Excess mortality from COVID and non-COVID causes in minority populations

2021 ◽  
Vol 118 (39) ◽  
pp. e2101386118 ◽  
Author(s):  
Christopher J. Cronin ◽  
William N. Evans
Keyword(s):  
Excess Mortality ◽  
Time Interval ◽  
Hispanic Males ◽  
Excess Death ◽  
Life Years ◽  
Life Years Lost ◽  
Race Ethnicity ◽  
And Gender ◽  
Death Count ◽  
Excess Deaths

The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than age-population–weighted mortality over the same time interval in 2017 to 2019, for a total excess death count of 413,592. We use data on weekly death counts by cause, as well as life tables, to quantify excess mortality and life years lost from both COVID-19 and non–COVID-19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non–COVID-19 causes is substantial and much more heavily concentrated among males and minorities, especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the excess life years lost for males is from non–COVID-19 causes. While minorities represent 36% of COVID-19 deaths, they represent 70% of non–COVID-19 related excess deaths and 58% of non–COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9% of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020 excess deaths from non–COVID-19 causes. For this group, nearly half of the excess life years lost in 2020 are due to non–COVID-19 causes.

Intersectionality of Race, Ethnicity, Gender, and Age on Criminal Punishment

2016 ◽  
Vol 60 (4) ◽  
pp. 810-833 ◽  
Author(s):  
Darrell Steffensmeier ◽  
Noah Painter-Davis ◽  
Jeffery Ulmer
Keyword(s):  
Black Males ◽  
Behavioral Outcomes ◽  
Hispanic Males ◽  
Race And Gender ◽  
Focal Concerns ◽  
Gender And Age ◽  
Statistical Studies ◽  
Novel Method ◽  
Race Ethnicity ◽  
And Gender

Race, ethnicity, gender, and age are core foci within sociology and law/criminology. Also prominent is how these statuses intersect to affect behavioral outcomes, but statistical studies of intersectionality are rare. In the area of criminal sentencing, an abundance of studies examine main and joint effects of race and gender but few investigate in detail how these effects are conditioned by defendant’s age. Using recent Pennsylvania sentencing data and a novel method for analyzing statistical interactions, we examine the main and combined effects of these statuses on sentencing. We find strong evidence for intersectionality: Harsher sentences concentrate among young black males and Hispanic males of all ages, while the youngest females (regardless of race/ethnicity) and some older defendants receive leniency. The focal concerns model of sentencing that frames our study has strong affinity with intersectionality perspectives and can serve as a template for research examining the ways social statuses shape inequality.

Excess Mortality During the COVID-19 Pandemic in Philadelphia

2021 ◽  
pp. e1-e6
Author(s):  
Megan Todd ◽  
Meagan Pharis ◽  
Sam P. Gulino ◽  
Jessica M. Robbins ◽  
Cheryl Bettigole
Keyword(s):  
Public Health ◽  
Excess Mortality ◽  
Poisson Model ◽  
People Of Color ◽  
Mortality Data ◽  
Registration System ◽  
Vital Registration System ◽  
All Cause Mortality ◽  
Race Ethnicity ◽  
Excess Deaths

Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n=2725) were attributed to COVID-19 on the death certificate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; official counts significantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306285 )

SO061SEX DIFFERENCES IN MORTALITY AMONG PEOPLE WITH END-STAGE KIDNEY DISEASE: DO WOMEN ALWAYS LIVE LONGER?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nicole De La Mata ◽  
Grace Macleod ◽  
Patrick Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
Kidney Transplantation ◽  
General Population ◽  
Excess Mortality ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

Abstract Background and Aims Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to sex-based differences or healthcare inequities. We aimed to explore sex differences in survival among people with end-stage kidney disease (ESKD) compared to the general population. Method We included the entire ESKD population in Australia, 1980-2013 and New Zealand, 1988-2012 from the Australian and New Zealand Dialysis and Transplant Registry. These were linked to national death registers to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), cumulative relative survival and expected life years lost, using general population data (adjusting for country, age, sex and calendar year) to account for background mortality. Results Of the 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Overall 34,417 deaths occurred over the 368,719 person-years of follow-up where a similar proportion of females (57%) and males (56%) died. While mortality sex differences within the ESKD population were minor, once compared to the general population female ESKD patients had greater excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Female ESKD patients had 12 times (SMR:11.5; 95%CI:11.3-11.7) and males had 7 times (SMR:6.7; 95%CI:6.7-6.8) the expected deaths, with the greatest sex disparity among younger ages and from cardiovascular disease. Relative survival was consistently lower in females (0.57, 95%CI:0.57-0.58 in males vs 0.54, 95%CI:0.54-0.55 in females at 5 years), where the excess mortality was 9% higher (95%CI:7-12%) in female ESKD patients (Fig 1A), adjusting for year and age. The average life years lost for female ESKD patients was 4-5 years greater than male ESKD patients (Average life years lost 25.9 years, 95%CI:25.1-26.7 in males and 31.4 years, 95%CI:30.5-32.1 in females aged 15 years at ESKD) (Fig 1B). Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42; Fig 1C) and average life years lost reduced to 3-4 years for females (Fig 1D). Conclusion The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

scholarly journals An inverse stage-shift model to estimate the excess mortality and health economic impact of delayed access to cancer services due to the COVID-19 pandemic

2020 ◽  
Author(s):  
Koen Degeling ◽  
Nancy N. Baxter ◽  
Jon Emery ◽  
Fanny Franchini ◽  
Peter Gibbs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Time Horizon ◽  
Treatment Initiation ◽  
Stage I ◽  
Stage Ii ◽  
Disease Stage ◽  
Life Years ◽  
Life Years Lost ◽  
Excess Deaths

AbstractBackgroundDecreased cancer incidence and reported changes to clinical management indicate that the COVID-19 pandemic will result in diagnostic and treatment delays for cancer patients. We aimed to develop a flexible model to estimate the impact of delayed diagnosis and treatment initiation on survival outcomes and healthcare costs based on a shift in the disease stage at treatment initiation.MethodsThe stage-shift model estimates population-level health economic outcomes by weighting disease stage-specific outcomes by the distribution of stages at treatment initiation, assuming delays lead to stage-progression. It allows for extrapolation of population-level survival data using parametric distributions to calculate the expected survival in life years. The model was demonstrated based on an analysis of the impact of 3 and 6-month delays for stage I breast cancer, colorectal cancer and lung cancer patients, and for T1 melanoma, based on Australian data. In the absence of patient-level data about time to stage progression, two approaches were explored to estimate the proportion of patients that would experience a stage shift following the delay: 1) based on the relation between time to treatment initiation and overall survival (breast, colorectal and lung cancer), and 2) based on the tumour growth rate (melanoma). The model is available on http://stage-shift.personex.nl/.ResultsA shift from stage I to stage II due to a 6-month delay is least likely for colorectal cancer patients, with an estimated proportion of 3% of the stage I patients diagnosed in 2020 progressing to stage II, resulting in 11 excess deaths after 5 years and a total of 96 life years lost over a 10-year time horizon. For breast and lung cancer, progression from stage I to stage II due to a 6-month delay were slightly higher at 5% (breast cancer) and 8% (lung cancer), resulting in 25 and 43 excess deaths after 5 years, and 239 and 373 life years lost over a 10-year time horizon, respectively. For melanoma, with 32% of T1 patients progressing to T2 disease following a 6-month delay, the model estimated 270 excess death after 5 years and 2584 life years lost over a 10-year time horizon.ConclusionsUsing a conservative 3-month delay in diagnosis and treatment initiation due to the COVID-19 pandemic, this study predicts nearly 90 excess deaths and $12 million excess healthcare costs in Australia over 5 years for the in 2020 diagnosed patients for 4 cancers. If the delays increase to 6 months, excess mortality and cost approach nearly 350 deaths and $46 million in Australia. More accurate data on stage of disease during and after the COVID-19 pandemic are critical to obtain more reliable estimates.

scholarly journals Racial/Ethnic Disparities in US Adolescents’ Dietary Quality and Its Modification by Weight-Related Factors and Physical Activity

2019 ◽  
Vol 16 (23) ◽  
pp. 4803 ◽  
Author(s):  
Furong Xu ◽  
Steven A. Cohen ◽  
Mary L. Greaney ◽  
Disa L. Hatfield ◽  
Geoffrey W. Greene
Keyword(s):  
Physical Activity ◽  
Ethnic Disparities ◽  
Dietary Quality ◽  
Quality Data ◽  
Related Factors ◽  
Hispanic Males ◽  
Hispanic Females ◽  
Race Ethnicity ◽  
And Gender ◽  
Racial Ethnic

There are well-known disparities in the prevalence of obesity across racial-ethnic groups, although the behavioral and psychological factors driving these disparities are less well understood. Therefore, the objectives of this study were: (1) to examine differences in dietary quality by race/ethnicity and weight-related variables [body mass index (BMI), weight loss attempt, and weight dissatisfaction] and physical activity (PA) using the Health Eating Index-2015 (HEI-2015); and (2) to investigate the interactions and independent associations of race/ethnicity, weight-related variables and PA on dietary quality. Data for adolescents aged 12–19 years (n = 3373) were abstracted from the 2007–2014 National Health and Nutrition and Examination Survey and analyzed using multiple PROC SURVEYREG, adjusting for demographics and accounting for complex sampling. Analyses determined that Hispanic males had better overall HEI-2015 scores than non-Hispanic whites (48.4 ± 0.5 vs. 45.7 ± 0.6, p = 0.003) or blacks (48.4 ± 0.5 vs. 45.5 ± 0.5, p < 0.001). Hispanic females also had better dietary quality than non-Hispanic whites (50.2 ± 0.4 vs. 47.5 ± 0.5, p < 0.001) and blacks (50.2 ± 0.4 vs. 47.1 ± 0.5, p < 0.001). Meeting the PA recommendation modified racial/ethnic differences in dietary quality for females (p = 0.011) and this was primarily driven by the associations among non-Hispanic white females (ΔR2 = 2.6%, p = 0.0004). The study identified racial/ethnic and gender differences among adolescents in factors that may promote obesity. Results may be useful for obesity prevention efforts designed to reduce health disparities in adolescents.

scholarly journals Sex Differences in Mortality Among People with End-Stage Kidney Disease: Bi-National Data-Linkage Cohort Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nicole L De La Mata ◽  
Grace Macleod ◽  
Patrick J Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
General Population ◽  
Excess Mortality ◽  
Data Linkage ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

IntroductionFemale life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to biological differences or healthcare inequities. Objectives and ApproachWe aimed to explore sex differences in mortality among people with end-stage kidney disease (ESKD). T he entire ESKD population in Australia, 1980-2013, and New Zealand,1988-2012, were included from the Australian and New Zealand Dialysis and Transplant Registry. Data linkage to national death registers was undertaken to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), relative survival and expected life years lost, using general population data to account for background mortality, adjusting for country, age, sex and year. ResultsOf 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Mortality sex differences within the ESKD population were minor, but once compared to the general population, female ESKD patients had more excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Females had 11.5 SMR (95%CI:11.3-11.7) and males had 6.7 SMR (95%CI:6.7-6.8), with greater disparity among younger ages and from certain causes. Relative survival was consistently lower in females, with adjusted excess mortality 9% higher (95%CI:7-12%) in ESKD females. Average life years lost was 4-5 years greater in ESKD females compared to males across all ages. Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42) and average life years lost reduced to 3-4 years for females. Conclusion / ImplicationsThe impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

scholarly journals Excess deaths among Latino people in California during the COVID-19 pandemic

2020 ◽  
Author(s):  
Alicia R. Riley ◽  
Yea-Hung Chen ◽  
Ellicott C. Matthay ◽  
M. Maria Glymour ◽  
Jacqueline M. Torres ◽  
...  
Keyword(s):  
Formal Education ◽  
Excess Mortality ◽  
Workplace Safety ◽  
Place Of Birth ◽  
Excess Death ◽  
High School Degree ◽  
Risk Of Death ◽  
Food And Agriculture ◽  
Access To Medical Care ◽  
Excess Deaths

ABSTRACTBackgroundLatinos in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which subgroups within this diverse population are most affected. Such information is necessary to target policies and programs that prevent further excess mortality and reduce inequities.MethodsUsing death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latinos in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups defined by age, sex, place of birth, education, occupation, and combinations of these factors.ResultsDuring the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,304, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or Central America (RR 1.49; 95% PI, 1.37, 1.63), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in manufacturing (RR 1.62; 95% PI, 1.52, 1.72) or food-and-agriculture occupations (RR 1.50; 95% PI, 1.40, 1.61). Disparities in excess death by place of birth and education were magnified among Latinos in essential occupations.ConclusionsForeign-birth, low formal education, and work in an essential sector put some Latinos in California at higher risk of death during the COVID-19 pandemic. Interventions should reduce the disproportionate impact of the pandemic on Latino immigrants and Latinos in unsafe working conditions; these may include early vaccination, workplace safety enforcement, and expanded access to medical care.

scholarly journals Estimation of excess all-cause mortality due to COVID-19 in Thailand

2022 ◽  
Author(s):  
Chaiwat Wilasang ◽  
Thanchanok Lincharoen ◽  
Charin Modchang ◽  
Sudarat Chadsuthi
Keyword(s):  
Correlation Coefficient ◽  
Mixed Models ◽  
New Record ◽  
Excess Mortality ◽  
Generalized Linear Mixed Models ◽  
Age Groups ◽  
Significant Rise ◽  
Excess Death ◽  
All Cause Mortality ◽  
Excess Deaths

Background: Thailand has recently experienced the most prominent COVID-19 outbreak, resulting in a new record for COVID-19 cases and deaths. To assess the influence of the COVID-19 outbreak on mortality, we aimed to estimate excess mortality in Thailand. Methods: We estimated the baseline number of deaths in the absence of COVID-19 using generalized linear mixed models (GLMMs). The models were adjusted for seasonality and demographics. We evaluated the excess mortality from April to October 2021 in Thailand. Results: We found that the estimated cumulative excess death from April to October 2021 was 14.3% (95% CI: 8.6%-18.8%) higher than the baseline. The results also showed that the excess deaths in males were higher than in females by approximately 26.3%. The excess deaths directly caused by the COVID-19 infections accounted for approximately 75.0% of the all-cause excess deaths. Furthermore, the cumulative COVID-19 cases were found to be correlated with the cumulative excess deaths with a correlation coefficient of 0.9912 (95% CI, 0.9392-0.9987). Conclusions: The recent COVID-19 outbreak in Thailand significantly impacts mortality and affects people for specific ages and sex. During the outbreak in 2021, there was a significant rise in excess fatalities, especially in the older age groups. The increase in mortality was higher in men than in women.

Mortality Rates and Excess Death Rates for the Seriously Mentally Ill

2018 ◽  
Vol 47 (4) ◽  
pp. 212-219 ◽  
Author(s):  
Robert J Reynolds ◽  
Steven M Day ◽  
Alan Shafer ◽  
Emilie Becker
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Mortality Rates ◽  
Life Tables ◽  
Death Rates ◽  
Excess Death ◽  
Life Years ◽  
Race Ethnicity ◽  
Summary Measures ◽  
Population Rate

Objectives.—To compute mortality rates and excess death rates for patients with serious mental illness, specific to categories of gender, age and race/ethnicity. Background.—People with serious mental illness are known to be at greatly increased risk of mortality across the lifespan. However, the measures of mortality reported for this high-risk population are typically only summary measures, which do not provide either the mortality rates or excess death rates needed to construct life tables for individuals with serious mental illness. Methods.—Mortality rates were computed by dividing the number of deaths by the amount of life-years lived in strata specific to gender, age and race/ethnicity. Age-specific excess death rates were determined as the difference between the study population rate and the corresponding general population rate in each stratum. To compute excess death rates beyond observed ages in the cohort, a method with documented reliability and validity for chronic medical conditions was used. Results.—For the cohort with mental illness, mortality rates for Black and White females were mostly equal, and consistently greater than those for Hispanic females; excess death rates for females displayed a similar pattern. Among males, mortality rates were highest for Whites, with Hispanics and Blacks close in magnitude at all ages. Excess death rates for males showed more divergence between the categories of race/ethnicity across the age range. Conclusions.—Mortality rates specific to categories of gender, age and race/ethnicity show sufficient differences as to make them the preferred way to construct life tables. This is especially true in contrast to broader summary measures such as risk ratios, standardized incidence rates, or life expectancy.

scholarly journals Characterizing all-cause excess mortality patterns during COVID-19 pandemic in Mexico

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sushma Dahal ◽  
Juan M. Banda ◽  
Ana I. Bento ◽  
Kenji Mizumoto ◽  
Gerardo Chowell
Keyword(s):  
Mortality Rate ◽  
Excess Mortality ◽  
Geographic Region ◽  
Logistic Growth ◽  
Excess Death ◽  
Mortality Burden ◽  
Media Interaction ◽  
Logistic Growth Model ◽  
Mortality Rate Ratio ◽  
Excess Deaths

Abstract Background Low testing rates and delays in reporting hinder the estimation of the mortality burden associated with the COVID-19 pandemic. During a public health emergency, estimating all cause excess deaths above an expected level of death can provide a more reliable picture of the mortality burden. Here, we aim to estimate the absolute and relative mortality impact of COVID-19 pandemic in Mexico. Methods We obtained weekly mortality time series due to all causes for Mexico, and by gender, and geographic region from 2015 to 2020. We also compiled surveillance data on COVID-19 cases and deaths to assess the timing and intensity of the pandemic and assembled weekly series of the proportion of tweets about ‘death’ from Mexico to assess the correlation between people’s media interaction about ‘death’ and the rise in pandemic deaths. We estimated all-cause excess mortality rates and mortality rate ratio increase over baseline by fitting Serfling regression models and forecasted the total excess deaths for Mexico for the first 4 weeks of 2021 using the generalized logistic growth model. Results We estimated the all-cause excess mortality rate associated with the COVID-19 pandemic in Mexico in 2020 at 26.10 per 10,000 population, which corresponds to 333,538 excess deaths. Males had about 2-fold higher excess mortality rate (33.99) compared to females (18.53). Mexico City reported the highest excess death rate (63.54) and RR (2.09) compared to rest of the country (excess rate = 23.25, RR = 1.62). While COVID-19 deaths accounted for only 38.64% of total excess deaths in Mexico, our forecast estimate that Mexico has accumulated a total of ~ 61,610 [95% PI: 60,003, 63,216] excess deaths in the first 4 weeks of 2021. Proportion of tweets was significantly correlated with the excess mortality (ρ = 0.508 [95% CI: 0.245, 0.701], p-value = 0.0004). Conclusion The COVID-19 pandemic has heavily affected Mexico. The lab-confirmed COVID-19 deaths accounted for only 38.64% of total all cause excess deaths (333,538) in Mexico in 2020. This reflects either the effect of low testing rates in Mexico, or the surge in number of deaths due to other causes during the pandemic. A model-based forecast indicates that an average of 61,610 excess deaths have occurred in January 2021.

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