1
|
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.
Collapse
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
| |
Collapse
|
2
|
Molenberghs G, Faes C, Verbeeck J, Deboosere P, Abrams S, Willem L, Aerts J, Theeten H, Devleesschauwer B, Bustos Sierra N, Renard F, Herzog S, Lusyne P, Van der Heyden J, Van Oyen H, Van Damme P, Hens N. COVID-19 mortality, excess mortality, deaths per million and infection fatality ratio, Belgium, 9 March 2020 to 28 June 2020. Euro Surveill 2022; 27. [PMID: 35177167 PMCID: PMC8855510 DOI: 10.2807/1560-7917.es.2022.27.7.2002060] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundCOVID-19 mortality, excess mortality, deaths per million population (DPM), infection fatality ratio (IFR) and case fatality ratio (CFR) are reported and compared for many countries globally. These measures may appear objective, however, they should be interpreted with caution.AimWe examined reported COVID-19-related mortality in Belgium from 9 March 2020 to 28 June 2020, placing it against the background of excess mortality and compared the DPM and IFR between countries and within subgroups.MethodsThe relation between COVID-19-related mortality and excess mortality was evaluated by comparing COVID-19 mortality and the difference between observed and weekly average predictions of all-cause mortality. DPM were evaluated using demographic data of the Belgian population. The number of infections was estimated by a stochastic compartmental model. The IFR was estimated using a delay distribution between infection and death.ResultsIn the study period, 9,621 COVID-19-related deaths were reported, which is close to the excess mortality estimated using weekly averages (8,985 deaths). This translates to 837 DPM and an IFR of 1.5% in the general population. Both DPM and IFR increase with age and are substantially larger in the nursing home population.DiscussionDuring the first pandemic wave, Belgium had no discrepancy between COVID-19-related mortality and excess mortality. In light of this close agreement, it is useful to consider the DPM and IFR, which are both age, sex, and nursing home population-dependent. Comparison of COVID-19 mortality between countries should rather be based on excess mortality than on COVID-19-related mortality.
Collapse
Affiliation(s)
- Geert Molenberghs
- I-BioStat, KU Leuven, Leuven, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Christel Faes
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Johan Verbeeck
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Patrick Deboosere
- Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Abrams
- Global Health Institute (GHI), Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Lander Willem
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Jan Aerts
- Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Brecht Devleesschauwer
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Ghent, Belgium.,Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Françoise Renard
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Sereina Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | | | - Herman Van Oyen
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Data Science Institute, I-BioStat, Universiteit Hasselt, Hasselt, Belgium
| |
Collapse
|
3
|
Gadeyne S, Rodriguez-Loureiro L, Surkyn J, Van Hemelrijck W, Nusselder W, Lusyne P, Vanthomme K. Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium. Int J Equity Health 2021; 20:258. [PMID: 34922557 PMCID: PMC8684273 DOI: 10.1186/s12939-021-01594-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.
Collapse
Affiliation(s)
- Sylvie Gadeyne
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Lucia Rodriguez-Loureiro
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Johan Surkyn
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Wanda Van Hemelrijck
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
- Netherlands Interdisciplinary Demographic Institute-KNAW/University of Groningen, Lange Houtstraat 19, The Hague, CV, NL-2511, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, GD, 3015, The Netherlands
| | - Patrick Lusyne
- Statbel, Directorate General Statistics - Statistics Belgium, North Gate - Boulevard du Roi Albert II, 16 - 1000, Brussels, Belgium
| | - Katrien Vanthomme
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| |
Collapse
|
4
|
Vanthomme K, Gadeyne S, Lusyne P, Vandenheede H. A population-based study on mortality among Belgian immigrants during the first COVID-19 wave in Belgium. Can demographic and socioeconomic indicators explain differential mortality? SSM Popul Health 2021; 14:100797. [PMID: 33997246 PMCID: PMC8093459 DOI: 10.1016/j.ssmph.2021.100797] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Belgium has noted a significant excess mortality during the first COVID-19 wave. Research in other countries has shown that people with migrant origin are disproportionally affected. Belgium has an ethnically diverse and increasingly ageing population and is therefore particularly apt to study differential mortality by migrant group during this first wave of COVID-19. DATA AND METHODS We used nationwide individually-linked data from the Belgian National Register providing sociodemographic indicators and mortality; and the administrative census of 2011 providing indicators of socioeconomic position. Age-standardized all-cause mortality rates (ASMRs) were calculated during the first COVID-19 wave (weeks 11-20 in 2020) and compared with ASMRs during weeks 11-20 in 2019 to calculate excess mortality by migrant origin, age and gender. For both years, relative inequalities were calculated by migrant group using Poisson regression, with and without adjustment for sociodemographic and socioeconomic indicators. RESULTS Among the middle-aged, ASMRs revealed increased mortality in all origin groups, with significant excess mortality for Belgians and Sub-Saharan African men. At old age, excess mortality up to 60% was observed for all groups. In relative terms, most male elderly migrant groups showed higher mortality than natives, as opposed to 2019 and to women. Adding the control variables decreased this excess mortality. DISCUSSION This study underlined important inequalities in overall and excess mortality in specific migrant communities, especially in men. Tailor-made policy measures and communication strategies should be set-up taking into account the particular risks to which groups are exposed.
Collapse
Affiliation(s)
- Katrien Vanthomme
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Sylvie Gadeyne
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Patrick Lusyne
- Statbel, Directorate General Statistics - Statistics Belgium, North Gate - Boulevard du Roi Albert II, 16 - 1000, Brussels, Belgium
| | - Hadewijch Vandenheede
- Sociology Department, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| |
Collapse
|
5
|
Maetens A, De Schreye R, Faes K, Houttekier D, Deliens L, Gielen B, De Gendt C, Lusyne P, Annemans L, Cohen J. Using linked administrative and disease-specific databases to study end-of-life care on a population level. BMC Palliat Care 2016; 15:86. [PMID: 27756296 PMCID: PMC5069861 DOI: 10.1186/s12904-016-0159-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 05/17/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of full-population databases is under-explored to study the use, quality and costs of end-of-life care. Using the case of Belgium, we explored: (1) which full-population databases provide valid information about end-of-life care, (2) what procedures are there to use these databases, and (3) what is needed to integrate separate databases. METHODS Technical and privacy-related aspects of linking and accessing Belgian administrative databases and disease registries were assessed in cooperation with the database administrators and privacy commission bodies. For all relevant databases, we followed procedures in cooperation with database administrators to link the databases and to access the data. RESULTS We identified several databases as fitting for end-of-life care research in Belgium: the InterMutualistic Agency's national registry of health care claims data, the Belgian Cancer Registry including data on incidence of cancer, and databases administrated by Statistics Belgium including data from the death certificate database, the socio-economic survey and fiscal data. To obtain access to the data, approval was required from all database administrators, supervisory bodies and two separate national privacy bodies. Two Trusted Third Parties linked the databases via a deterministic matching procedure using multiple encrypted social security numbers. CONCLUSION In this article we describe how various routinely collected population-level databases and disease registries can be accessed and linked to study patterns in the use, quality and costs of end-of-life care in the full population and in specific diagnostic groups.
Collapse
Affiliation(s)
- Arno Maetens
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium.
| | - Robrecht De Schreye
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
| | - Kristof Faes
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium.,Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Dirk Houttekier
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
| | - Luc Deliens
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium.,Department of medical oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Lieven Annemans
- Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium & Ghent University, Ghent, Belgium
| |
Collapse
|
6
|
Eeckhaut MCW, Lievens J, Van de Putte B, Lusyne P. Partner selection and divorce in ethnic minorities: distinguishing between two types of ethnic homogamous marriages. Int Migr Rev 2012; 45:269-96. [PMID: 22069768 DOI: 10.1111/j.1747-7379.2011.00848.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article compares divorce risks according to marriage type. The common dichotomy between ethnic homogamous and ethnic heterogamous marriages is further elaborated by differentiating a third marriage type; ethnic homogamous marriages between individuals from an ethnic minority group and a partner from the country of origin. Based on the analysis of data concerning the Turkish and Moroccan minorities in Belgium, it has been confirmed that the divorce risk associated with these marriages is higher than that of other ethnic homogamous marriages. However, specific divorce patterns according to marriage type also indicate the importance of differences between the minority groups.
Collapse
|
7
|
Abstract
Since Durkheim's work on suicide, the family has widely been seen as providing partial protection against the development of tendencies to suicide. This study assesses the impact of parenthood (both number of children and age of youngest child) on suicide following the death of a spouse. Using data for Belgium in the 5 years following the 1991 census, the study adopts a nested case-control design with information on 3,800 suicides and 75,673 matched controls. The analysis takes into account several social-economic variables. The findings show that the impact of children on the elevated suicide levels found among widows and widowers relative to the still married can be positive or negative, and differs by both age and sex of the parent, age of the child or children, and time since bereavement.
Collapse
|
8
|
Abstract
This paper examines excess mortality following spousal bereavement by time since bereavement, sex, age, and education. The main hypothesis challenged is that higher education buffers the harmful effects of spousal loss. Using a log-rate model, death-rate ratios (widowed/married) are estimated for 49,849 and 126,746 Belgian widowers and widows and an equal number of non-bereaved controls matched to the bereaved on their socio-demographic characteristics. The hypothesis that the more educated suffer less excess mortality is not supported. Although higher educational levels are associated with lower mortality in general, they do not alleviate the effects of bereavement. On the contrary, in the period immediately following spousal loss, the more highly educated seem to have more, rather than less, excess mortality. Three possible arguments are suggested to account for this: education-related differences in the partner-relationship, structural differences in the availability of appropriate social support, and cultural differences in potential support networks.
Collapse
Affiliation(s)
- P Lusyne
- Department of Population Studies and Social Science Research Methods, University of Ghent
| | | | | |
Collapse
|