Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation, and region in England and Wales during 2020: A registry-based study

Cause-specific excess mortality in Denmark, Finland, Norway, and Sweden during the COVID-19 pandemic 2020-2022: a study using nationwide population data

While there is substantial evidence on excess mortality in the first two years of the COVID-19 pandemic, no study has conducted a cause-specific analysis of excess mortality for the whole period 2020-2022 across multiple countries. We examined cause-specific excess mortality during 2020-2022 in Denmark, Finland, Norway, and Sweden-four countries with similar demographics and welfare provisions, which implemented different pandemic response policies. To this end, we utilized nationwide register-based information on annual cause-specific deaths stratified by age and sex, and applied linear regression models to predict mortality in 2020-2022 based on the reference period 2010-2019. Excess deaths were obtained by contrasting actual and expected deaths. Additional analyses employed standardization to a common population, as well as population adjustments to account for previous deaths. Our results showed that, besides deaths due to COVID-19 (a total of 32,491 during 2020-2022), all countries experienced excess deaths due to cardiovascular diseases (in total 11,610 excess deaths), and under-mortality due to respiratory diseases other than COVID-19 (in total 9878) and dementia (in total 8721). The excess mortality due to cardiovascular diseases was particularly pronounced in Finland and Norway in 2022, and the under-mortality due to dementia was particularly pronounced in Sweden in 2021-2022. In conclusion, while COVID-19 deaths emerge as the most apparent consequence of the pandemic, our findings suggest that mortality has also been influenced by substitutions between different causes of death and over time, as well as indirect consequences of COVID-19 infection and pandemic responses-albeit to different extents in the different countries.

Disentangling the relationship between cancer mortality and COVID-19 in the US

Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer's. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2-7%) than cancers with a poor survival rate (lung and pancreatic, 0-1%). In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer's (19%). To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19.

The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic

OBJECTIVE

To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic.

STUDY DESIGN

Cross-sectional survey.

METHODS

An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7).

RESULTS

Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79-18.60), cancer (OR = 8.47; 95% CI = 3.73-19.30), and emergency (OR = 14.2; 95% CI = 5.57-36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52-0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL.

CONCLUSIONS

ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic.

Has the first year of the COVID pandemic impacted the trends in obesity-related CVD mortality between 1999 and 2019 in the United States?

Background

During the covid-19 pandemic there was a marked rise in the number of cardiovascular deaths. Obesity is a well-known modifiable risk factor for cardiovascular disease and has been identified as a factor which leads to poorer covid-19 related outcomes. In this study we aimed to analyse the impact of covid-19 on obesity-related cardiovascular deaths compared to trends seen 20 years prior. We also analysed the influence different demographics had on mortality.

Methods

Multiple Cause of Mortality database was accessed through CDC WONDER to obtain the obesity-related and general cardiovascular crude mortality and age adjusted mortality rates (AMMR) between 1999 and 2020 in the US. The obesity-related sample was stratified by demographics and cardiovascular mortality was subdivided into ischemic heart disease, heart failure, hypertension and cerebrovascular disease. Joinpoint Regression Program (Version 4.9.1.0) was used to calculate the average annual percent change (AAPC) in AAMR, and hence projected AAMR. Excess mortality was calculated by comparing actual AAMR in 2020 to projected values.

Results and discussion

There were an estimated 3058 excess deaths during the early stages of the pandemic impacting all cohorts. The greatest excess mortalities were seen in men, rural populations and in Asian/Pacific Islander and Native Americans. Interestingly the greatest overall mortality was seen in the Black American population. Our study highlights important, both pre and during the pandemic, in obesity related cardiovascular disease mortality which has important implications for ongoing public health measures.

Premature Mortality Excess Rates Before and During the COVID-19 Pandemic: A Comparative Analysis Conducted in Bihor County, Romania

BACKGROUND

Estimating the excess of premature deaths (before the age of 75 years) and Potential Years of Life Lost allows ranking causes of death as an expression of the burden of disease in a population. We statistically analysed the impact of the coronavirus disease 2019 (COVID-19) pandemic on excess premature mortality in the total population and specifically, by sexes, compared to the pre-pandemic period, through Potential Years of Life Lost.

MATERIAL AND METHOD

In this retrospective descriptive observational study, we counted excess of premature mortality in the years 2020, 2021, and 2022 by cause of death (cardiovascular diseases, cancer, digestive diseases, injury, COVID-19, and other causes) and by sexes compared to the period average from 2017-2019, based on the deaths registered in Bihor County (48,948 people).

RESULTS

Premature deaths due to COVID-19 (1,745 people of both sexes) contributed 71.3% to excess mortality, the population being similar for both sexes (71.4% in men and 71.2% in women). The Potential Years of Life Lost/death due to COVID-19 was 11.84 years for both sexes (11.76 years in men and 12.02 years in women). Potential Years of Life Lost/all-cause heath was lower during the pandemic (13.42 years for both sexes, 14.06 years for men and 12.32 years for women) compared to the pre-pandemic period (14.6 years for both sexes, 15.1 years for men and 13.5 years for women).

CONCLUSIONS

The excess of premature mortality and decreased Potential Years of Life Lost/death during the pandemic, shows an increase in the proportion of deaths at ages closer to the established limit for premature mortality (75 years) compared to the pre-pandemic period.

Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data

BACKGROUND

Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+.

METHODS

Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy.

RESULTS

Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile.

CONCLUSIONS

Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.

Effects on Cancer Prevention from the COVID-19 Pandemic

The COVID-19 pandemic led to disruption of health services around the world, including cancer services. We carried out a narrative review of the effect of the pandemic on cancer prevention services, including screening. Services were severely affected in the early months of the pandemic, and in some areas are still recovering. Large numbers of additional cancers or additional late-stage cancers have been predicted to arise over the coming years as a result of this disruption. To minimize the effects on cancer outcomes, it is necessary to return as quickly as possible to prepandemic levels of screening and prevention activity or indeed to exceed these levels. The recovery of services should address health inequalities.

Evaluating Spatial, Cause-Specific and Seasonal Effects of Excess Mortality Associated with the COVID-19 Pandemic: The Case of Germany, 2020

BACKGROUND

Evaluating mortality effects of the COVID-19 pandemic using all-cause mortality data for national populations is inevitably associated with the risk of masking important subnational differentials and hampering targeted health policies. This study aims at assessing simultaneously cause-specific, spatial and seasonal mortality effects attributable to the pandemic in Germany in 2020.

METHODS

Our analyses rely on official cause-of-death statistics consisting of 5.65 million individual death records reported for the German population during 2015-2020. We conduct differential mortality analyses by age, sex, cause, month and district (N = 400), using decomposition and standardisation methods, comparing each strata of the mortality level observed in 2020 with its expected value, as well as spatial regression to explore the association of excess mortality with pre-pandemic indicators.

RESULTS

The spatial analyses of excess mortality reveal a very heterogenous pattern, even within federal states. The coastal areas in the north were least affected, while the south of eastern Germany experienced the highest levels. Excess mortality in the most affected districts, with standardised mortality ratios reaching up to 20%, is driven widely by older ages and deaths reported in December, particularly from COVID-19 but also from cardiovascular and mental/nervous diseases.

CONCLUSIONS

Our results suggest that increased psychosocial stress influenced the outcome of excess mortality in the most affected areas during the second lockdown, thus hinting at possible adverse effects of strict policy measures. It is essential to accelerate the collection of detailed mortality data to provide policymakers earlier with relevant information in times of crisis.

Evaluation of the effect of the COVID-19 pandemic on the all-cause, cause-specific mortality, YLL, and life expectancy in the first 2 years in an Iranian population-an ecological study

Background

COVID-19 pandemic resulted in excess mortality and changed the trends of causes of death worldwide. In this study, we investigate the all-cause and cause-specific deaths during the COVID-19 pandemic (2020-2022) compared to the baseline (2018-2020), considering age groups, gender, place of residence, and place of death in south Khorasan, east of Iran.

Methods

The present ecological study was conducted using South Khorasan Province death certificate data during 2018-2022. The number of death and all-cause and cause-specific mortality rates (per 100,000 people) were calculated and compared based on age groups, place of residence, place of death, and gender before (2018-2020) and during the COVID-19 pandemic (2020-2022). We also calculated total and cause-specific years of life lost (YLL) to death and gender-specific life expectancy at birth.

Results

A total of 7,766 deaths occurred from March 21, 2018, to March 20, 2020 (pre-pandemic) and 9,984 deaths from March 21, 2020, to March 20, 2022 (pandemic). The mean age at death increased by about 2 years during the COVID-19 pandemic. The mortality rate was significantly increased in the age groups 20 years and older. The most excess deaths were recorded in men, Aged more than 60 years, death at home, and the rural population. Mortality due to COVID-19 accounted for nearly 17% of deaths. The highest increase in mortality rate was observed due to endocrine and Cardiovascular diseases. Mortality rates due to the genitourinary system and Certain conditions originating in the perinatal period have decreased during the COVID-19 pandemic. The major causes of death during the pandemic were Cardiovascular diseases, COVID-19, cancer, chronic respiratory diseases, accidents, and endocrine diseases in both sexes, in rural and urban areas. Years of life lost (YLL) increased by nearly 15.0%, which was mostly due to COVID-19, life expectancy at birth has steadily declined from 2018 to202 for both genders (from 78.4 to 75).

Conclusion

In this study, we found that All-cause mortality increased by 25.5% during the COVID-19 pandemic, especially in men, older adult, Rural residents, and those who died at home (outside the hospital). Considering that the most common causes of death during the COVID-19 pandemic are also non-communicable diseases. It is necessary to pay attention to non-communicable diseases even during the pandemic of a serious infectious disease like COVID-19. The years of life lost also increased during the COVID-19 pandemic, which is necessary to pay attention to all age groups, especially the causes of death in young people. In most developing countries, the first cause of death of these groups is accidents.

Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data

BACKGROUND

Few studies have compared breastfeeding rates before and during the pandemic using comparable data across time. We used data from two national maternity surveys (NMS) to compare breastfeeding rates in England before and during the pandemic.

METHODS

Analysis was conducted using the NMS from 2018 (pre-pandemic; n = 4,509) and 2020 (during the pandemic; n = 4,611). The prevalence of breastfeeding initiation, and 'any' breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared between these surveys. Data were interpreted in the context of underlying trends in these prevalences from previous NMS (from 2010 and 2014), and annual routine data for England (from 2009-10 to 2020-21). Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the effect of birth during the pandemic (2020 versus 2018) on breastfeeding, with adjustment for sociodemographic and birth-related factors.

RESULTS

Breastfeeding initiation and any breastfeeding at 6 weeks remained relatively constant in the NMS and the routine data. Birth during the pandemic was associated with a 3 percentage point decrease in EBF at 6 weeks in the NMS (aRR 0.92, 95%CI: 0.87, 0.98 for pandemic versus pre-pandemic), but a smaller decrease in the routine data. Birth during the pandemic was associated with a 3 percentage point increase in any breastfeeding at 6 months in the NMS (aRR 1.05, 95%CI: 1.00, 1.10). Breastfeeding varied across different groups of women in the NMS (i.e. marked inequalities), but the small changes observed between the pandemic and pre-pandemic NMS were broadly similar across the sociodemographic and birth-related factors examined (i.e. no change in inequalities).

CONCLUSION

Breastfeeding initiation and any breastfeeding at 6 weeks in England were unaffected by the pandemic, and the persistent inequalities in breastfeeding did not widen. Services should aim to reduce these inequalities in breastfeeding which have been documented since the 1970s.

Inequity in mortality rates and potential years of life lost caused by COVID-19 in the Greater Santiago, Chile

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.

Years of life lost to COVID-19 in 49 countries: A gender- and life cycle-based analysis of the first two years of the pandemic

Specific mortality rates have been widely used to monitor the main impacts of the COVID-19 pandemic; however, a more meaningful measure is the Years of Life Lost (YLL) due to the disease, considering it takes into account the premature nature of each death. We estimated the YLL due to COVID-19 between January 2020 and December 2021 in 49 countries for which information was available, developing an analytical method that mathematically refines that proposed by the World Health Organization. We then calculated YLL rates overall, as well as by sex and life cycle. Additionally, we estimated the national cost-effective budgets required to manage COVID-19 from a health system perspective. During the two years of analysis, we estimated that 85.6 million years of life were lost due to COVID-19 in the 49 countries studied. However, due to a lack of data, we were unable to analyze the burden of COVID-19 in about 75% of the countries in the world. We found no difference in the magnitude of YLL rates by gender but did find differences according to life cycle, with older adults contributing the greatest burden of YLL. The COVID-19 pandemic has posed a significant burden of disease, which has varied between countries. However, due to the lack of quality and disaggregated data, it has been difficult to monitor and compare the pandemic internationally. Therefore, it is imperative to strengthen health information systems in order to prepare for future pandemics as well as to evaluate their impacts.

Impact of the COVID-19 Pandemic on the Socioeconomic Inequalities in Mortality in Spanish Provinces

BACKGROUND

Although many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain.

METHODS

We used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders.

RESULTS

Our main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer.

CONCLUSION

Our results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects.

Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?

OBJECTIVES

This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19).

METHODS

From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea's cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.

RESULTS

All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.

CONCLUSIONS

In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Socioeconomic inequalities of Long COVID: a retrospective population-based cohort study in the United Kingdom

OBJECTIVES

To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the inequality by sex and occupation.

DESIGN

We conducted a retrospective population-based cohort study using data from the ONS COVID-19 Infection Survey between 26 April 2020 and 31 January 2022. This is the largest nationally representative survey of COVID-19 in the UK with longitudinal data on occupation, COVID-19 exposure and Long COVID.

SETTING

Community-based survey in the UK.

PARTICIPANTS

A total of 201,799 participants aged 16 to 64 years and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

MAIN OUTCOME MEASURES

The risk of Long COVID at least 4 weeks after SARS-CoV-2 infection by index of multiple deprivation (IMD) and the modifying effects of socioeconomic deprivation by sex and occupation.

RESULTS

Nearly 10% (n = 19,315) of participants reported having Long COVID. Multivariable logistic regression models, adjusted for a range of variables (demographic, co-morbidity and time), showed that participants in the most deprived decile had a higher risk of Long COVID (11.4% vs. 8.2%; adjusted odds ratio (aOR): 1.46; 95% confidence interval (CI): 1.34, 1.59) compared to the least deprived decile. Significantly higher inequalities (most vs. least deprived decile) in Long COVID existed in healthcare and patient-facing roles (aOR: 1.76; 95% CI: 1.27, 2.44), in the education sector (aOR: 1.68; 95% CI: 1.31, 2.16) and in women (aOR: 1.56; 95% CI: 1.40, 1.73) than men (aOR: 1.32; 95% CI: 1.15, 1.51).

CONCLUSIONS

This study provides insights into the heterogeneous degree of inequality in Long COVID by deprivation, sex and occupation. These findings will help inform public health policies and interventions in incorporating a social justice and health inequality lens.

The impact of the COVID-19 pandemic on life expectancy by the level of area deprivation in South Korea

Objective

Comparative evidence suggests that the impact of COVID-19 on life expectancy has been relatively milder in South Korea. This study aims to examine whether the pandemic has universal or unequal impacts on life expectancy across 250 districts with varying levels of deprivation.

Methods

Using mortality data from 2012 to 2021 obtained from the Microdata Integrated Service of Statistics Korea, we calculated life expectancy at birth and age 65 for both sexes, by deprivation quintiles, before and during the pandemic. We summarized life expectancy gaps using the slope of the inequality index (SII) and further decomposed the gaps by the contribution of age and cause of death using Arriaga's method.

Results

Both men and women experienced consistent improvements in life expectancy from 2012 to 2019, but the trend was disrupted during 2020 and 2021, primarily driven by older people. While men in more deprived areas were initially hit harder by the pandemic, the life expectancy gap across deprivation quintiles remained relatively constant and persistent across the study period [SII: -2.48 (CI: -2.70 from -2.27) for 2019 and - 2.84 (CI: -3.06 from -2.63) for 2020]. Middle-aged men from the most deprived areas were the most significant contributors to the life expectancy gap, with liver disease, liver cancer, transport accidents, and intentional injuries being the leading causes, both in the pre and during the pandemic. While these contributors remained largely similar before and during the pandemic, the contribution of transport accidents and liver cancer to the male life expectancy gap slightly decreased during the pandemic, while that of ischemic heart disease and pneumonia slightly increased. A similar increase was also observed for the female life expectancy gap.

Conclusion

This study found no clear evidence of an increased life expectancy gap during the pandemic in South Korea, unlike in other countries, although access to emergency healthcare services may have been slightly more disturbed in deprived areas. This achievement can provide lessons for other countries. However, the persistent regional gaps in life expectancy observed over the past decade indicate the need for more targeted public health policies to address this issue.

Changes in all-cause and cause-specific excess mortality before and after the Omicron outbreak of COVID-19 in Hong Kong

Background

While coronavirus 2019 (COVID-19) deaths were generally underestimated in many countries, Hong Kong may show a different trend of excess mortality due to stringent measures, especially for deaths related to respiratory diseases. Nevertheless, the Omicron outbreak in Hong Kong evolved into a territory-wide transmission, similar to other settings such as Singapore, South Korea, and recently, mainland China. We hypothesized that the excess mortality would differ substantially before and after the Omicron outbreak.

Methods

We conducted a time-series analysis of daily deaths stratified by age, reported causes, and epidemic wave. We determined the excess mortality from the difference between observed and expected mortality from 23 January 2020 to 1 June 2022 by fitting mortality data from 2013 to 2019.

Results

During the early phase of the pandemic, the estimated excess mortality was -19.92 (95% confidence interval (CI) = -29.09, -10.75) and -115.57 (95% CI = -161.34, -69.79) per 100 000 population overall and for the elderly, respectively. However, the overall excess mortality rate was 234.08 (95% CI = 224.66, 243.50) per 100 000 population overall and as high as 928.09 (95% CI = 885.14, 971.04) per 100 000 population for the elderly during the Omicron epidemic. We generally observed negative excess mortality rates of non-COVID-19 respiratory diseases before and after the Omicron outbreak. In contrast, increases in excess mortality were generally reported in non-respiratory diseases after the Omicron outbreak.

Conclusions

Our results highlighted the averted mortality before 2022 among the elderly and patients with non-COVID-19 respiratory diseases, due to indirect benefits from stringent non-pharmaceutical interventions. The high excess mortality during the Omicron epidemic demonstrated a significant impact from the surge of COVID-19 infections in a SARS-CoV-2 infection-naive population, particularly evident in the elderly group.

Has COVID-19 increased inequality in mortality by income in the Netherlands?

BACKGROUND

In the Netherlands in 2020, COVID-19 deaths were more concentrated among individuals with a lower income. At the same time, COVID-19 was a new cause that also displaced some deaths from other causes, potentially reducing income-related inequality in non-COVID deaths. Our aim is to estimate the impact of the COVID-19 pandemic on the income-related inequality in total mortality and decompose this into the inequality in COVID-attributed deaths and changes in the inequality in non-COVID causes.

METHODS

We estimate excess deaths (observed minus trend-predicted deaths) by sex, age and income group for the Netherlands in 2020. Using a measure of income-related inequality (the concentration index), we decompose the inequality in total excess mortality into COVID-19 versus non-COVID causes.

RESULTS

Cause-attributed COVID-19 mortality exceeded total excess mortality by 12% for the 65-79 age group and by about 35% for 80+ in the Netherlands in 2020, implying a decrease in the number of non-COVID deaths compared with what was predicted. The income-related inequality in all-cause mortality was higher than predicted. This increase in inequality resulted from the combination of COVID-19 mortality, which was more unequally distributed than predicted total mortality, and the inequality in non-COVID causes, which was less unequal than predicted.

CONCLUSION

The COVID-19 pandemic has led to an increase in income-related inequality in all-cause mortality. Non-COVID mortality was less unequally distributed than expected due to displacement of other causes by COVID-19 and the potentially unequal broader societal impact of the pandemic.

Informal care, older people, and COVID-19: Evidence from the UK

The negative health effects and mortality caused by the COVID-19 pandemic disproportionately fell upon older and disabled people. Protecting these vulnerable groups has been a key policy priority throughout the pandemic and related vaccination campaigns. Using data from the latest survey of the UK Household Longitudinal Study on COVID-19 we found that people who receive informal care have higher probability of being infected when compared to those not receiving informal care. Further, we found that care recipients who are in the lowest income groups have a higher probability of catching the virus when compared to those in the highest income groups. We also estimated the likelihood of being infected for informal carers versus those who did not provide any care during the pandemic and found no significant differences between these two groups. Our empirical findings suggest that the standard measures introduced with the aim of protecting vulnerable groups, such as closing care homes or prioritising the vaccination of their staff, were not sufficient to avoid the spread of the virus amongst disabled and older people. Informal carers play an important role in the social care sector. As such, protecting vulnerable people by investing in the informal care sector should be a priority for future health policy.

Impact of social deprivation on clinical outcomes of adults hospitalised with community-acquired pneumonia in England: a retrospective cohort study

INTRODUCTION

Socioeconomic deprivation has been associated with an increased incidence of infection and poorer clinical outcomes during influenza pandemics and the COVID-19 pandemic. The aim of this study was to determine the relationship between deprivation and adverse clinical outcomes following hospital admission with community-acquired pneumonia (CAP), specifically 30-day all-cause mortality and non-elective hospital readmission.

METHODS

Data from the British Thoracic Society national CAP audit on patients admitted to hospital with CAP in England between 1 December 2018 and 31 January 2019 were linked to patient-level Hospital Episode Statistics data and Index of Multiple Deprivation (IMD) scores. Multivariable logistic regression models were used to examine the association between deprivation and (a) 30-day mortality and (b) 30-day readmission with p values for trend reported. Age was examined as a potential effect modifier on the effect of IMD quintile on mortality and subsequent subanalysis in those <65 and ≥65 years was performed.

RESULTS

Of 9165 adults admitted with CAP, 24.7% (n=2263) were in the most deprived quintile. No significant trend between deprivation and mortality was observed (p trend=0.38); however, the association between deprivation and mortality differed by age group. In adults aged<65 years, 30-day mortality was highest in the most deprived and lowest in the least deprived quintiles (4.4% vs 2.5%, aOR 1.83, 95% CI 0.84 to 4.0) with a significant trend across groups (p trend=0.04). Thirty-day readmission was highest in the most deprived quintile (17.1%) with a significant p trend across groups (p trend 0.003). Age-adjusted odds of readmission were highest in the most deprived compared with the least deprived (aOR 1.41, 95% CI 1.16 to 1.73).

CONCLUSIONS

In adults aged<65 years hospitalised with CAP in England, mortality varied inversely with indices of social deprivation. There was also a significant association between deprivation and 30-day readmission. Strategies are required to decrease health inequalities in pneumonia mortality and hospital readmissions associated with deprivation.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.

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

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.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Precarity and the Pandemic: The Impact of COVID-19 on Single Men Living Alone

BACKGROUND AND OBJECTIVES

Existing research reveals that single men living alone are at a heightened risk of isolation and precarity. This study traced the impact of the pandemic on the daily lives of a group of single men over three waves of the COVID-19 pandemic in the United Kingdom.

RESEARCH DESIGN AND METHODS

A qualitative longitudinal study with older people aged 50 and older (n = 102), interviewed by telephone in 2020-2021. This analysis focuses on a subsample comprising single men (n = 16) who lived alone and were interviewed three times (n = 48). The men were White British, Black, and Asian, aged 58-88 years, and were identified as facing difficulties in their lives arising from long-term health problems and or/social isolation. Participants were asked about the impact of, and response to, three lockdowns. Data were analyzed using themes identified in the secondary literature using thematic and longitudinal analysis.

RESULTS

For single men living alone, precarity intensified during the pandemic due to worsening physical and/or mental health combined with restricted access to relationships and activities. Key moments in the life course influenced how these men experienced and viewed the impact of COVID-19.

DISCUSSION AND IMPLICATIONS

This analysis sheds light on the deepening precarity of older men living alone during the pandemic, highlighting the emergence of new vulnerabilities for some. The findings emphasize the need, given the likelihood of future waves of the pandemic, to target support at those living alone, particularly in relation to the provision of community health services, social infrastructure, and combating digital exclusion.