Spatial determinants of excess all-cause mortality during the first wave of the COVID-19 epidemic in France.

BACKGROUND: The first wave of the COVID-19 pandemic in France was associated with high excess mortality, and anecdotal evidence pointed to differing excess mortality patterns depending on social and environmental determinants. In this study we aimed to investigate the spatial distribution of excess mortality during the first wave of the COVID-19 pandemic in France and relate it at the subnational level to contextual determinants from various dimensions (socioeconomic, population density, overall health status, healthcare access etc.). We also explored whether the determinants identified at the national level varied depending on geographical location. METHODS: We used available national data on deaths in France to calculate excess mortality by department for three age groups: 0-49, 50-74 and > 74 yrs. between March 1st and April 27th, 2020. We selected 15 variables at the department level that represent four dimensions that may be related to overall mortality at the ecological level, two representing population-level vulnerabilities (morbidity, social deprivation) and two representing environmental-level vulnerabilities (primary healthcare supply, urbanization). We modelled excess mortality by age group for our contextual variables at the department level. We conducted both a global (i.e., country-wide) analysis and a multiscale geographically weighted regression (MGWR) model to account for the spatial variations in excess mortality. RESULTS: In both age groups, excess all-cause mortality was significantly higher in departments where urbanization was higher (50-74 yrs.: ß = 15.33, p < 0.001; > 74 yrs.: ß = 18.24, p < 0.001) and the supply of primary healthcare providers lower (50-74 yrs.: ß = - 8.10, p < 0.001; > 74 yrs.: ß = - 8.27, p < 0.001). In the 50-74 yrs. age group, excess mortality was negatively associated with the supply of pharmacists (ß = - 3.70, p < 0.02) and positively associated with work-related mobility (ß = 4.62, p < 0.003); in the > 74 yrs. age group our measures of deprivation (ß = 15.46, p < 0.05) and morbidity (ß = 0.79, p < 0.008) were associated with excess mortality. Associations between excess mortality and contextual variables varied significantly across departments for both age groups. CONCLUSIONS: Public health strategies aiming at mitigating the effects of future epidemics should consider all dimensions involved to develop efficient and locally tailored policies within the context of an evolving, socially and spatially complex situation.

COVID-19: An emergency educational model

The current health crisis reminds us of the importance of communicating prevention messages and ensuring that they are understood by the population. If messages on barrier gestures were designed to be easily understood, the fact remains that the transition from information processing to the implementation of health behaviour represents a real challenge. In order to bring about changes in health behaviour to cope with the epidemic, it is imperative to provide "crisis education", coupled with an information strategy, particularly to help the most vulnerable and needy. In this context, the Health Education and Practices Laboratory (LEPSUR3412) of the Sorbonne Paris Nord University has designed a brief educational intervention for people affected by COVID-19. This intervention (30 min to 1 h) is based on three fields of practice: discharge education (ETP-SH), health literacy and identity-housing. The different phases of this intervention are similar to those of the ETP-SH: an educational diagnosis followed by the negotiation of possible applications with the person, a phase of interactive exchanges, the permanent verification of the person's understanding and the planning of a telephone session scheduled at a distance. (PsycInfo Database Record (c) 2020 APA, all rights reserved) Abstract (French) La crise sanitaire actuelle rappelle tout l'enjeu de la communication des messages de prevention et de leur comprehension par la population. Si les messages sur les gestes barrieres ont ete concus pour etre facilement compris, il n'en reste pas moins que le passage du traitement de l'information a la mise en oeuvre d'un comportement de sante represente un veritable defi. Pour obtenir des changements de comportements de sante face a l'epidemie, il est imperatif de proposer une << education d'urgence , couplee a une strategie d'information, en particulier pour aider les personnes les plus vulnerables et demunies. Dans ce contexte, le Laboratoire Educations et Pratiques de Sante (LEPSUR3412) de l'Universite Sorbonne Paris Nord a concu une intervention educative breve pour les personnes concernees par le COVID-19. Cette intervention (30 min a 1 h) s'adosse a trois champs de pratiques : l'education therapeutique de sortie d'hopital dite ETPSH, la litteratie en sante et l'identite-logement. Les differentes phases de cette intervention sont proches de celles de celles de l'ETP-SH : un diagnostic educatif suivi de la negociation des applications possibles avec la personne, une phase d'echanges interactifs, la verification permanente de la comprehension par la personne et la planification d'une seance telephonique planifiee a distance. (PsycInfo Database Record (c) 2020 APA, all rights reserved)