the samples, the viral recovery efficacy of three processing methods was determined in spiked wastewater with SARS-CoV-2. This evaluation demonstrated the highest recovery rate with direct analysis (72.2 %), as compared to ultrafiltration (50.8 %) and skimmed milk flocculation (5.6 %). Wastewater monitoring revealed that 72 % (36/50) of the samples tested positive for SARS-CoV-2, with direct analysis yielding the highest detection frequency and quantification of SARS-CoV-2. Furthermore, a strong correlation was observed between the concentration of SARS-CoV-2 in wastewater and the reported cases of COVID-19, mainly when we shift the concentration of SARS-CoV-2 by two weeks, which allows us to anticipate the onset of the fourth and fifth waves of the pandemic in Peru up to two weeks in advance. All samples processed using the skimmed milk flocculation method tested positive and showed high concentrations of RV, NoV GGII, and HAdV. In fact, the highest RV concentrations were detected up to four weeks before outbreaks of acute gastroenteritis reported in children under four years of age. In conclusion, the results of this study suggest that periodic wastewater monitoring is an excellent epidemiological tool for surveillance and can anticipate outbreaks of infectious diseases, such as COVID-19, in low- and middle-income countries.
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Affiliation(s)
- Cesar A Valdivia-Carrera
- Tropical and Highlands Veterinary Research Institute, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Jr. 28 de Julio s/n, Km 34, margen izquierda, Carretera Central, El Mantaro, Jauja, Junin, Peru; Department of Animal Health and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Av. Circunvalacion 2800, San Borja, Lima, Peru.
| | - Ana C Ho-Palma
- Department of Human Medicine, School of Human Medicine, Universidad Nacional del Centro del Peru, Av. Mariscal Castilla 3909, Huancayo, Peru.
| | - Astrid Munguia-Mercado
- Tropical and Highlands Veterinary Research Institute, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Jr. 28 de Julio s/n, Km 34, margen izquierda, Carretera Central, El Mantaro, Jauja, Junin, Peru.
| | - Karoll Gonzalez-Pizarro
- Centro de Micro-Bioinnovación, Universidad de Valparaíso, Av. Gran Bretaña 1093, Valparaíso, Chile.
| | - Claudia Ibacache-Quiroga
- Centro de Micro-Bioinnovación, Universidad de Valparaíso, Av. Gran Bretaña 1093, Valparaíso, Chile; Escuela de Nutrición y Dietética, Facultad de Farmacia, Universidad de Valparaíso, Av. Gran Bretaña 1093, Valparaíso, Chile.
| | - Alejandro Dinamarca
- Centro de Micro-Bioinnovación, Universidad de Valparaíso, Av. Gran Bretaña 1093, Valparaíso, Chile; Escuela de Nutrición y Dietética, Facultad de Farmacia, Universidad de Valparaíso, Av. Gran Bretaña 1093, Valparaíso, Chile.
| | - Milan Stehlík
- Institute of Statistics, Universidad de Valparaiso, Av. Gran Bretana 1111, Valparaiso, Chile; Linz Institute of Technology & Department of Applied Statistics, Johannes Kepler University in Linz, Altenberger Straße 69, 4040 Linz, Austria.
| | - Marta Rusiñol
- Laboratory of Virus Contaminants of Water and Food, Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Avinguda Diagonal 643, 08028 Barcelona, Catalonia, Spain.
| | - Rosina Girones
- Laboratory of Virus Contaminants of Water and Food, Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Avinguda Diagonal 643, 08028 Barcelona, Catalonia, Spain.
| | - Maria T Lopez-Urbina
- Laboratory of Veterinary Epidemiology and Economics, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Av. Circunvalacion 2800, San Borja, Lima, Peru.
| | - Anani Basaldua Galarza
- Department of Human Medicine, School of Human Medicine, Universidad Nacional del Centro del Peru, Av. Mariscal Castilla 3909, Huancayo, Peru; Dirección Ejecutiva de Epidemiología, Dirección Regional de Salud, Jr. Julio Cesar Tello 488, Huancayo 12004, Junin, Peru.
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Jr. 28 de Julio s/n, Km 34, margen izquierda, Carretera Central, El Mantaro, Jauja, Junin, Peru; Department of Animal Health and Public Health, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Av. Circunvalacion 2800, San Borja, Lima, Peru.
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Torres EC, Moreno M, Rivadeneira MF. Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador. Vaccine X 2023; 15:100393. [PMID: 37767539 PMCID: PMC10520883 DOI: 10.1016/j.jvacx.2023.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Background Equity in vaccination against COVID-19 is a public health concern. The objective of this study was to analyze socioeconomic inequalities related to vaccination for the first and second doses from primary series against COVID-19 in Ecuador. Methods Secondary database study in 12,743,507 respondents from 15 years and over. The COVID-19 section of the National Survey of Employment, Unemployment and Underemployment (ENEMDU) was analyzed. Socioeconomic characteristics and vaccination against COVID-19 were associated with the at least one dose and second dose. Poisson regressions for complex samples were obtained. Results As of the date of the survey, 87.3% of the sample (95% CI 86.7%-87.8%) had received at least one vaccine against COVID-19. A lower probability of having received at least one vaccine against COVID-19 was found in rural areas (PR 0.82, 95% CI 0.74-0.91), indigenous population (PR 0.43, 95% CI 0.29-0.64), no level of education (PR 0.25, 95% CI 0.14-0.43), and the lowest economic income (PR 0.42, 95% CI 0.35-0.52). A significantly lower probability of vaccination with two or more doses was found in rural vs urban area (PR 0.88, 95% CI 0.80-0.96), women vs men (PR 0.85, 95% CI 0.77-0.91), indigenous population vs white (PR 0.44, 95% CI 0.33-0.59) and individuals in the lowest income quartile vs highest income quartile (PR 0.48, 95% CI 0.42-0.55). Underemployment, population economically inactive (PR 0.77, 95% CI 0.67-0.88 and PR 0.71, 95% CI 0.61-0.83) and individuals with no level of education (PR 0.39, 95% CI 0.27-0.58) also were less likely to complete the primary phase of vaccination compared with individuals in the highest income quartile, employment and postgraduate level of education. Conclusions There were socioeconomic inequalities with the primary series of vaccine against COVID-19, with a greater disadvantage for rural residents, women, indigenous populations, lower economic income and lower levels of education.
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Affiliation(s)
- Eulalia C. Torres
- Facultad de Medicina, Maestría en Epidemiología para la Salud Pública, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Coordinación de Auditoria Médica, Hospital de Especialidades “José Carrasco Arteaga”, Cuenca, Ecuador
| | - Maribel Moreno
- Facultad de Medicina, Maestría en Epidemiología para la Salud Pública, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
- Coordinación de Gestión de Calidad, Hospital General de Ambato, Ecuador
| | - María F. Rivadeneira
- Facultad de Medicina, Maestría en Epidemiología para la Salud Pública, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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Ortiz-Prado E, Izquierdo-Condoy JS, Mora C, Vasconez-Gonzalez J, Fernandez-Naranjo R. Poor regulation, desperation, and misinformation, a countrywide analysis of self-medication and prescription patterns in Ecuador during the COVID-19 pandemic. Res Social Adm Pharm 2023; 19:1579-1589. [PMID: 37659922 DOI: 10.1016/j.sapharm.2023.08.011] [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: 02/13/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The rapid spread of the SARS-CoV-2 virus during the early phase of the pandemic led to an unprecedented global health crisis. Various factors have influenced self-medication practices among the general population and unsubstantiated prescribing practices among healthcare professionals. OBJECTIVE This study aimed to describe trends in the purchase and sale of medicines during the COVID-19 pandemic period (2020-2022) in Ecuador, by comparing them with pre-pandemic periods. METHODS In this study, a cross-sectional design was employed to conduct a comprehensive analysis of 28 pharmacological groups, categorized according to the Anatomical Therapeutic Chemical Classification (ATC). Utilizing an integrated drug consumption database, the study examined physician prescribing data, medicine usage, and spending levels in Ecuador during the COVID-19 pandemic. The analysis involved computing absolute differences in monthly resolution, calculating excessive expenditure in comparison to previous yearly averages, and using Defined Daily Dose (DDD) methodology for internationally comparable results. Furthermore, a correlation analysis was performed to investigate potential associations between prescribed and consumed medicines and the number of new cases and deaths. RESULTS In Ecuador, the average yearly expenditure among these groups prior to the pandemic (2017-2019) amounted to $150,646,206 USD, whereas during 2020 and 2021, the same groups represented a total expenditure of $228,327,210, reflecting a significant increase. The excess expenditure during this period reached 51.4%, equivalent to $77,681,004 USD. Notably, 13% of this expenditure consisted of Over the Counter (OTC) Medicines. The study also identified a remarkable surge in sales of ivermectin, which increased by 2,057%, and hydroxychloroquine, which increased by 171%, as measured by DDD. CONCLUSIONS This study highlights the substantial consumption of medicines by the population in Ecuador during the pandemic. It is concerning that many medications were sold without proven therapeutic indications, indicating that misinformation and desperation may have led to improper prescribing by physicians and patients resorting to ineffective drugs. Moreover, since the sale of these therapeutic drugs requires a prescription, poor regulation, and a lack of control within pharmacies likely contributed to such practices.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, 170125, Ecuador.
| | - Juan S Izquierdo-Condoy
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, 170125, Ecuador
| | - Carla Mora
- Medical Department, Quifatex, Quito, 170138, Ecuador
| | - Jorge Vasconez-Gonzalez
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, 170125, Ecuador
| | - Raúl Fernandez-Naranjo
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, 170125, Ecuador
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Adair T, Mikkelsen L, Hooper J, Badr A, Lopez AD. Assessing the policy utility of routine mortality statistics: a global classification of countries. Bull World Health Organ 2023; 101:777-785. [PMID: 38046370 PMCID: PMC10680110 DOI: 10.2471/blt.22.289036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/29/2023] [Accepted: 08/16/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To evaluate the utility and quality of death registration data across countries. Methods We compiled routine death and cause of death statistics data from 2015-2019 from national authorities. We estimated completeness of death registration using the Adair-Lopez empirical method. The quality of cause of death data was assessed by evaluating the assignment of usable causes of death among people younger than 80 years. We grouped data into nine policy utility categories based on data availability, registration completeness and diagnostic precision. Findings Of an estimated 55 million global deaths in 2019, 70% of deaths were registered across 156 countries, but only 52% had medically certified causes and 42% of deaths were assigned a usable cause. In 54 countries, which are mostly high-income, there is complete and high-quality mortality data. In a further 29 countries, located across different regions, death registration is complete, but cause of death data quality remains suboptimal. Additionally, 37 countries possess functional death registration systems with cause of death data of poor to moderate quality. In 30 countries, death registration ranges from limited to nascent completeness, accompanied by poor or unavailable cause of death data. Furthermore, 38 countries lack accessible data altogether. Conclusion By implementing more proactive death notification processes, expanding the use of digitized data collection platforms, streamlining data compilation procedures and improving data quality assessment, governments could enhance the policy utility of mortality data. Encouraging the routine application of automated verbal autopsy methods is crucial for accurately determining the causes of deaths occurring at home.
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Affiliation(s)
- Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 32 Lincoln Square North, Carlton3053, Victoria, Australia
| | | | | | - Azza Badr
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
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Ferreira DP, Bolognani CV, Santana LA, Fernandes SES, de Moraes MSF, Fernandes LAS, Pereira CDS, Ferreira GB, Göttems LBD, Amorim FF. Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study. Int J Womens Health 2023; 15:1693-1703. [PMID: 38020934 PMCID: PMC10631387 DOI: 10.2147/ijwh.s429122] [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: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic. Patients and Methods Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software. Results There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: -24.0-33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9-23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53-6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.
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Affiliation(s)
- Dilson Palhares Ferreira
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
| | - Cláudia Vicari Bolognani
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Levy Aniceto Santana
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Sérgio Eduardo Soares Fernandes
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | | | | | - Camila de Sousa Pereira
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | | | - Leila Bernarda Donato Göttems
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
| | - Fábio Ferreira Amorim
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
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12
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Ayala A, Vargas C, Elorrieta F, Villalobos Dintrans P, Maddaleno M. Inequity in mortality rates and potential years of life lost caused by COVID-19 in the Greater Santiago, Chile. Sci Rep 2023; 13:16293. [PMID: 37770515 PMCID: PMC10539509 DOI: 10.1038/s41598-023-43531-x] [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: 01/16/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
Several studies have shown that, in Chile, income inequality is relevant in explaining health inequities. The COVID-19 pandemic has also had a negative impact, with higher mortality rates in those municipalities of Greater Santiago with lower socioeconomic status. We study inequity in mortality based on Potential Years of Life Lost (PYLL) in 34 urban municipalities of the Metropolitan Region (Greater Santiago) and analyze its evolution between 2018 and 2021 and by COVID-19 waves. To compare the results obtained for PYLL, we also computed the mortality rates adjusted by direct standardization. In addition, we used the concentration index (CI) to measure the health inequalities between municipalities. In the first year of the pandemic, the absolute PYLL and the standardized mortality rate for all causes of death showed an increase of 13.6% and 18.9%, respectively. Moreover, 409,086 years of life were prematurely lost in 2020, one-fifth of them due to COVID-19. The concentration indices confirm inequality in both mortality rates and PYLL, where it is more pronounced when calculating the latter measure. Results show that the deaths due to the COVID-19 pandemic affected the most economically disadvantaged municipalities, and particularly young people in those places.
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Affiliation(s)
- Andrés Ayala
- Departamento de Matemática y Ciencia de la Computación, Facultad de Ciencias, Universidad de Santiago de Chile, Santiago, Chile
| | - Claudio Vargas
- Departamento de Matemática y Ciencia de la Computación, Facultad de Ciencias, Universidad de Santiago de Chile, Santiago, Chile
| | - Felipe Elorrieta
- Departamento de Matemática y Ciencia de la Computación, Facultad de Ciencias, Universidad de Santiago de Chile, Santiago, Chile.
| | - Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Matilde Maddaleno
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
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Charles CM, Souza Neto LA, Soares CF, Souza Araújo T, Torezzan C, Lima EEC, Munezero A, Bahamondes L, Souza RT, Costa ML, Cecatti JG, Pacagnella RC. Preterm births prevalence during the COVID-19 pandemic in Brazil: results from the national database. Sci Rep 2023; 13:14580. [PMID: 37666901 PMCID: PMC10477268 DOI: 10.1038/s41598-023-37871-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/28/2023] [Indexed: 09/06/2023] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic impacted the health systems between and within countries, and in the course of the pandemic sexual and reproductive health services were the most disrupted. Findings from high-income settings have reported significant changes in preterm birth prevalence during the pandemic period. To understand the possible effects of the COVID-19 pandemic on preterm birth numbers at the Brazilian national level. We compare the number of preterm deliveries during the COVID-19 pandemic period (2020 and 2021) with previous years. We conducted a population-based cross-sectional study taking the period from January 2017 to December 2021 to account. We use individual-level live births data from the Brazilian Live Birth Information System (SINASC), and we estimate the odds ratio (OR) of preterm deliveries using propensity score weighting analysis in Brazil and its regions. During the study period (from 2017 to 2021), about 2.7 million live births were recorded per year, and the missing value for gestational age at delivery was less than 1.5%. The preterm birth prevalence slightly increased during the COVID-19 pandemic compared to the pre-pandemic period (11.32% in 2021 vs 11.09% in 2019, p-value < 0.0001). After adjusting for sociodemographic variables, the OR of preterm births in Brazil has significantly increased, 4% in 2020 (OR: 1.04 [1.03-1.05] 95% CI, p-value < 0.001), and 2% in 2021(OR: 1.02 [1.01-1.03] 95% CI, p-value < 0.001), compared to 2019. At the regional level, the preterm birth pattern in the South, Southeast and Northeast regions show a similar pattern. The highest odds ratio was observed in the South region (2020 vs 2019, OR: 1.07 [1.05-1.10] 95% CI; 2021 vs 2019, OR: 1.03 [1.01-1.06] 95% CI). However, we also observed a significant reduction in the ORs of preterm births in the northern region during the COVID-19 pandemic (2020 vs 2019, OR: 0.96 [0.94-0.98] 95% CI) and (2021 vs 2019, OR: 0.97 [0.95-0.99] 95% CI). Our analysis shows that the pandemic has increased regional variation in the number of preterm births in Brazil in 2020 and 2021 compared to the pre-pandemic years.
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Affiliation(s)
- Charles M'poca Charles
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
- Provincial Health Administration, DPS Manica, Chimoio, Mozambique
| | - Luiz Alves Souza Neto
- Institute of Mathematics, Statistics and Scientific Computing (IMEEC), University of Campinas, Campinas, SP, Brazil
- School of Applied Sciences (FCA), University of Campinas, Campinas, SP, Brazil
| | - Camila Ferreira Soares
- College of Philosophy and Human Sciences (IFCH), University of Campinas, Campinas, SP, Brazil
| | - Tacildo Souza Araújo
- Institute of Mathematics, Statistics and Scientific Computing (IMEEC), University of Campinas, Campinas, SP, Brazil
| | - Cristiano Torezzan
- Center for Population Studies (NEPO), University of Campinas, Campinas, SP, Brazil
| | - Everton Emanuel Campos Lima
- College of Philosophy and Human Sciences (IFCH), University of Campinas, Campinas, SP, Brazil
- Center for Population Studies (NEPO), University of Campinas, Campinas, SP, Brazil
| | - Aline Munezero
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
- Campinas Reproductive Health Research Center (CEMICAMP), Campinas, Brasil
| | - Renato Teixeira Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil
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Paz de Sousa KM, Rosana de Araújo Oliveira S, Alencar Sousa Macau Furtado BM, Ribeiro de Vasconcelos AL, Gomes de Medeiros S, Cazarin G, Soares Sampaio A, Ridde V. Hospital Resilience in Three COVID-19 Referral Hospitals in Brazil. Health Syst Reform 2023; 9:2205726. [PMID: 37364170 DOI: 10.1080/23288604.2023.2205726] [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: 09/12/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/28/2023] Open
Abstract
Health crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience-the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil-one public, one private, and one philanthropic hospital-by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.
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Affiliation(s)
| | | | | | | | | | - Gisele Cazarin
- Department of Public Health, Instituto Aggeu Magalhães, Fiocruz, Pernambuco, Brazil
| | | | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
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15
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Demetriou CA, Achilleos S, Quattrocchi A, Gabel J, Critselis E, Constantinou C, Nicolaou N, Ambrosio G, Bennett CM, Le Meur N, Critchley JA, Mortensen LH, Rodriguez-Llanes JM, Chong M, Denissov G, Klepac P, Goldsmith LP, Costa AJL, Hagen TP, Chan Sun M, Huang Q, Pidmurniak N, Zucker I, Cuthbertson J, Burström B, Barron M, Eržen I, Stracci F, Calmon W, Martial C, Verstiuk O, Kaufman Z, Tao W, Kereselidze M, Chikhladze N, Polemitis A, Charalambous A. Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project. Int J Epidemiol 2023; 52:664-676. [PMID: 36029524 PMCID: PMC9452146 DOI: 10.1093/ije/dyac170] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.
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Affiliation(s)
- Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicoletta Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Giuseppe Ambrosio
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | | | - Nolwenn Le Meur
- University of Rennes, EHESP, CNRS, Inserm, Arènes—UMR 6051, RSMS—U 1309, Rennes, France
| | - Julia A Critchley
- Population Health Research Institute, St George’s, University of London, London, UK
| | | | | | - Mario Chong
- Departamento de Ingeniería, Universidad del Pacífico, Lima, Peru
| | - Gleb Denissov
- Estonian Causes of Death Registry, National institute for Health Development, Tallinn, Estonia
| | - Petra Klepac
- Department of Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | - Lucy P Goldsmith
- Institute for Infection and Immunity, and Population Health Research Institute, St George's, University of London, London, UK
| | - Antonio José Leal Costa
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Terje P Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marie Chan Sun
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius
| | - Qian Huang
- Department of Geography, Center for Rural and Primary Healthcare, University of South Carolina, Columbia, SC, USA
| | - Nataliia Pidmurniak
- Department of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Inbar Zucker
- School of Public Health, Ministry of Health, Ramat Gan, Israel
| | - Joseph Cuthbertson
- Disaster Resilience Initiative, Monash University, Clayton,VIC, Australia
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Barron
- Department of Economics, Universidad del Pacifico Av Sanchez Cerro, Lima, Peru
| | - Ivan Eržen
- School of Public Health, National Institute of Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Fabrizio Stracci
- Public Health Section, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi, Perugia, Italy
| | - Wilson Calmon
- Institute of Mathematics and Statistics, Fluminense Federal University, Niteroi, Brazil
| | - Cyndy Martial
- Department of Demography, Statistics Mauritius, LIC Centre, Port Louis, Mauritius
| | | | - Zalman Kaufman
- Israeli Center of Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Wenjing Tao
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and SURGERY, Karolinska Institutet, Stockholm, Sweden
| | - Maia Kereselidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Fantin R, Barboza-Solís C, Hildesheim A, Herrero R. Excess mortality from COVID 19 in Costa Rica: a registry based study using Poisson regression. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100451. [PMID: 36852399 PMCID: PMC9945505 DOI: 10.1016/j.lana.2023.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
Background Official death toll related to COVID-19 has been considerably underestimated in reports from some Latin American countries. This study aimed to analyze the mortality associated with the COVID-19 pandemic in Costa Rica between March 2020 and December 2021. Methods A registry based study based on 2017-2021 data from the National Institute of Statistics and Census was designed (N = 128,106). Excess deaths were defined by the WHO as "the difference in the total number of deaths in a crisis compared to those expected under normal conditions"; and were estimated using a Poisson regression, and mortality and years of potential life lost (YPLL) rates were calculated. Findings The COVID-19 pandemic represented 15% of the deaths in Costa Rica between March 2020 and December 2021. The mortality rate related to COVID-19 was 83 per 100,000 person-years. Between March and July 2020 (low-incidence period), observed number of deaths was 9%-lower than expected, whereas it was 15% and 24% higher than expected between July 2020 and March 2021 (high incidence period - no vaccination), and between March 2021 and December 2021 (high incidence period - progressive vaccination) respectively. Between July 2020 and December 2021, excess deaths observed and COVID-19 deaths reported were comparable (7461 and 7620 respectively). Nevertheless, there were more deaths than expected for conditions that predispose to COVID-19 deaths. YPLL and mortality rates increased with age, but significant excess deaths were observed in all age-groups older than 30-39 years. No large differences were noted by districts' socioeconomic characteristics although excess death rate was lower in rural compared to urban areas. Interpretation Reporting of deaths was only slightly underestimated. In the pre-vaccination period, mortality rate and YPLL rates increased with age, being highest in people aged 60 years or older and justifying the decision to initially prioritize vaccination of older individuals. Funding The study was supported by the University of Costa Rica and the Agencia Costarricense de Investigaciones Biomédicas - Fundación Inciensa.
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Affiliation(s)
- Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San Pedro, Costa Rica,Agencia Costarricense de Investigaciones Biomédicas – Fundación Inciensa, San José, Costa Rica,Facultad de Odontología, Universidad de Costa Rica, San Pedro, Costa Rica,Corresponding author. Agencia Costarricense de Investigaciones Biomédicas – Fundación Inciensa, San José, Costa Rica
| | | | - Allan Hildesheim
- Agencia Costarricense de Investigaciones Biomédicas – Fundación Inciensa, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas – Fundación Inciensa, San José, Costa Rica
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Choudhary R, Carter E, Monzon J, Stewart A, Slotnick J, Samayoa Jerez LL, Rodriguez Araujo DS, Zielinski-Gutierrez E, Suchdev PS. Sociodemographic Factors Associated with COVID-19 Vaccination among People in Guatemalan Municipalities. Vaccines (Basel) 2023; 11:745. [PMID: 37112656 PMCID: PMC10143355 DOI: 10.3390/vaccines11040745] [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: 03/06/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
The Republic of Guatemala's reported COVID-19 vaccination coverage is among the lowest in the Americas and there are limited studies describing the disparities in vaccine uptake within the country. We performed a cross-sectional ecological analysis using multi-level modeling to identify sociodemographic characteristics that were associated with low COVID-19 vaccination coverage among Guatemalan municipalities as of 30 November 2022. Municipalities with a higher proportion of people experiencing poverty (β = -0.25, 95% CI: -0.43--0.07) had lower vaccination coverage. Municipalities with a higher proportion of people who had received at least a primary education (β = 0.74, 95% CI: 0.38-1.08), children (β = 1.07, 95% CI: 0.36-1.77), people aged 60 years and older (β = 2.94, 95% CI: 1.70-4.12), and testing for SARS-CoV-2 infection (β = 0.25, 95% CI: 0.14-0.36) had higher vaccination coverage. In the simplified multivariable model, these factors explained 59.4% of the variation in COVID-19 vaccination coverage. Poverty remained significantly associated with low COVID-19 vaccination coverage in two subanalyses restricting the data to the time period of the highest national COVID-19-related death rate and to COVID-19 vaccination coverage only among those aged 60 years or older. Poverty is a key factor associated with low COVID-19 vaccination and focusing public health interventions in municipalities most affected by poverty may help address COVID-19 vaccination and health disparities in Guatemala.
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Affiliation(s)
- Rewa Choudhary
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Emily Carter
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Jose Monzon
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Allison Stewart
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Jennifer Slotnick
- U.S. Agency for International Development (USAID), Guatemala City 01016, Guatemala
| | | | | | - Emily Zielinski-Gutierrez
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
| | - Parminder S. Suchdev
- Centers for Disease Control and Prevention Central America Regional Office, Guatemala City 01015, Guatemala
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Rekers R, Luna F. Pandemic justice for and from Latin America. ETHIC@ : AN INTERNATIONAL JOURNAL FOR MORAL PHILOSOPHY = REVISTA INTERNACIONAL DE FILOSOFIA DA MORAL 2023; 22:1-25. [PMID: 38379809 PMCID: PMC10878728 DOI: 10.5007/1677-2954.2023.e97435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Introdução ao Dossiê Justiça Pandêmica Global
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19
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Nowak SA, Nascimento de Lima P, Vardavas R. Optimal non-pharmaceutical pandemic response strategies depend critically on time horizons and costs. Sci Rep 2023; 13:2416. [PMID: 36765151 PMCID: PMC9912209 DOI: 10.1038/s41598-023-28936-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
The COVID-19 pandemic has called for swift action from local governments, which have instated non-pharmaceutical interventions (NPIs) to curb the spread of the disease. The swift implementation of social distancing policies has raised questions about the costs and benefits of strategies that either aim to keep cases as low as possible (suppression) or aim to reach herd immunity quickly (mitigation) to tackle the COVID-19 pandemic. While curbing COVID-19 required blunt instruments, it is unclear whether a less-transmissible and less-deadly emerging pathogen would justify the same response. This paper illuminates this question using a parsimonious transmission model by formulating the social distancing lives vs. livelihoods dilemma as a boundary value problem using calculus of variations. In this setup, society balances the costs and benefits of social distancing contingent on the costs of reducing transmission relative to the burden imposed by the disease. We consider both single-objective and multi-objective formulations of the problem. To the best of our knowledge, our approach is distinct in the sense that strategies emerge from the problem structure rather than being imposed a priori. We find that the relative time-horizon of the pandemic (i.e., the time it takes to develop effective vaccines and treatments) and the relative cost of social distancing influence the choice of the optimal policy. Unsurprisingly, we find that the appropriate policy response depends on these two factors. We discuss the conditions under which each policy archetype (suppression vs. mitigation) appears to be the most appropriate.
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Affiliation(s)
- Sarah A Nowak
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
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20
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Acosta E. Global estimates of excess deaths from COVID-19. Nature 2023; 613:31-33. [PMID: 36517677 DOI: 10.1038/d41586-022-04138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Guedes R, Dutra GJ, Machado C, Palma MA. Avaliação dos dados de mortes por COVID-19 nas bases dos cartórios do RC-Arpen, SIVEP-Gripe e SIM no Brasil em 2020. CAD SAUDE PUBLICA 2023; 39:e00077222. [PMID: 37018774 DOI: 10.1590/0102-311xpt077222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023] Open
Abstract
Este estudo compara os registros de óbitos por COVID-19 em 2020 para todo o território nacional. Utilizamos três bases distintas: Registro Civil (RC-Arpen), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe). Há discordâncias entre os números de mortes por COVID-19 divulgados pelas diversas bases e essas diferenças variam em cada Unidade da Federação. A base do RC-Arpen é atualizada mais rapidamente que as outras duas bases do Departamento de Informática do Sistema Único de Saúde - DATASUS (SIM e SIVEP-Gripe), além de ser mais indicada para monitoramentos e pesquisas que abrangem períodos mais recentes. Apesar da atualização mais lenta, as bases do DATASUS apresentam números geograficamente similares e divulgam dados mais detalhados sobre as mortes. Esse detalhamento das informações torna as bases do DATASUS mais adequadas para pesquisas que demandam mais informações sobre o paciente e o tratamento.
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Affiliation(s)
- Ricardo Guedes
- FGV EPGE Escola Brasileira de Economia e Finanças, Brazil
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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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23
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Moya-Espinoza JG, Moya-Salazar J, Chicoma-Flores K. A systematic review of the impact of corruption in Latin America during the spread of the first wave of COVID-19. Med Leg J 2022; 90:206-211. [PMID: 36124417 DOI: 10.1177/00258172221111689] [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: 06/15/2023]
Abstract
As the Covid-19 pandemic crisis raged in Latin America, numerous acts of corruption affected containment strategies and weakened institutional systems. A systematic review was conducted during the first wave of contagion in 2020 to analyse the relationship between corruption and Covid-19 in Latin American countries, highlighting its components and the institutions involved. Following the PRISMA guidelines, scientific databases and prepublications were searched using the terms (((SARS-CoV-2) OR (Covid-19)) AND ((Corruption [Mesh]) AND (Latin America))). Seventy-two studies were included in the initial search, 36 in MEDLINE/PubMed, 20 in Scielo, and 11 prepublications. Of the 25 eligible studies, none met the required standard for inclusion. Although corruption is endemic in Latin America, its levels and impact during the first wave of Covid-19 contagion have not been quantified.
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Age and sex differences in the impact of the COVID-19 pandemic on mental health and coping mechanisms in Latin American youth. J Psychiatr Res 2022; 156:372-378. [PMID: 36323139 PMCID: PMC9548050 DOI: 10.1016/j.jpsychires.2022.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/28/2022] [Accepted: 10/03/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had negative effects on mental health. Understanding sex and age differences in the perception of stressors, the use of coping strategies, and the prevalence of depression and anxiety can lead to detecting at-risk groups. METHODS A cross-sectional online study surveyed perceived stressors, coping strategies, and the PHQ-9 and GAD-7 rating scales for symptoms of depression and anxiety. The study was open from Spring 2020 to Spring 2021 and was aimed at children, adolescents and young adults of Latin America. RESULTS The survey was completed by 3965 participants (63.8% females). The sample was divided into children (N = 621, 15.7%), adolescents (N = 1123, 28.3%) and young adults (N = 2021, 56%). Moderate to severe symptoms of depression and anxiety were found in 43.53% and 27%, respectively, being more frequent in females. Children of both sexes showed the lowest scores in rating scales. Adult females reported a higher level of stress in regards to pandemic news, having someone close diagnosed with COVID-19,the possibility of getting sick, academic delays, economic impact, and depression, while female adolescents reported a higher level of stress regarding the lockdown, losing contact with peers and anxiety. In juxtaposition, females also reported a higher frequency of positive coping strategies. A multivariate analysis confirmed the association of several variables with the presence of depression and anxiety. CONCLUSION A high prevalence of depression and anxiety was found among young people. Specific intervention programs must be created taking into account age and sex differences.
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Colnago M, Benvenuto GA, Casaca W, Negri RG, Fernandes EG, Cuminato JA. Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil. Bioengineering (Basel) 2022; 9:bioengineering9100584. [PMID: 36290552 PMCID: PMC9598428 DOI: 10.3390/bioengineering9100584] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Considering the imminence of new SARS-CoV-2 variants and COVID-19 vaccine availability, it is essential to understand the impact of the disease on the most vulnerable groups and those at risk of death from the disease. To this end, the odds ratio (OR) for mortality and hospitalization was calculated for different groups of patients by applying an adjusted logistic regression model based on the following variables of interest: gender, booster vaccination, age group, and comorbidity occurrence. A massive number of data were extracted and compiled from official Brazilian government resources, which include all reported cases of hospitalizations and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Brazil during the “wave” of the Omicron variant (BA.1 substrain). Males (1.242; 95% CI 1.196–1.290) aged 60–79 (3.348; 95% CI 3.050–3.674) and 80 years or older (5.453; 95% CI 4.966–5.989), and hospitalized patients with comorbidities (1.418; 95% CI 1.355–1.483), were more likely to die. There was a reduction in the risk of death (0.907; 95% CI 0.866–0.951) among patients who had received the third dose of the anti-SARS-CoV-2 vaccine (booster). Additionally, this big data investigation has found statistical evidence that vaccination can support mitigation plans concerning the current scenario of COVID-19 in Brazil since the Omicron variant and its substrains are now prevalent across the entire country.
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Affiliation(s)
- Marilaine Colnago
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara 14800-060, Brazil
| | - Giovana A. Benvenuto
- Faculty of Science and Technology (FCT), São Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Wallace Casaca
- Institute of Biosciences, Letters and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto 15054-000, Brazil
- Correspondence:
| | - Rogério G. Negri
- Science and Technology Institute, São Paulo State University (UNESP), São José dos Campos 12247-004, Brazil
| | - Eder G. Fernandes
- Immunization Division—Centre of Epidemiology Surveillance of the São Paulo State Health Department, São Paulo 01246-000, Brazil
| | - José A. Cuminato
- Institute of Mathematics and Computer Science, São Paulo University (USP), São Carlos 13566-590, Brazil
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26
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Antonio-Villa NE, Bello-Chavolla OY, Fermín-Martínez CA, Aburto JM, Fernández-Chirino L, Ramírez-García D, Pisanty-Alatorre J, González-Díaz A, Vargas-Vázquez A, Barquera S, Gutiérrez-Robledo LM, Seiglie JA. Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico. Int J Epidemiol 2022; 51:1711-1721. [PMID: 36174226 PMCID: PMC9619535 DOI: 10.1093/ije/dyac184] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized. METHODS We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively. RESULTS We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths. CONCLUSION Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- Corresponding author. Division de Investigación, Instituto Nacional de Geriatría, Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, 10200 Mexico City, Mexico. E-mail:
| | | | - Carlos A Fermín-Martínez
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico,MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, Oxford, United Kindom,Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Luisa Fernández-Chirino
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico,Faculty of Chemistry, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Julio Pisanty-Alatorre
- Instituto Mexicano del Seguro Social, Mexico City, Mexico,Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Armando González-Díaz
- Facultad de Ciencias Politicas Sociales y Sociales, National Autonomous University of Mexico, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Division de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico,MD/PhD (PECEM) Program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Simón Barquera
- Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
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Palacio-Mejía LS, Hernández-Ávila JE, Hernández-Ávila M, Dyer-Leal D, Barranco A, Quezada-Sánchez AD, Alvarez-Aceves M, Cortés-Alcalá R, Fernández-Wheatley JL, Ordoñez-Hernández I, Vielma-Orozco E, Muradás-Troitiño MDLC, Muro-Orozco O, Navarro-Luévano E, Rodriguez-González K, Gabastou JM, López-Ridaura R, López-Gatell H. Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100303. [PMID: 35782204 PMCID: PMC9230439 DOI: 10.1016/j.lana.2022.100303] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection. Methods We did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015–2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model. Findings COVID-19 was the leading cause of death in 2020–2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%). Interpretation Mortality from COVID-19 became the first cause of death in 2020–2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out. Funding This study was funded by Conacyt.
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Affiliation(s)
- Lina Sofía Palacio-Mejía
- Ph.D. in Population Studies, Researcher for México-Conacyt, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Juan Eugenio Hernández-Ávila
- Sc.D. in Epidemiology, Researcher in Medical Science, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Mauricio Hernández-Ávila
- M.D., Ms.C., Sc.D. in Epidemiology, Director of Economic and Social Benefits, Mexican Institute of Social Security, Mexico City, Mexico
| | - Dwight Dyer-Leal
- Ph.D. in Political Science, General Directorate of Health Information, Mexico City, Mexico
| | - Arturo Barranco
- Master in Demography, General Directorate of Health Information, Mexico City, Mexico
| | - Amado D Quezada-Sánchez
- Master in Applied Statistics, Researcher in Medical Sciences, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Mariana Alvarez-Aceves
- ScD. in Economic Administrative Sciences, Postdoctoral fellow, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ricardo Cortés-Alcalá
- M.D., M.P.H. General Director of Health Promotion, Ministry of Health, Mexico City, Mexico
| | | | - Iliana Ordoñez-Hernández
- Graduate in Design of Human Settlements, National Registry of Population and Identity, Mexico City, Mexico
| | - Edgar Vielma-Orozco
- Master in Economy, National Institute of Statistics and Geography, Mexico City, Mexico
| | - María de la Cruz Muradás-Troitiño
- Ph.D. in Population Studies, Coordinator of Sociodemographic and Prospective Studies of the General Secretariat of the National Population Council, Mexico City, Mexico
| | - Omar Muro-Orozco
- M.S. National Institute of Statistics and Geography, Aguascalientes, Mexico
| | | | | | | | - Ruy López-Ridaura
- Ms.C., Sc.D. in Nutritional Epidemiology, Director General of the National Center for Preventive Programs and Disease Control, Ministry of Health, Mexico City, Mexico
| | - Hugo López-Gatell
- M.D., Ms.C., Ph.D. in Epidemiology, Undersecretary of Prevention and Health Promotion, Ministry of Health, Mexico City, Mexico
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Schwalb A, Armyra E, Méndez-Aranda M, Ugarte-Gil C. COVID-19 in Latin America and the Caribbean: Two years of the pandemic. J Intern Med 2022; 292:409-427. [PMID: 35411985 PMCID: PMC9115176 DOI: 10.1111/joim.13499] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Worldwide, nations have struggled during the coronavirus disease 2019 (COVID-19) pandemic. However, Latin America and the Caribbean faced an unmatched catastrophic toll. As of March 2022, the region has reported approximately 15% of cases and 28% of deaths worldwide. Considering the relatively late arrival of SARS-CoV-2, several factors in the region were determinants of the humanitarian crisis that ensued. Pandemic unpreparedness, fragile healthcare systems, forthright inequalities, and poor governmental support facilitated the spread of the virus throughout the region. Moreover, reliance on repurposed and ineffective drugs such as hydroxychloroquine and ivermectin-to treat or prevent COVID-19-was publicised through misinformation and created a false sense of security and poor adherence to social distancing measures. While there were hopes that herd immunity could be achieved after the region's disastrous first peak, the emergence of the Gamma, Lambda, and Mu variants made this unattainable. This review explores how Latin America and the Caribbean fared during the first 2 years of the pandemic, and how, despite all the challenges, the region became a global leader in COVID-19 vaccination, with 63% of its population fully vaccinated.
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Affiliation(s)
- Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,London School of Hygiene and Tropical Medicine, London, UK
| | - Eleonora Armyra
- Health Innovation Lab, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Melissa Méndez-Aranda
- Facultad de Ciencias y Filosofía, Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,London School of Hygiene and Tropical Medicine, London, UK.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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29
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Mena G, Aburto JM. Unequal impact of the COVID-19 pandemic in 2020 on life expectancy across urban areas in Chile: a cross-sectional demographic study. BMJ Open 2022; 12:e059201. [PMID: 35985781 PMCID: PMC9395593 DOI: 10.1136/bmjopen-2021-059201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To quantify the impact of the COVID-19 pandemic on life expectancy in Chile categorised by rural and urban areas, and to correlate life expectancy changes with socioeconomic factors at the municipal level. DESIGN Retrospective cross-sectional demographic analysis using aggregated national all-cause death data stratified by year, sex and municipality during the period 2010-2020. SETTING AND POPULATION Chilean population by age, sex and municipality from 2002 to 2020. MAIN OUTCOME MEASURES Stratified mortality rates using a Bayesian methodology. These were based on vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for males and females and analysed previous mortality trends since 2010. RESULTS Life expectancy declined for both males and females in 2020 compared with 2019. Urban areas were the most affected, with males losing 1.89 years and females 1.33 years. The strength of the decline in life expectancy correlated positively with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities. CONCLUSIONS Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.
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Affiliation(s)
- Gonzalo Mena
- Department of Statistics, Oxford University, Oxford, UK
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Nuffield College, University of Oxford, Oxford, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Inderdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Halpern B, Ranzani OT. Enseñanzas de la pandemia de COVID-19 en América Latina: la vulnerabilidad genera más vulnerabilidad. Rev Panam Salud Publica 2022; 46:e59. [PMID: 35990527 PMCID: PMC9384897 DOI: 10.26633/rpsp.2022.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bruno Halpern
- Centro de Control de Peso del Hospital Nove de Julho de São Paulo, Brasil; Federación Latinoamericana de Sociedades de Obesidad (Federación Mundial de Obesidad)
| | - Otavio T. Ranzani
- División de Neumología del Hospital de Clínicas de la Universidad de São Paulo, Brasil; Instituto de Salud Global, Barcelona, España
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Halpern B, Ranzani OT. Lessons From the COVID-19 Pandemic in Latin America: Vulnerability Leading to More Vulnerability. Am J Public Health 2022; 112:S579-S580. [PMID: 35977335 PMCID: PMC9382141 DOI: 10.2105/ajph.2022.306812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Bruno Halpern
- Bruno Halpern is with the Obesity Centre, Hospital 9 de Julho, São Paulo, Brazil, and the Latin American Federation of Obesity Societies, World Obesity Federation. Otavio T. Ranzani is with the Pulmonary Division, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil, and the Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
| | - Otavio T Ranzani
- Bruno Halpern is with the Obesity Centre, Hospital 9 de Julho, São Paulo, Brazil, and the Latin American Federation of Obesity Societies, World Obesity Federation. Otavio T. Ranzani is with the Pulmonary Division, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil, and the Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
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Perez-Cuevas R, Doubova SV. Syndemic Nature of COVID-19 in Latin American and Caribbean Countries: The Challenge Ahead. Arch Med Res 2022; 53:535-538. [PMID: 35817648 PMCID: PMC9264275 DOI: 10.1016/j.arcmed.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ricardo Perez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Jamaica Country Office, Jamaica.
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Karlinsky A. Estimating national excess mortality from subnational data: application to Argentina. Rev Panam Salud Publica 2022; 46:e19. [PMID: 35350453 PMCID: PMC8948443 DOI: 10.26633/rpsp.2022.19] [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: 10/18/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022] Open
Abstract
This paper presents a method to estimate excess mortality where national data are missing for some or all of the coronavirus disease 2019 (COVID-19) pandemic period, but subnational data exist, such as in Argentina. By making use of the stability of the regional distribution of deaths, data on deaths in Córdoba province were used to project excess deaths in Argentina from March 2020 up to the end of 2021. The number of excess deaths was estimated at 134 504, which is 14.8% higher than the reported number of COVID-19 deaths in Argentina for the same time period.
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Affiliation(s)
- Ariel Karlinsky
- Hebrew University Jerusalem Israel Hebrew University, Jerusalem, Israel
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Aburto JM, Schöley J, Kashnitsky I, Kashyap R. Life expectancy declines in Russia during the COVID-19 pandemic in 2020. Int J Epidemiol 2022; 51:1695-1697. [PMID: 35348708 PMCID: PMC9383604 DOI: 10.1093/ije/dyac055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Manuel Aburto
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
- Nuffield College, Oxford, UK
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Jonas Schöley
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
- Nuffield College, Oxford, UK
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Heuveline P. Global and National Declines in Life Expectancy: An End-of-2021 Assessment. POPULATION AND DEVELOPMENT REVIEW 2022; 48:31-50. [PMID: 37325186 PMCID: PMC10270701 DOI: 10.1111/padr.12477] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Timely, high-quality mortality data have allowed for assessments of the impact of the novel coronavirus disease 2019 (COVID-19) on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by 0.92 years between 2019 and 2020 and by another 0.72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed on rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the acquired immunodeficiency syndrome (AIDS) pandemic.
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Affiliation(s)
- Patrick Heuveline
- California Center for Population Research (CCPR), University of California, 4284 Public Affairs Building; Los Angeles, CA 90095, USA
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Silva R. Population perspectives and demographic methods to strengthen CRVS systems: introduction. GENUS 2022; 78:8. [PMID: 35221352 PMCID: PMC8864586 DOI: 10.1186/s41118-022-00156-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Civil registration and vital statistics (CRVS) systems and legal identity systems have become increasingly recognized as catalytic both for inclusive development and for monitoring population dynamics spanning the entire life course. Population scientists have a long history of contributing to the strengthening of CRVS and legal identity systems and of using vital registration data to understand population and development dynamics. This paper provides an overview of the Genus thematic series on CRVS systems. The series spans 11 research articles that document new insights on the registration of births, marriages, separations/divorces, deaths and legal residency. This introductory article to the series reviews the importance of population perspectives and demographic methods in strengthening CRVS systems and improving our understanding of population dynamics across the lifecourse. The paper highlights the major contributions from this thematic series and discusses emerging challenges and future research directions on CRVS systems for the population science community.
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Affiliation(s)
- Romesh Silva
- Scientific Panel on Population Perspectives and Demographic Methods to Strengthen CRVS Systems, International Union of the Scientific Study of Population, Paris, France
- Population and Development Branch, Technical Division, United Nations Population Fund, New York, USA
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Helleringer S, Queiroz BL. Commentary: Measuring excess mortality due to the COVID-19 pandemic: progress and persistent challenges. Int J Epidemiol 2022; 51:85-87. [PMID: 34904168 PMCID: PMC8856005 DOI: 10.1093/ije/dyab260] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Stéphane Helleringer
- New York University—Abu Dhabi Campus, Division of Social Science, Program in Social Research and Public Policy, Abu Dhabi, United Arab Emirates and
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas Gerais, Department of Demography and Centro de Desenvolvimento e Planejamento Regional (CEDEPLAR), Belo Horizonte, Minas Gerais, Brazil
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Konstantinoudis G, Cameletti M, Gómez-Rubio V, Gómez IL, Pirani M, Baio G, Larrauri A, Riou J, Egger M, Vineis P, Blangiardo M. Regional excess mortality during the 2020 COVID-19 pandemic in five European countries. Nat Commun 2022; 13:482. [PMID: 35079022 PMCID: PMC8789777 DOI: 10.1038/s41467-022-28157-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 12/11/2022] Open
Abstract
The impact of the COVID-19 pandemic on excess mortality from all causes in 2020 varied across and within European countries. Using data for 2015-2019, we applied Bayesian spatio-temporal models to quantify the expected weekly deaths at the regional level had the pandemic not occurred in England, Greece, Italy, Spain, and Switzerland. With around 30%, Madrid, Castile-La Mancha, Castile-Leon (Spain) and Lombardia (Italy) were the regions with the highest excess mortality. In England, Greece and Switzerland, the regions most affected were Outer London and the West Midlands (England), Eastern, Western and Central Macedonia (Greece), and Ticino (Switzerland), with 15-20% excess mortality in 2020. Our study highlights the importance of the large transportation hubs for establishing community transmission in the first stages of the pandemic. Here, we show that acting promptly to limit transmission around these hubs is essential to prevent spread to other regions and countries.
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Affiliation(s)
- Garyfallos Konstantinoudis
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | | | - Virgilio Gómez-Rubio
- Departamento de Matemáticas, Escuela Técnica Superior de Ingenieros Industriales, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Inmaculada León Gómez
- National Centre of Epidemiology (CNE), Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Monica Pirani
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Gianluca Baio
- Department of Statistical Sciences, University College London, London, UK
| | - Amparo Larrauri
- National Centre of Epidemiology (CNE), Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paolo Vineis
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marta Blangiardo
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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