COVID-19 and excess mortality: Was it possible to lower the number of deaths in Slovenia?

This paper presents new data on the age structure of hospitalised SARI (severe acute respiratory infection) patients, with or without COVID-19, broken down by gender, place of infection, and region. The leading hypothesis that COVID-19 deaths are overestimated despite the high share of excess deaths was confirmed, bringing to light the important issue of the demographic breakdown of the population at risk. Thus, the main reason for the decreasing number of COVID-19 deaths is to be sought within the exhausted demographic pool of the elderly population in 2020, when the mortality rate was 19% higher compared to the previous five-year period (2015-2019). Demographic disparities across regions are immense and statistically explain the differences in the ?infected versus deceased? ratio. The excess mortality in 2020 was unusually high, but the projected value for 2020 based on the mortality pattern across age groups from 2015 to 2019 contributed up to one-third of the surplus. So, for one-quarter of alleged COVID-19 deaths (roughly 600 out of some 3,300 in 2020), death was expected to take place in 2020 anyway.

Download Full-text

Insights Into Excess Mortality During the First Months of the COVID-19 Pandemic From a Rural, Demographic Surveillance Site in Bangladesh

Frontiers in Public Health ◽

10.3389/fpubh.2021.622379 ◽

2021 ◽

Vol 9 ◽

Author(s):

Syed Manzoor Ahmed Hanifi ◽

Sayed Saidul Alam ◽

Sanjida Siddiqua Shuma ◽

Daniel D. Reidpath

Keyword(s):

Mortality Rate ◽

Rural Area ◽

Elderly Population ◽

Excess Mortality ◽

The Elderly ◽

Community Level ◽

Mortality Estimation ◽

False Result ◽

The Government ◽

Excess Deaths

Background: Coronavirus disease 2019 (COVID-19) has spread globally, and the government of each affected country is publishing the number of deaths every day. This official figure is an underestimate as it excludes anybody who did not die in a hospital, who did not test positive, who had a false result, or those who recovered on their own without a test.Objective: This study aimed to measure the community level excess mortality using health and demographic surveillance in a rural area of Bangladesh.Method: The study was conducted in Matlab, in a rural area of Bangladesh, with a Health and Demographic Surveillance System (HDSS) covering a population of 239,030 individuals living in 54,823 households in 142 villages. We examined the mortality in January-April from 2015 to 2020 and compared the mortality in 2020 with the historical trend of 2015–2019. Between 2015 and 2020, we followed 276,868 people until migration or death, whichever occurred first. We analyzed mortality using crude mortality rate ratio (MRR) and adjusted MRR (aMRR) from a Cox proportional hazard model. Mortality was analyzed according to age, sex, and period.Results: During follow-up, 3,197 people died. The mortality rate per 1,000 person-years increased from 10 in 2019 to 12 in 2020. Excess mortality was observed among the elderly population (aged 65 years and above). The elderly mortality rate per 1,000 person-years increased from 80 in 2019 to 110 in 2020, and the aMRR was 1.40 (95% CI: 1.19–1.64). Although an increasing tendency in mortality was observed between 2015 and 2019, it was statistically insignificant.Conclusions: The study reported a 28% increase in excess deaths among the elderly population during the first months of the pandemic. This all-cause mortality estimation at the community level will urge policymakers, public health professionals, and researchers to further investigate the causes of death and the underlying reasons for excess deaths in the older age-group.

Download Full-text

Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis (Preprint)

10.2196/preprints.32559 ◽

2021 ◽

Author(s):

Yousef Khader ◽

Mohannad Al Nsour

Keyword(s):

Generalized Linear Models ◽

Excess Mortality ◽

Linear Models ◽

Age Groups ◽

Secondary Data ◽

The Elderly ◽

Standardized Mortality Ratio ◽

Mortality Ratio ◽

Health Database ◽

Excess Deaths

BACKGROUND All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. OBJECTIVE This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. METHODS Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. RESULTS Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (<i>P</i><.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. CONCLUSIONS The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.

Download Full-text

COVID-19 symptoms-does pregnancy alter the course of the disease

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205243 ◽

2020 ◽

Vol 9 (12) ◽

pp. 5032

Author(s):

Sabnam S. Nambiar ◽

Reshmi V. P. ◽

Ajith S.

Keyword(s):

Pregnant Women ◽

Sore Throat ◽

Acute Respiratory Infection ◽

Age Groups ◽

The Elderly ◽

Nasopharyngeal Swab ◽

Severe Acute Respiratory Infection ◽

The World ◽

Immunocompromised State ◽

Period Of Gestation

Background: COVID-19 or corona virus 2 is a widespread pandemic taking a huge toll on the world population.it has a varied presentation in different age groups. Similarly, it has a poorer outcome in the elderly with various comorbidities and those who are immunocompromised. Though pregnancy is a relatively immunocompromised state studies have found that pregnant women have a less severe presentation. We have tried to assess this aspect of COVID-19 in pregnant women.Methods: We evaluated the records of 158 pregnant women who presented to our hospital from April 2020 till September 2020.Their symptoms at presentation were evaluated. we also noted the outcome of these pregnancies.Results: 16% of these were more than 34 weeks of period of gestation. 65.19% presented without any symptoms. 15.19% presented with fever. 10.75% presented with cough. 8.22% presented with headache. 5.69% presented with sore throat alone. 3.16% presented with breathlessness. 0.63% presented with anosmia alone, loss of taste, severe acute respiratory infection, vomiting, sore throat and breathlessness respectively. 54 patients delivered of which 7 delivered vaginally and there were 47 caesareans. Remaining patients after cure were discharged. There were 3 miscarriages. Two babies were found to be COVID-19 positive from nasopharyngeal swab taken on day 1, however this was a small number to indicate vertical transmission.Conclusion: Our study showed that a large proportion of pregnant patients presented without symptoms.it remains to be evaluated why this is so.it may provide us with clues on how to deal with disease in the general population.

Download Full-text

Moves into Supported Private Households among Elderly People in England and Wales

Environment and Planning A Economy and Space ◽

10.1068/a251467 ◽

1993 ◽

Vol 25 (10) ◽

pp. 1467-1479 ◽

Cited By ~ 8

Author(s):

E M D Grundy

Keyword(s):

Longitudinal Study ◽

Mortality Rate ◽

Elderly People ◽

Elderly Population ◽

Local Authority ◽

Age Groups ◽

The Elderly ◽

Geographic Mobility ◽

Never Married ◽

Private Households

Data from the Longitudinal Study (LS) of the Office of Population Censuses and Surveys have been used to examine differentials in the proportion of elderly people living in ‘independent’ households (alone or with only a spouse) in 1971 but in ‘supported’ households (with relatives or friends) ten years later. Overall, 6% of men and 8% of women aged 65 years or over in 1971 and then in independent households were by 1981 living in a supported private household, slightly higher than the proportion who had moved into institutions. Children predominated among the coresidents of elderly people in supported households. Rates of transition to supported private households were higher in older age-groups, higher among the widowed than the currently or never-married, and, in general, higher for owner-occupiers and private renters than for local authority tenants. Elderly people living in Wales in 1971 were more likely to be in supported households ten years later than their counterparts in England. Transitions to supported households were strongly associated with geographic mobility. Among elderly people aged 75 years or over and in independent households in 1971 over half of those living at a different address in 1981 were by then in supported private households or institutions. LS members who moved from independent to supported private households between 1971 and 1981 had an elevated mortality rate, observed over the period 1981–85. However, the mortality of those who had moved to institutions was even higher, suggesting that in terms of health status the elderly population living with relatives is not equivalent to the institutional population.

Download Full-text

Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis

JMIR Public Health and Surveillance ◽

10.2196/32559 ◽

2021 ◽

Vol 7 (10) ◽

pp. e32559

Author(s):

Yousef Khader ◽

Mohannad Al Nsour

Keyword(s):

Generalized Linear Models ◽

Excess Mortality ◽

Linear Models ◽

Age Groups ◽

Secondary Data ◽

The Elderly ◽

Standardized Mortality Ratio ◽

Mortality Ratio ◽

Health Database ◽

Excess Deaths

Background All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. Objective This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. Methods Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. Results Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. Conclusions The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.

Download Full-text

Estimation of Excess Mortality and Years of Life Lost to COVID-19 in Norway and Sweden between March and November 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083913 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3913

Author(s):

Martin Rypdal ◽

Kristoffer Rypdal ◽

Ola Løvsletten ◽

Sigrunn Holbek Sørbye ◽

Elinor Ytterstad ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

Years Of Life Lost ◽

Regressive Model ◽

Epidemic Period ◽

All Cause Mortality ◽

Auto Regressive ◽

Expected Mortality ◽

Auto Regressive Model ◽

Excess Deaths

We estimate the weekly excess all-cause mortality in Norway and Sweden, the years of life lost (YLL) attributed to COVID-19 in Sweden, and the significance of mortality displacement. We computed the expected mortality by taking into account the declining trend and the seasonality in mortality in the two countries over the past 20 years. From the excess mortality in Sweden in 2019/20, we estimated the YLL attributed to COVID-19 using the life expectancy in different age groups. We adjusted this estimate for possible displacement using an auto-regressive model for the year-to-year variations in excess mortality. We found that excess all-cause mortality over the epidemic year, July 2019 to July 2020, was 517 (95%CI = (12, 1074)) in Norway and 4329 [3331, 5325] in Sweden. There were 255 COVID-19 related deaths reported in Norway, and 5741 in Sweden, that year. During the epidemic period of 11 March–11 November, there were 6247 reported COVID-19 deaths and 5517 (4701, 6330) excess deaths in Sweden. We estimated that the number of YLL attributed to COVID-19 in Sweden was 45,850 [13,915, 80,276] without adjusting for mortality displacement and 43,073 (12,160, 85,451) after adjusting for the displacement accounted for by the auto-regressive model. In conclusion, we find good agreement between officially recorded COVID-19 related deaths and all-cause excess deaths in both countries during the first epidemic wave and no significant mortality displacement that can explain those deaths.

Download Full-text

Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

Microbiology Insights ◽

10.1177/1178636120988604 ◽

2021 ◽

Vol 14 ◽

pp. 117863612098860

Author(s):

Vishal Shah

Keyword(s):

Respiratory System ◽

Elderly Population ◽

Age Groups ◽

The Elderly ◽

Elderly Adult ◽

Human Respiratory Tract ◽

System A ◽

Number Of Patients ◽

Children And Young Adults ◽

Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

Download Full-text

Mortality due to respiratory diseases in the elderly after influenza vaccination campaigns in the Federal District, Brazil, 1996-2009

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132013000200011 ◽

2013 ◽

Vol 39 (2) ◽

pp. 198-204 ◽

Cited By ~ 2

Author(s):

Francisca Magalhães Scoralick ◽

Luciana Paganini Piazzolla ◽

Liana Laura Pires ◽

Cleudsom Neri ◽

Wladimir Kummer de Paula

Keyword(s):

Mortality Rate ◽

Influenza Vaccination ◽

Respiratory Diseases ◽

Positive Impact ◽

Vaccination Campaign ◽

Age Groups ◽

Federal District ◽

The Elderly ◽

Analysis Data ◽

Proportional Mortality

OBJECTIVE: To compare mortality rates due to respiratory diseases among elderly individuals residing in the Federal District of Brasília, Brazil, prior to and after the implementation of a national influenza vaccination campaign. METHODS: This was an ecological time series analysis. Data regarding the population of individuals who were over 60 years of age between 1996 and 2009 were obtained from official databases. The variables of interest were the crude mortality rate (CMR), the mortality rate due to the respiratory disease (MRRD), and the proportional mortality ratio (PMR) for respiratory diseases. We performed a qualitative analysis of the data for the period prior to and after the implementation of the vaccination campaign (1996-1999 and 2000-2009, respectively). RESULTS: The CMR increased with advancing age. Over the course of the study period, we observed reductions in the CMR in all of the age brackets studied, particularly among those aged 80 years or older. Reductions in the MRRD were also found in all of the age groups, especially in those aged 80 years or older. In addition, there was a decrease in the PMR for respiratory diseases in all age groups throughout the study period. The most pronounced decrease in the PMR for respiratory diseases in the ≥ 70 year age bracket occurred in 2000 (immediately following the implementation of the national vaccination campaign); in 2001, that rate increased in all age groups, despite the greater adherence to the vaccination campaign in comparison with that recorded for 2000. CONCLUSIONS: Influenza vaccination appears to have a positive impact on the prevention of mortality due to respiratory diseases, particularly in the population aged 70 or over.

Download Full-text

Excess mortality in Guadeloupe and Martinique, islands of the French West Indies, during the chikungunya epidemic of 2014

Epidemiology and Infection ◽

10.1017/s0950268818002315 ◽

2018 ◽

Vol 146 (16) ◽

pp. 2059-2065 ◽

Cited By ~ 10

Author(s):

A. R. R. Freitas ◽

P. M. Alarcón-Elbal ◽

M. R. Donalisio

Keyword(s):

Strong Correlation ◽

Excess Mortality ◽

Pearson Correlation ◽

Age Groups ◽

Epidemiological Data ◽

Mortality Data ◽

Surveillance Systems ◽

Mortality And Morbidity ◽

The Impact ◽

Excess Deaths

AbstractIn some chikungunya epidemics, deaths are not completely captured by traditional surveillance systems, which record case and death reports. We evaluated excess deaths associated with the 2014 chikungunya virus (CHIKV) epidemic in Guadeloupe and Martinique, Antilles. Population (784 097 inhabitants) and mortality data, estimated by sex and age, were accessed from the Institut National de la Statistique et des Études Économiques in France. Epidemiological data, cases, hospitalisations and deaths on CHIKV were obtained from the official epidemiological reports of the Cellule de Institut de Veille Sanitaire in France. Excess deaths were calculated as the difference between the expected and observed deaths for all age groups for each month in 2014 and 2015, considering the upper limit of 99% confidence interval. The Pearson correlation coefficient showed a strong correlation between monthly excess deaths and reported cases of chikungunya (R= 0.81,p< 0.005) and with a 1-month lag (R= 0.87,p< 0.001); and a strong correlation was also observed between monthly rates of hospitalisation for CHIKV and excess deaths with a delay of 1 month (R= 0.87,p< 0.0005). The peak of the epidemic occurred in the month with the highest mortality, returning to normal soon after the end of the CHIKV epidemic. There were excess deaths in almost all age groups, and excess mortality rate was higher among the elderly but was similar between male and female individuals. The overall mortality estimated in the current study (639 deaths) was about four times greater than that obtained through death declarations (160 deaths). Although the aetiological diagnosis of all deaths associated with CHIKV infection is not always possible, already well-known statistical tools can contribute to the evaluation of the impact of CHIKV on mortality and morbidity in the different age groups.

Download Full-text

Acceptance and use of communication technology by the elderly (Preprint)

10.2196/preprints.35995 ◽

2021 ◽

Author(s):

Malcolm Clarke ◽

Precious Onyeachu

Keyword(s):

Elderly Population ◽

Population Aging ◽

Age Groups ◽

Smart Phone ◽

The Elderly ◽

Accurate Information ◽

Target Groups ◽

Flu Vaccination ◽

Use Of Technology ◽

Working Age

BACKGROUND Population aging is a global phenomenon, with the proportion of the population over the age of 60 increasingly rapidly. However ownership and use of technology by people in this age group remains low, which impacts on introduction of and the assumptions made for, technology-based activities such as telehealth and telemedicine. It is essential to gain accurate information on the level of technology ownership in target groups. However, many studies on levels of technology ownership and use report using electronic methods for their survey, which introduces bias and may result in a higher value. OBJECTIVE To determine the level of ownership of technology in the elderly population using an unbiased data collection methodology. METHODS Our study collects data from patients invited to attend a clinic for their annual flu vaccination, and thereby captures a cross section of the population that is unbiased by the collection method. 309 patients completed a questionnaire, and were considered in three (3) age groups; young adults (25 to 45) (n=72), working-age (46 to 59) (n=80) and older adults (60 and above) (n=157). RESULTS In the older adult group (60+), 50 people (32%) out of 157 respondents had a mobile or smart phone and 107 (68%) did not; 38 people (24%) out of 157 respondents owned and used a computer and 119 (76%) had never used or owned a computer or tablet CONCLUSIONS Our results show a significantly lower ownership of technology in the elderly than found in other similar studies, which we attribute to the method of collection of the data, and consider to be a true reflection of the ownership in the general population.

Download Full-text