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Cavillot L, van Loenhout JAF, Devleesschauwer B, Wyndham-Thomas C, Van Oyen H, Ghattas J, Blot K, Van den Borre L, Billuart M, Speybroeck N, De Pauw R, Stouten V, Catteau L, Hubin P. Sociodemographic and socioeconomic disparities in COVID-19 vaccine uptake in Belgium: a nationwide record linkage study. J Epidemiol Community Health 2023; 78:jech-2023-220751. [PMID: 38148149 PMCID: PMC11045363 DOI: 10.1136/jech-2023-220751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Recent studies have identified important social inequalities in SARS-CoV-2 infections and related COVID-19 outcomes in the Belgian population. The aim of our study was to investigate the sociodemographic and socioeconomic characteristics associated with the uptake of COVID-19 vaccine in Belgium. METHODS We conducted a cross-sectional analysis of the uptake of a first COVID-19 vaccine dose among 5 342 110 adults (≥18 years) in Belgium on 31 August 2021. We integrated data from four national data sources: the Belgian vaccine register (vaccination status), COVID-19 Healthdata (laboratory test results), DEMOBEL (sociodemographic/socioeconomic data) and the Common Base Register for HealthCare Actors (individuals licensed to practice a healthcare profession in Belgium). We used multivariable logistic regression analysis for identifying characteristics associated with not having obtained a first COVID-19 vaccine dose in Belgium and for each of its three regions (Flanders, Brussels and Wallonia). RESULTS During the study period, 10% (536 716/5 342 110) of the Belgian adult population included in our study sample was not vaccinated with a first COVID-19 vaccine dose. A lower COVID-19 vaccine uptake was found among young individuals, men, migrants, single parents, one-person households and disadvantaged socioeconomic groups (with lower levels of income and education, unemployed). Overall, the sociodemographic and socioeconomic disparities were comparable for all regions. CONCLUSIONS The identification of sociodemographic and socioeconomic disparities in COVID-19 vaccination uptake is critical to develop strategies guaranteeing a more equitable vaccination coverage of the Belgian adult population.
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Affiliation(s)
- Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jinane Ghattas
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Koen Blot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matthieu Billuart
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Niko Speybroeck
- Health and Society Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Veerle Stouten
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Pierre Hubin
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Khan Y, Verhaeghe N, Devleesschauwer B, Cavillot L, Gadeyne S, Pauwels N, Van den Borre L, De Smedt D. The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review. Eur Heart J Qual Care Clin Outcomes 2023; 9:647-661. [PMID: 37667483 DOI: 10.1093/ehjqcco/qcad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
AIMS Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. METHODS AND RESULTS PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. CONCLUSION The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.
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Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Research Institute for Work and Society, KU Leuven, Leuven 3000, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent 9000, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke 9000, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Research Institute of Health and Society, University of Louvain, Brussels 1200, Belgium
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nele Pauwels
- Faculty of Medicine, Ghent University, Ghent 9000, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
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3
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Khan Y, Verhaeghe N, Devleesschauwer B, Cavillot L, Gadeyne S, Pauwels NS, Van den Borre L, De Smedt D. Impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review. Lancet 2023; 402 Suppl 1:S61. [PMID: 37997105 DOI: 10.1016/s0140-6736(23)02117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Cardiovascular diseases remain the foremost global cause of death. The COVID-19 pandemic has strained health-care systems, leading to delays in essential medical services, including treatment for cardiovascular diseases. We aimed to examine the impact of the pandemic on delayed cardiovascular care in Europe. METHODS In this systematic review, we searched PubMed, Embase, and Web of Science for peer-reviewed and published quantitative studies in English from Nov 1, 2019, to Sept 18, 2022, that addressed pandemic-induced delays in cardiovascular disease care for adult patients in Europe. Data appraisal, extraction, and quality assessment were done by two reviewers using the 14-item QualSyst tool checklist. We extracted summary patient-level data from the studies, including around 3·5 million patients. Evaluated outcomes included changes pre-March 2020 and during the COVID-19 pandemic in hospital admissions, mortality rates, medical help-seeking delays post-symptom onset, treatment initiation delays, and treatment procedure counts. The protocol is registered on PROSPERO (CRD42022354443). FINDINGS Of the 132 included studies (20% from the UK), all were observational retrospective, with 87% focusing on the first wave of the pandemic. Results were categorised into five disease groups: ischaemic heart diseases, cerebrovascular diseases, cardiac arrests, heart failures, and others. Hospital admissions showed significant decreases around the ranges of 12-66% for ischaemic heart diseases, 9-40% for cerebrovascular diseases, 9-66% for heart failures, 27-88% for urgent and elective cardiac procedures, and an increase between 11-56% for cardiac arrests. Mortality rates were significantly higher during the pandemic, ranging between 1-25% (vs 16-22% before the pandemic) for ischaemic heart diseases and 8-70% (vs 8-26% before the pandemic) for cerebrovascular diseases. Only one study ranked low in quality. INTERPRETATION The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Policymakers and health-care systems should work together on implementing adequate resource allocation strategies and clear guidelines on how to handle care during health crises, reducing diagnosis and treatment initiation delays, and promoting a healthy lifestyle. Future studies should evaluate the long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19. FUNDING Belgian Science Policy Office.
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Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Research Institute for Work and Society, KU Leuven, Leuven, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Research Institute of Health and Society, University of Louvain, Brussels, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Khan Y, Verhaeghe N, De Pauw R, Devleesschauwer B, Gadeyne S, Gorasso V, Lievens Y, Speybroek N, Vandamme N, Vandemaele M, Van den Borre L, Vandepitte S, Vanthomme K, Verdoodt F, De Smedt D. Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol. PLoS One 2023; 18:e0288777. [PMID: 37903130 PMCID: PMC10615261 DOI: 10.1371/journal.pone.0288777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/28/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION Cancer causes a substantial burden to our society, both from a health and an economic perspective. To improve cancer patient outcomes and lower society expenses, early diagnosis and timely treatment are essential. The recent COVID-19 crisis has disrupted the care trajectory of cancer patients, which may affect their prognosis in a potentially negative way. The purpose of this paper is to present a flexible decision-analytic Markov model methodology allowing the evaluation of the impact of delayed cancer care caused by the COVID-19 pandemic in Belgium which can be used by researchers to respond to diverse research questions in a variety of disruptive events, contexts and settings. METHODS A decision-analytic Markov model was developed for 4 selected cancer types (i.e. breast, colorectal, lung, and head and neck), comparing the estimated costs and quality-adjusted life year losses between the pre-COVID-19 situation and the COVID-19 pandemic in Belgium. Input parameters were derived from published studies (transition probabilities, utilities and indirect costs) and administrative databases (epidemiological data and direct medical costs). One-way and probabilistic sensitivity analyses are proposed to consider uncertainty in the input parameters and to assess the robustness of the model's results. Scenario analyses are suggested to evaluate methodological and structural assumptions. DISCUSSION The results that such decision-analytic Markov model can provide are of interest to decision makers because they help them to effectively allocate resources to improve the health outcomes of cancer patients and to reduce the costs of care for both patients and healthcare systems. Our study provides insights into methodological aspects of conducting a health economic evaluation of cancer care and COVID-19 including insights on cancer type selection, the elaboration of a Markov model, data inputs and analysis.
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Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Institute for Work and Society, KU Leuven, Leuven, Belgium
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Niko Speybroek
- Research Institute of Health and Society, University of Louvain, Brussels, Belgium
| | - Nancy Vandamme
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Miet Vandemaele
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sophie Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Katrien Vanthomme
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Freija Verdoodt
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Devleesschauwer B, Scohy A, De Pauw R, Gorasso V, Kongs A, Neirynck E, Verduyckt P, Wyper GMA, Van den Borre L. Investigating years of life lost in Belgium, 2004-2019: A comprehensive analysis using a probabilistic redistribution approach. Arch Public Health 2023; 81:160. [PMID: 37626403 PMCID: PMC10464430 DOI: 10.1186/s13690-023-01163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Information on years of life lost (YLL) due to premature mortality is instrumental to assess the fatal impact of disease and necessary for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to reallocate causes of death data. MATERIALS AND METHODS Causes of death data are provided by Statistics Belgium (Statbel). First, the specific ICD-10 codes that define the underlying cause of death are mapped to the GBD cause list. Second, ill-defined deaths (IDDs) are redistributed to specific ICD-10 codes. A four-step probabilistic redistribution was developed to fit the Belgian context: redistribution using predefined ICD codes, redistribution using multiple causes of death data, internal redistribution, and redistribution to all causes. Finally, we used the GBD 2019 reference life table to calculate Standard Expected Years of Life Lost (SEYLL). RESULTS In Belgium, between 2004 and 2019, IDDs increased from 31 to 34% of all deaths. The majority was redistributed using predefined ICD codes (14-15%), followed by the redistribution using multiple causes of death data (10-12%). The total number of SEYLL decreased from 1.83 to 1.73 million per year. In 2019, the top cause of SEYLL was lung cancer with a share of 8.5%, followed by ischemic heart disease (8.1%) and Alzheimer's disease and other dementias (5.7%). All results are available in an online tool https://burden.sciensano.be/shiny/mortality2019/ . CONCLUSION The redistribution process assigned a specific cause of death to all deaths in Belgium, making it possible to investigate the full mortality burden for the first time. A large number of estimates were produced to estimate SEYLL by age, sex, and region for a large number of causes of death and every year between 2004 and 2019. These estimates are important stepping stones for future investigations on Disability-Adjusted Life Years (DALYs) in Belgium.
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Affiliation(s)
- Brecht Devleesschauwer
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium.
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
| | - Aline Scohy
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
| | - Robby De Pauw
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Vanessa Gorasso
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Anne Kongs
- Department of Care, Flemish Public Administration, Brussels, Belgium
| | | | - Peter Verduyckt
- Brussels-Capital Health and Social Observatory, Brussels, Belgium
| | - Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura Van den Borre
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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Otavova M, Masquelier B, Faes C, Van den Borre L, Bouland C, De Clercq E, Vandeninden B, De Bleser A, Devleesschauwer B. Measuring small-area level deprivation in Belgium: The Belgian Index of Multiple Deprivation. Spat Spatiotemporal Epidemiol 2023; 45:100587. [PMID: 37301602 DOI: 10.1016/j.sste.2023.100587] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/02/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In the past, deprivation has been mostly captured through simple and univariate measures such as low income or poor educational attainment in research on health and social inequalities in Belgium. This paper presents a shift towards a more complex, multidimensional measure of deprivation at the aggregate level and describes the development of the first Belgian Indices of Multiple Deprivation (BIMDs) for the years 2001 and 2011. METHODS The BIMDs are constructed at the level of the smallest administrative unit in Belgium, the statistical sector. They are a combination of six domains of deprivation: income, employment, education, housing, crime and health. Each domain is built on a suite of relevant indicators representing individuals that suffer from a certain deprivation in an area. The indicators are combined to create the domain deprivation scores, and these scores are then weighted to create the overall BIMDs scores. The domain and BIMDs scores can be ranked and assigned to deciles from 1 (the most deprived) to 10 (the least deprived). RESULTS We show geographical variations in the distribution of the most and least deprived statistical sectors in terms of individual domains and overall BIMDs, and we identify hotspots of deprivation. The majority of the most deprived statistical sectors are located in Wallonia, whereas most of the least deprived statistical sectors are in Flanders. CONCLUSION The BIMDs offer a new tool for researches and policy makers for analyzing patterns of deprivation and identifying areas that would benefit from special initiatives and programs.
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Affiliation(s)
- Martina Otavova
- Center for Demographic Research, UCLouvain, Louvain-la-Neuve, Belgium; Data Science Institute, I-BioStat, Hasselt University, Belgium; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Bruno Masquelier
- Center for Demographic Research, UCLouvain, Louvain-la-Neuve, Belgium
| | - Christel Faes
- Data Science Institute, I-BioStat, Hasselt University, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Interface Demography, Department of Sociology, Vrije Universiteit Brussels, Belgium
| | - Catherine Bouland
- Research Centre on Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Eva De Clercq
- Department of Risk and Health Impact Assessment, Sciensano, Brussels, Belgium
| | - Bram Vandeninden
- Data Science Institute, I-BioStat, Hasselt University, Belgium; Research Centre on Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Department of Risk and Health Impact Assessment, Sciensano, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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De Pauw R, Van den Borre L, Baeyens Y, Cavillot L, Gadeyne S, Ghattas J, De Smedt D, Jaminé D, Khan Y, Lusyne P, Speybroeck N, Racape J, Rea A, Van Cauteren D, Vandepitte S, Vanthomme K, Devleesschauwer B. Social inequalities and long-term health impact of COVID-19 in Belgium: protocol of the HELICON population data linkage. BMJ Open 2023; 13:e069355. [PMID: 37202131 DOI: 10.1136/bmjopen-2022-069355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Data linkage systems have proven to be a powerful tool in support of combating and managing the COVID-19 pandemic. However, the interoperability and the reuse of different data sources may pose a number of technical, administrative and data security challenges. METHODS AND ANALYSIS This protocol aims to provide a case study for linking highly sensitive individual-level information. We describe the data linkages between health surveillance records and administrative data sources necessary to investigate social health inequalities and the long-term health impact of COVID-19 in Belgium. Data at the national institute for public health, Statistics Belgium and InterMutualistic Agency are used to develop a representative case-cohort study of 1.2 million randomly selected Belgians and 4.5 million Belgians with a confirmed COVID-19 diagnosis (PCR or antigen test), of which 108 211 are COVID-19 hospitalised patients (PCR or antigen test). Yearly updates are scheduled over a period of 4 years. The data set covers inpandemic and postpandemic health information between July 2020 and January 2026, as well as sociodemographic characteristics, socioeconomic indicators, healthcare use and related costs. Two main research questions will be addressed. First, can we identify socioeconomic and sociodemographic risk factors in COVID-19 testing, infection, hospitalisations and mortality? Second, what is the medium-term and long-term health impact of COVID-19 infections and hospitalisations? More specific objectives are (2a) To compare healthcare expenditure during and after a COVID-19 infection or hospitalisation; (2b) To investigate long-term health complications or premature mortality after a COVID-19 infection or hospitalisation; and (2c) To validate the administrative COVID-19 reimbursement nomenclature. The analysis plan includes the calculation of absolute and relative risks using survival analysis methods. ETHICS AND DISSEMINATION This study involves human participants and was approved by Ghent University hospital ethics committee: reference B.U.N. 1432020000371 and the Belgian Information Security Committee: reference Beraadslaging nr. 22/014 van 11 January 2022, available via https://www.ehealth.fgov.be/ehealthplatform/file/view/AX54CWc4Fbc33iE1rY5a?filename=22-014-n034-HELICON-project.pdf. Dissemination activities include peer-reviewed publications, a webinar series and a project website.The pseudonymised data are derived from administrative and health sources. Acquiring informed consent would require extra information on the subjects. The research team is prohibited from gaining additional knowledge on the study subjects by the Belgian Information Security Committee's interpretation of the Belgian privacy framework.
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Affiliation(s)
- Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Interface Demography, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Research Institute of Health and Society (IRSS), Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Sylvie Gadeyne
- Interface Demography, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jinane Ghattas
- Research Institute of Health and Society (IRSS), Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | | | | | - Yasmine Khan
- Interface Demography, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Public Health, Ghent University, Gent, Belgium
| | | | - Niko Speybroeck
- Research Institute of Health and Society (IRSS), Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Judith Racape
- School of Public Health, Universite Libre de Bruxelles - Campus Erasme, Bruxelles, Belgium
- Groupe de Recherche sur les Relations Ethniques, les Migrations et l'Egalité, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Andrea Rea
- Groupe de Recherche sur les Relations Ethniques, les Migrations et l'Egalité, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Katrien Vanthomme
- Interface Demography, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Public Health, Ghent University, Gent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Department of Translational Physiology, Infectiology and Public health, Ghent University, Merelbeke, Belgium
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8
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Meurisse M, Lajot A, Devleesschauwer B, Van Cauteren D, Van Oyen H, Van den Borre L, Brondeel R. Correction to: The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020-2021. Arch Public Health 2022; 80:128. [PMID: 35488294 PMCID: PMC9052175 DOI: 10.1186/s13690-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marjan Meurisse
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Adrien Lajot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ruben Brondeel
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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9
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Douglas T, Van den Borre L. Asbestos neglect: Why asbestos exposure deserves greater policy attention. Health Policy 2019; 123:516-519. [PMID: 30770142 DOI: 10.1016/j.healthpol.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/18/2022]
Abstract
While many public health threats are now widely appreciated by the public, the risks from asbestos exposure remain poorly understood, even in high-risk groups. This article makes the case that asbestos exposure is an important, ongoing global health threat, and argues for greater policy efforts to raise awareness of this threat. It also proposes the extension of asbestos bans to developing countries and increased public subsidies for asbestos testing and abatement.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, United Kingdom.
| | - Laura Van den Borre
- Interface Demography, Sociology Department, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
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10
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Van den Borre L, Deboosere P. Investigating self-reported health by occupational group after a 10-year lag: results from the total Belgian workforce. ACTA ACUST UNITED AC 2018; 76:68. [PMID: 30455881 PMCID: PMC6223069 DOI: 10.1186/s13690-018-0313-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022]
Abstract
Background Belgium lacks a systematic overview of health differences by occupation. This is the first study to examine self-reported health among 27 occupational groups in Belgium with a lag time of 10 years. Methods Individual data are derived from an anonymous linkage between the 1991 and 2001 Belgian census. The total working population (25–55 years) is selected from the 1991 Belgian census. Self-reported health (1 = fair or (very) bad health; 0 = (very) good health) was obtained from the 2001 census. Logistic regression analysis was used to analyse the health of 1.5 million men and 1.0 million women by occupational group in 1991. The active sex-specific population in 1991 and 2001 was the reference group. Controls include age, activity status and housing status at the time of 2001 census. Results Both male and female workers in physically demanding occupations were more likely to report poor health. The three occupations with the highest age-adjusted Odds Ratios (OR) were extraction and building trade workers (ORmale 2.08 95% Confidence Interval (CI) 2.05–2.10; ORfemale 2.15 CI 1.93–2.40); services elementary workers (ORmale 2.06 CI 2.03–2.10; ORfemale 2.37 CI 2.34–2.41); and labourers in construction, manufacturing and transport (ORmale 1.90 CI 1.86–1.93; ORfemale 2.21 CI 2.12–2.29). Men and women in teaching, scientific, health-related and managerial positions had the lowest age-adjusted ORs for poor self-reported health. The pattern in occupational health differences remained the same after controlling for activity status and socio-economic position. Conclusions Occupational health inequalities are apparent after a lag time of 10 years. The identification of types of workers in poor health provide valuable insights to future health promotion strategies in the Belgian workforce.
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Affiliation(s)
- Laura Van den Borre
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
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11
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Van den Borre L, Deboosere P. Understanding a Man-Made Epidemic: The Relation between Historical Asbestos Consumption and Mesothelioma Mortality in Belgium. ACTA ACUST UNITED AC 2018. [DOI: 10.18352/tseg.989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Vanthomme K, Van den Borre L, Vandenheede H, Hagedoorn P, Gadeyne S. Site-specific cancer mortality inequalities by employment and occupational groups: a cohort study among Belgian adults, 2001-2011. BMJ Open 2017; 7:e015216. [PMID: 29133313 PMCID: PMC5695485 DOI: 10.1136/bmjopen-2016-015216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study probes into site-specific cancer mortality inequalities by employment and occupational group among Belgians, adjusted for other indicators of socioeconomic (SE) position. DESIGN This cohort study is based on record linkage between the Belgian censuses of 1991 and 2001 and register data on emigration and mortality for 01/10/2001 to 31/12/2011. SETTING Belgium. PARTICIPANTS The study population contains all Belgians within the economically active age (25-65 years) at the census of 1991. OUTCOME MEASURES Both absolute and relative measures were calculated. First, age-standardised mortality rates have been calculated, directly standardised to the Belgian population. Second, mortality rate ratios were calculated using Poisson's regression, adjusted for education, housing conditions, attained age, region and migrant background. RESULTS This study highlights inequalities in site-specific cancer mortality, both related to being employed or not and to the occupational group of the employed population. Unemployed men and women show consistently higher overall and site-specific cancer mortality compared with the employed group. Also within the employed group, inequalities are observed by occupational group. Generally manual workers and service and sales workers have higher site-specific cancer mortality rates compared with white-collar workers and agricultural and fishery workers. These inequalities are manifest for almost all preventable cancer sites, especially those cancer sites related to alcohol and smoking such as cancers of the lung, oesophagus and head and neck. Overall, occupational inequalities were less pronounced among women compared with men. CONCLUSIONS Important SE inequalities in site-specific cancer mortality were observed by employment and occupational group. Ensuring financial security for the unemployed is a key issue in this regard. Future studies could also take a look at other working regimes, for instance temporary employment or part-time employment and their relation to health.
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Affiliation(s)
- Katrien Vanthomme
- Department of Sociology - Interface Demography, Economic and Social Sciences and Solvay Business School - Vrije Universiteit Brussel, Brussels, Belgium
| | - Laura Van den Borre
- Department of Sociology - Interface Demography, Economic and Social Sciences and Solvay Business School - Vrije Universiteit Brussel, Brussels, Belgium
| | - Hadewijch Vandenheede
- Department of Sociology - Interface Demography, Economic and Social Sciences and Solvay Business School - Vrije Universiteit Brussel, Brussels, Belgium
| | - Paulien Hagedoorn
- Department of Sociology - Interface Demography, Economic and Social Sciences and Solvay Business School - Vrije Universiteit Brussel, Brussels, Belgium
| | - Sylvie Gadeyne
- Department of Sociology - Interface Demography, Economic and Social Sciences and Solvay Business School - Vrije Universiteit Brussel, Brussels, Belgium
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13
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Van den Borre L, Deboosere P. Health risks in the cleaning industry: a Belgian census-linked mortality study (1991–2011). Int Arch Occup Environ Health 2017; 91:13-21. [DOI: 10.1007/s00420-017-1252-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/07/2017] [Indexed: 02/08/2023]
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14
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Abstract
OBJECTIVE To investigate cause-specific mortality among asbestos workers and potentially exposed workers in Belgium and evaluate potential excess in mortality due to established and suspected asbestos-related diseases. DESIGN This cohort study is based on an individual record linkage between the 1991 Belgian census and cause-specific mortality information for Flanders and Brussels (2001-2009). SETTING Belgium (Flanders and Brussels region). PARTICIPANTS The study population consists of 1,397,699 male workers (18-65,years) with 72,074 deaths between 1 October 2001 and 31 December 2009. Using a classification of high-risk industries, mortality patterns between 2056 asbestos workers, 385,046 potentially exposed workers and the working population have been compared. OUTCOME MEASURES Standardised mortality ratios (SMRs) and 95% CIs are calculated for manual and non-manual workers. RESULTS Our findings show clear excess in asbestos-related mortality in the asbestos industry with SMRs for mesothelioma of 4071 (CI 2327 to 6611) among manual workers and of 4489 (CI 1458 to 10,476) among non-manual workers. Excess risks in asbestos-related mortality are also found in the chemical industry, the construction industry, the electrical generation and distribution industry, the basic metals manufacturing industry, the metal products manufacturing industry, the railroad industry, and the shipping industry. Oral cancer mortality is significantly higher for asbestos workers (SMR 383; CI 124 to 894), railroad workers (SMR 192; CI 112 to 308), shipping workers (SMR 172; CI 102 to 271) and construction workers (SMR 125; CI 100 to 153), indicating a possible association with occupational asbestos exposure. Workers in all four industries have elevated mortality rates for cancer of the mouth. Only construction workers experience significantly higher pharyngeal cancer mortality (SMR 151; CI 104 to 212). CONCLUSIONS The study identifies vulnerable groups of Belgian asbestos workers, demonstrating the current-day health repercussions of historical asbestos use. Results support the hypothesis of a possible association between the development of oral cancer and occupational asbestos exposure.
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Affiliation(s)
- Laura Van den Borre
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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15
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Abstract
Background: Although Belgium was once a major international manufacturer of asbestos products, asbestos-related diseases in the country have remained scarcely researched. Objectives: The aim of this study is to provide a descriptive analysis of Belgian mesothelioma mortality rates in order to improve the understanding of asbestos health hazards from an international perspective. Methods: Temporal and geographical analyses were performed on cause-specific mortality data (1969–2009) using quantitative demographic measures. Results were compared to recent findings on global mesothelioma deaths. Results: Belgium has one of the highest mesothelioma mortality rates in the world, following the UK, Australia, and Italy. With a progressive increase of male mesothelioma deaths in the mid-1980s, large differences in mortality rates between sexes are apparent. Mesothelioma deaths are primarily concentrated in geographic areas with proximity to former asbestos industries. Conclusions: Asbestos mortality in Belgium has been underestimated for decades. Our findings suggest that the location of asbestos industries is correlated with rates of mesothelioma, underlining the need to avert future asbestos exposure by thorough screening of potential contaminated sites and by pursuing a global ban on asbestos.
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Affiliation(s)
- Laura Van den Borre
- Interface Demography, Department of Sociology, Vrije Universiteit, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit, Brussels, Belgium
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