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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial Variation in Excess Mortality Across Europe: A Cross-Sectional Study of 561 Regions in 21 Countries. J Epidemiol Glob Health 2024:10.1007/s44197-024-00200-0. [PMID: 38376764 DOI: 10.1007/s44197-024-00200-0] [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: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. METHODS Statistical and demographic analyses of regional all-cause mortality data provided by the vital statistics systems of 21 European countries for 561 regions in Central and Western Europe. Life expectancy losses at ages 0 and 60 for males and females were estimated. RESULTS We found evidence of a loss in life expectancy in 391 regions, whilst only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years and three regions showed losses greater than 3 years. We highlight geographical clusters of high mortality in Northern Italy, Spain and Poland, whilst clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden. CONCLUSIONS Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France.
| | - Pavel Grigoriev
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | | | - Carlo-Giovanni Camarda
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
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Petit MP, Ouellette N, Bourbeau R. The case for counting multiple causes of death in the COVID-19 era. Int J Epidemiol 2024; 53:dyad149. [PMID: 37930034 DOI: 10.1093/ije/dyad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Marie-Pier Petit
- Department of Demography, Université de Montréal, Montreal, QC, Canada
| | - Nadine Ouellette
- Department of Demography, Université de Montréal, Montreal, QC, Canada
| | - Robert Bourbeau
- Department of Demography, Université de Montréal, Montreal, QC, Canada
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Bonnet F, Camarda CG. Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020. PLoS One 2024; 19:e0293752. [PMID: 38241216 PMCID: PMC10798530 DOI: 10.1371/journal.pone.0293752] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/18/2023] [Indexed: 01/21/2024] Open
Abstract
The COVID-19 pandemic's uneven impact on subnational regions highlights the importance of understanding its local-level mortality impact. Vital statistics are available for an increasing number of countries for 2020, 2021, and 2022, facilitating the computation of subnational excess mortality and a more comprehensive assessment of its burden. However, this calculation faces two important methodological challenges: it requires appropriate mortality projection models; and small populations imply considerable, though commonly neglected, uncertainty in the estimates. We address both issues using a method to forecast mortality at the subnational level, which incorporates uncertainty in the computation of mortality measures. We illustrate our approach by examining French départements (NUTS 3 regions, or 95 geographical units), and produce sex-specific estimates for 2020. This approach is highly flexible, allowing one to estimate excess mortality during COVID-19 in most demographic scenarios and for past pandemics.
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Affiliation(s)
- Florian Bonnet
- Institut national d’études démographiques (INED), Aubervilliers, France
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Torres C, García J, Meslé F, Barbieri M, Bonnet F, Camarda CG, Cambois E, Caporali A, Couppié É, Poniakina S, Robine JM. Identifying age- and sex-specific COVID-19 mortality trends over time in six countries. Int J Infect Dis 2023; 128:32-40. [PMID: 36509336 DOI: 10.1016/j.ijid.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. METHODS We focus on five European countries and the United States. Using standardized and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, and demographic characteristics and seasonality patterns. RESULTS Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analyzed but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared with women, men have higher COVID-19 mortality rates at most ages and in most seasons. CONCLUSION There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having targeted those ages specifically.
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Schöley J, Aburto JM, Kashnitsky I, Kniffka MS, Zhang L, Jaadla H, Dowd JB, Kashyap R. Life expectancy changes since COVID-19. Nat Hum Behav 2022; 6:1649-1659. [PMID: 36253520 PMCID: PMC9755047 DOI: 10.1038/s41562-022-01450-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 01/14/2023]
Abstract
The COVID-19 pandemic triggered an unprecedented rise in mortality that translated into life expectancy losses around the world, with only a few exceptions. We estimate life expectancy changes in 29 countries since 2020 (including most of Europe, the United States and Chile), attribute them to mortality changes by age group and compare them with historic life expectancy shocks. Our results show divergence in mortality impacts of the pandemic in 2021. While countries in western Europe experienced bounce backs from life expectancy losses of 2020, eastern Europe and the United States witnessed sustained and substantial life expectancy deficits. Life expectancy deficits during fall/winter 2021 among people ages 60+ and <60 were negatively correlated with measures of vaccination uptake across countries (r60+ = -0.86; two-tailed P < 0.001; 95% confidence interval, -0.94 to -0.69; r<60 = -0.74; two-tailed P < 0.001; 95% confidence interval, -0.88 to -0.46). In contrast to 2020, the age profile of excess mortality in 2021 was younger, with those in under-80 age groups contributing more to life expectancy losses. However, even in 2021, registered COVID-19 deaths continued to account for most life expectancy losses.
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Affiliation(s)
- Jonas Schöley
- Max Planck Institute for Demographic Research, Rostock, Germany.
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Ilya Kashnitsky
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Maxi S Kniffka
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Luyin Zhang
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
| | - Hannaliis Jaadla
- Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
- Cambridge Group for the History of Population and Social Structure, Department of Geography, University of Cambridge, Cambridge, UK
| | - Jennifer B Dowd
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Ridhi Kashyap
- Leverhulme Centre for Demographic Science and Department of Sociology, University of Oxford, Oxford, UK.
- Nuffield College, University of Oxford, Oxford, UK.
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Bignami-Van Assche S, Ghio D. Comparing COVID-19 fatality across countries: a synthetic demographic indicator. J Pop Research 2022; 39:513-525. [PMID: 36065463 PMCID: PMC9430010 DOI: 10.1007/s12546-022-09289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/04/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
Background The case fatality rate (CFR) is one of the most important measures for monitoring disease progression and evaluating appropriate policy health measures over the course of the COVID-19 pandemic. To remove biases arising from the age structure of COVID-19 cases in international comparisons of the CFR, existing studies have relied mainly on direct standardisation. Objective We propose and validate a synthetic indicator of COVID-19 fatality (SCFR) that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases without relying on the arbitrary choice of a standard population. Results Contrary to what comparisons of the crude CFR suggest, differences in COVID-19 fatality across countries according to the proposed SCFR are not very stark. Importantly, once we adjust for the age structure of COVID-19 cases, the higher case fatality among men emerges as the main driver of international differences in COVID-19 CFR. Conclusions The SCFR is a simple indicator that is useful for monitoring the fatality of SARS-CoV-2 mutations and the efficacy of health policy measures for COVID-19, including vaccination. Contributions (1) A simple synthetic indicator of COVID-19 fatality that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases; (2) Evidence that sex differences in COVID-19 fatality drive international differences in the overall CFR.
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Schlüter BS, Masquelier B, Camarda CG. Heterogeneity in subnational mortality in the context of the COVID-19 pandemic: the case of Belgian districts in 2020. Arch Public Health 2022; 80:130. [PMID: 35524287 PMCID: PMC9073828 DOI: 10.1186/s13690-022-00874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/13/2021] [Accepted: 03/26/2022] [Indexed: 03/29/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to major shocks in mortality trends in many countries. Yet few studies have evaluated the heterogeneity of the mortality shocks at the sub-national level, rigorously accounting for the different sources of uncertainty. METHODS Using death registration data from Belgium, we first assess change in the heterogeneity of districts' standardized mortality ratios in 2020, when compared to previous years. We then measure the shock effect of the pandemic using district-level values of life expectancy, comparing districts' observed and projected life expectancy, accounting for all sources of uncertainty (stemming from life-table construction at district level and from projection methods at country and district levels). Bayesian modelling makes it easy to combine the different sources of uncertainty in the assessment of the shock. This is of particular interest at a finer geographical scale characterized by high stochastic variation in annual death counts. RESULTS The heterogeneity in the impact of the pandemic on all-cause mortality across districts is substantial: while some districts barely show any impact, the Bruxelles-Capitale and Mons districts experienced a decrease in life expectancy at birth of 2.24 (95% CI:1.33-3.05) and 2.10 (95% CI:0.86-3.30) years, respectively. The year 2020 was associated with an increase in the heterogeneity of mortality levels at a subnational scale in comparison to past years, measured in terms of both standardized mortality ratios and life expectancies at birth. Decisions on uncertainty thresholds have a large bearing on the interpretation of the results. CONCLUSION Developing sub-national mortality estimates taking careful account of uncertainty is key to identifying which areas have been disproportionately affected.
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Affiliation(s)
| | - Bruno Masquelier
- IACCHOS (DEMO), Catholic University of Louvain (UCLouvain), Louvain-la-Neuve, Belgium
| | - Carlo Giovanni Camarda
- Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France
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Breton D, Belliot N, Barbieri M, d’Albis H, Mazuy M. L’évolution démographique récente de la France. Population 2022. [DOI: 10.3917/popu.2104.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Caporali A, Garcia J, Couppié É, Poniakina S, Barbieri M, Bonnet F, Camarda CG, Cambois E, Hourani I, Korotkova D, Meslé F, Penina O, Robine JM, Sauerberg M, Torres C. The demography of COVID-19 deaths database, a gateway to well-documented international data. Sci Data 2022; 9:93. [PMID: 35318326 DOI: 10.1038/s41597-022-01191-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/04/2022] [Indexed: 12/02/2022] Open
Abstract
National authorities publish COVID-19 death counts, which are extensively re-circulated and compared; but data are generally poorly sourced and documented. Academics and stakeholders need tools to assess data quality and to track data-related discrepancies for comparability over time or across countries. “The Demography of COVID-19 Deaths” database aims at bridging this gap. It provides COVID-19 death counts along with associated documentation, which includes the exact data sources and points out issues of quality and coverage of the data. The database — launched in April 2020 and continuously updated — contains daily cumulative death counts attributable to COVID-19 broken down by sex and age, place and date of occurrence of the death. Data and metadata undergo quality control checks prior to online release. As of mid-December 2021, it covers 21 countries in Europe and beyond. It is open access at a bilingual (English and French) website with content intended for expert users and non-specialists (https://dc-covid.site.ined.fr/en/; figshare: 10.6084/m9.figshare.c.5807027). Data and metadata are available for each country separately and pooled over all countries. Measurement(s) | mortality | Technology Type(s) | digital curation | Factor Type(s) | Death counts | Sample Characteristic - Organism | Homo sapiens • Covid-19 deaths | Sample Characteristic - Environment | Country | Sample Characteristic - Location | Austria, Belgium, Canada, England and Wales, Denmark, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, the Republic of Korea, the Republic of Moldova, Romania, Scotland, Spain, Sweden, Switzerland, Ukraine, and the United States of America |
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Helleringer S, Queiroz BL. Commentary: Measuring excess mortality due to the COVID-19 pandemic: progress and persistent challenges. Int J Epidemiol 2022; 51:85-87. [PMID: 34904168 PMCID: PMC8856005 DOI: 10.1093/ije/dyab260] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Stéphane Helleringer
- New York University—Abu Dhabi Campus, Division of Social Science, Program in Social Research and Public Policy, Abu Dhabi, United Arab Emirates and
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas Gerais, Department of Demography and Centro de Desenvolvimento e Planejamento Regional (CEDEPLAR), Belo Horizonte, Minas Gerais, Brazil
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Abstract
BACKGROUND Despite the growing evidence of the extreme efficacy of COVID-19 vaccines in adults and the elderly, the administration of the same prophylactic measures to pediatric subjects is debated by some parents and by a number of researchers. The aim of this manuscript is to explain the reasons for overcoming hesitancy towards COVID-19 vaccination in children and adolescents and to highlight the importance of universal COVID-19 vaccination in the pediatric population. MAIN FINDINGS Recent epidemiological data suggest that the risk that a child with COVID-19 is hospitalized or admitted to the pediatric intensive care unit is greater than initially thought. Children may also suffer from long COVID and school closure because of COVID-19 can cause relevant mental health problems in the pediatric population. Placebo-controlled, observer-blinded, clinical trials showed appropriate efficacy, safety and tolerability of authorized mRNA COVID-19 vaccines in children and adolescents 12-17 years old. Vaccination in children younger than 12 years of age will allow further benefits . CONCLUSIONS COVID-19 vaccine administration seems mandatory in all the children and adolescents because of COVID-19 related complications as well as the efficacy, safety and tolerability of COVID-19 vaccines in this population. Due to the recent approval of COVID-9 vaccines for children 5-10 years old, it is desirable that vaccine opponents can understand how important is the universal immunization against COVID-19 for the pediatric subjects.
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Affiliation(s)
| | - Susanna Esposito
- Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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Dorrington RE, Moultrie TA, Laubscher R, Groenewald PJ, Bradshaw D. Rapid mortality surveillance using a national population register to monitor excess deaths during SARS-CoV-2 pandemic in South Africa. Genus 2021; 77:19. [PMID: 34493876 PMCID: PMC8414474 DOI: 10.1186/s41118-021-00134-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
This paper describes how an up-to-date national population register recording deaths by age and sex, whether deaths were due to natural or unnatural causes, and the offices at which the deaths were recorded can be used to monitor excess death during the SARS-CoV-2 pandemic, both nationally, and sub-nationally, in a country with a vital registration system that is neither up to date nor complete. Apart from suggesting an approach for estimating completeness of reporting at a sub-national level, the application produces estimates of the number of deaths in excess of those expected in the absence of the SARS-CoV-2 epidemic that are highly correlated with the confirmed number of COVID-19 deaths over time, but at a level 2.5 to 3 times higher than the official numbers of COVID-19 deaths. Apportioning the observed excess deaths more precisely to COVID, COVID-related and collateral deaths, and non-COVID deaths averted by interventions with reduced mobility and gatherings, etc., requires access to real-time cause-of-death information. It is suggested that the transition from ICD-10 to ICD-11 should be used as an opportunity to change from a paper-based system to electronic capture of the medical cause-of-death information.
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Affiliation(s)
- Rob E. Dorrington
- Centre for Actuarial Research, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7700 South Africa
| | - Tom A. Moultrie
- Centre for Actuarial Research, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7700 South Africa
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Pam J. Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- Department of Family Medicine and Public Health, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7700 South Africa
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