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Larsen SL, Shin I, Joseph J, West H, Anorga R, Mena GE, Mahmud AS, Martinez PP. Quantifying the impact of SARS-CoV-2 temporal vaccination trends and disparities on disease control. SCIENCE ADVANCES 2023; 9:eadh9920. [PMID: 37531439 PMCID: PMC10396293 DOI: 10.1126/sciadv.adh9920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
SARS-CoV-2 vaccines have been distributed at unprecedented speed. Still, little is known about temporal vaccination trends, their association with socioeconomic inequality, and their consequences for disease control. Using data from 161 countries/territories and 58 states, we examined vaccination rates across high and low socioeconomic status (SES), showing that disparities in coverage exist at national and subnational levels. We also identified two distinct vaccination trends: a rapid initial rollout, quickly reaching a plateau, or sigmoidal and slow to begin. Informed by these patterns, we implemented an SES-stratified mechanistic model, finding profound differences in mortality and incidence across these two vaccination types. Timing of initial rollout affects disease outcomes more substantially than final coverage or degree of SES disparity. Unexpectedly, timing is not associated with wealth inequality or GDP per capita. While socioeconomic disparity should be addressed, accelerating initial rollout for all over focusing on increasing coverage is an accessible intervention that could minimize the burden of disease across socioeconomic groups.
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Affiliation(s)
- Sophie L. Larsen
- Program in Ecology, Evolution, and Conservation Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Ikgyu Shin
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Jefrin Joseph
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Haylee West
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Rafael Anorga
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | | | - Ayesha S. Mahmud
- Department of Demography, University of California, Berkeley, CA, USA
| | - Pamela P. Martinez
- Department of Statistics, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Microbiology, School of Molecular and Cellular Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
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Gomes M, Begum R, Sati P, Dikshit R, Gupta PC, Kumar R, Sheth J, Habib A, Jha P. Nationwide Mortality Studies To Quantify Causes Of Death: Relevant Lessons From India's Million Death Study. Health Aff (Millwood) 2018; 36:1887-1895. [PMID: 29137507 DOI: 10.1377/hlthaff.2017.0635] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Progress toward the United Nations 2030 Sustainable Development Goals requires improved information on mortality and causes of death. However, causes of many of the fifty million annual deaths in low- and middle-income countries remain unknown, as most of the deaths occur at home without medical attention. In 2001 India began the Million Death Study in 1.3 million nationally representative households. Nonmedical staff conduct verbal autopsies, which are structured interviews including a half-page narrative in local language of the family's story of the symptoms and events leading to death. Two physicians independently assess each death to arrive at an underlying cause of death. The study has thus far yielded information that substantially altered previous estimates of cause-specific mortality and risk factors in India. Similar robust studies are feasible at low cost in other low- and middle-income countries, particularly if they adopt electronic data management and ensure high quality of fieldwork and physician coding. Nationwide mortality studies enable the quantification of avoidable premature mortality and key risk factors for disease, and provide a practicable method to monitor progress toward the Sustainable Development Goals.
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Affiliation(s)
- Mireille Gomes
- Mireille Gomes is a scientist at the Centre for Global Health Research, St. Michael's Hospital and University of Toronto, in Ontario
| | - Rehana Begum
- Rehana Begum is director of operations at the Centre for Global Health Research, St. Michael's Hospital and University of Toronto
| | - Prabha Sati
- Prabha Sati is associate director for program outreach at the Centre for Global Health Research, St. Michael's Hospital and University of Toronto
| | - Rajesh Dikshit
- Rajesh Dikshit is a professor of epidemiology at the Tata Memorial Centre, in Mumbai, India
| | - Prakash C Gupta
- Prakash C. Gupta is managing director of the Healis Sekhsaria Institute for Public Health, in Mumbai
| | - Rajesh Kumar
- Rajesh Kumar is dean (academic) of the Post Graduate Institute of Medical Education and Research, in Chandigarh, India
| | - Jay Sheth
- Jay Sheth is an associate professor in the Department of Community Medicine at Ahmedabad Municipal Corporation's Medical Education Trust Medical College, in Ahmedabad, India
| | - Asad Habib
- Asad Habib is a project manager and senior software systems developer at the Centre for Global Health Research, St. Michael's Hospital and University of Toronto
| | - Prabhat Jha
- Prabhat Jha ( ) is director of the Centre for Global Health Research, St. Michael's Hospital and University of Toronto, and a professor of global health and epidemiology, also at the University of Toronto
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Bishai DM, Cohen R, Alfonso YN, Adam T, Kuruvilla S, Schweitzer J. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010. PLoS One 2016; 11:e0144908. [PMID: 26783759 PMCID: PMC4718632 DOI: 10.1371/journal.pone.0144908] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 11/26/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.
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Affiliation(s)
- David M. Bishai
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Robert Cohen
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Y. Natalia Alfonso
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Taghreed Adam
- World Health Organization, Health Systems and Innovation, Geneva, Switzerland
| | - Shyama Kuruvilla
- World Health Organization, Family, Women's and Children's Health, Geneva, Switzerland
| | - Julian Schweitzer
- Results for Development, Washington, District of Columbia, United States of America
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Hum RJ, Verguet S, Cheng YL, McGahan AM, Jha P. Are global and regional improvements in life expectancy and in child, adult and senior survival slowing? PLoS One 2015; 10:e0124479. [PMID: 25992949 PMCID: PMC4436293 DOI: 10.1371/journal.pone.0124479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/18/2015] [Indexed: 11/21/2022] Open
Abstract
Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of -0.07 months/year2; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of -0.06 deaths/1000/year2; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of -0.08 deaths/1000/year2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health–primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest.
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Affiliation(s)
- Ryan J. Hum
- Center for Global Engineering and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Yu-Ling Cheng
- Center for Global Engineering and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Anita M. McGahan
- Rotman School of Management and Munk School of Global Affairs, University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
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Jit M, Gerland P. Enzymes provide demographers with food for thought. eLife 2012; 1:e00340. [PMID: 23240089 PMCID: PMC3510472 DOI: 10.7554/elife.00340] [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] [Indexed: 11/23/2022] Open
Abstract
Life expectancy has increased by 20 years since the middle of the last century, but children under five have fared better than adult males.
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Affiliation(s)
- Mark Jit
- is in the Modelling and Economics Unit , Health Protection Agency , London , UK , and the Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , United Kingdom
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