[Syndemic Pandemic in Portugal: Social Inequality in Risk Factors Associated With COVID-19 Mortality]. / Pandemia Sindémica em Portugal: Desigualdade Social nos Fatores de Risco Associados à Mortalidade por COVID-19.

INTRODUCTION: International evidence has unveiled the existence of social inequalities in the risk of death associated with SARS-CoV-2 (COVID-19). In Portugal, the impossibility to identify the socioeconomic condition of deceased people hinders this evaluation. This study analyzes the social inequalities in the risk factors of COVID-19 mortality in Portugal. MATERIAL AND METHODS: We used data from the sixth National Health Survey, carried out between September 2019 and December 2019, for the subgroup of people aged between 25 and 79 years old (n = 12 052). We considered the comorbidities with demonstrated link to COVID-19 mortality: asthma, chronic bronchitis, cardiovascular (CVD) and cerebrovascular disease, diabetes, hypertension, chronic renal disease (CRD), and obesity. The inequality, stratified by sex, was measured in terms of education and income, using logistic regression (odds ratios and relative index of inequality). RESULTS: Compared to men with the lowest level of formal education, we measured a risk reduction, among men with tertiary education, of CVD (-90%), chronic bronchitis (-75%), stroke (-70%), diabetes (-62%), hypertension (-41%), and obesity (-43%). Among tertiaryeducated women, we observed a reduced risk of CRD (-77%), hypertension, diabetes, stroke (-70%), obesity (-64%), and CVD (-55%). Except for obesity among men, the risk of disease was always significantly lower in the highest income quintile, compared with the lowest. CONCLUSION: In 2019, we observed socioeconomic inequalities of high magnitude for the eight diseases with demonstrated link to COVID-19 mortality.

Introdução: A evidência internacional tem demonstrado desigualdades sociais no risco de morte por SARS-CoV-2 (COVID-19). Em Portugal, a impossibilidade de identificar a condição socioeconómica dos indivíduos falecidos impede esta medição. Este estudo analisa as desigualdades sociais nos fatores de risco de morte por COVID-19 em Portugal. Material e Métodos: Foram utilizados dados do sexto Inquérito Nacional de Saúde, conduzido entre setembro e dezembro de 2019, para pessoas entre 25 e 79 anos (n = 12 052). Foram consideradas as morbilidades com ligação demonstrada à morte por COVID-19: asma, bronquite crónica, doenças cardiovasculares (DCV) e cerebrovasculares (AVC), diabetes, hipertensão, doença renal crónica (DRC) e obesidade. A desigualdade, estratificada por sexo, foi medida em termos de educação e rendimento, através de regressões logísticas (odds ratios e índice relativo de desigualdade).Resultados: Em comparação com os homens com o nível de educação mais baixo, foi medido um risco inferior, para os homens com educação terciária, de DCV (-90%), bronquite crónica (-75%), AVC (-70%), diabetes (-62%), hipertensão (-41%) e obesidade (-43%). Nas mulheres com educação terciária, foi observada uma redução de risco de DRC (-77%), hipertensão, diabetes e AVC (-70%), obesidade (-64%) e DCV (-55%). Exceto no caso da obesidade nos homens, o risco de doença foi sempre estatisticamente inferior no quinto quintil de rendimento, comparado com o primeiro. Conclusão: Existiam, em 2019, desigualdades socioeconómicas de grande magnitude para oito doenças cuja ligação à mortalidade por COVID-19 foi amplamente identificada.

How do European Mature Adults and Elderly Perceive SARS-COV-2 and Associated Control Measures? A Cross-Country Analysis of Mental Health Symptoms in June and July 2020.

Objectives: Recent literature points out that elderly people are psychologically resilient to COVID-19, but the studies were performed in specific contexts. We measured the link between the worsening of mental health symptoms, the epidemiologic situation, and control measures among European people aged 50 or older. Methods: We used data from the 2020 wave of SHARE, merged with Oxford COVID-19 Government Response Tracker data (n = 38,358). We modeled the risk of worsening of depression, anxiety, sleeping trouble, and loneliness symptoms' self-perception, as functions of control measures and 7-days death incidence, using logistic regressions. Results: The worsening of anxiety and depression perception were more common (16.2 and 23.1%, respectively), compared to that of sleeping troubles and loneliness (8.1 and 11.5%, respectively). The worsening of depression and anxiety perception was negatively related to the rigor of control measures. The seven-days death incidence was positively linked to all symptoms except sleeping troubles. Conclusion: Older people were the most exposed to death risk and were affected psychologically by the COVID-19 epidemiological situation; yet control measures were protective (or neutral) to their mental health condition.

How do European Mature Adults and Elderly Perceive SARS-COV-2 and Associated Control Measures? A Cross-Country Analysis of Mental Health Symptoms in June and July 2020

Objectives: Recent literature points out that elderly people are psychologically resilient to COVID-19, but the studies were performed in specific contexts. We measured the link between the worsening of mental health symptoms, the epidemiologic situation, and control measures among European people aged 50 or older. Methods: We used data from the 2020 wave of SHARE, merged with Oxford COVID-19 Government Response Tracker data (n = 38,358). We modeled the risk of worsening of depression, anxiety, sleeping trouble, and loneliness symptoms’ self-perception, as functions of control measures and 7-days death incidence, using logistic regressions. Results: The worsening of anxiety and depression perception were more common (16.2 and 23.1%, respectively), compared to that of sleeping troubles and loneliness (8.1 and 11.5%, respectively). The worsening of depression and anxiety perception was negatively related to the rigor of control measures. The seven-days death incidence was positively linked to all symptoms except sleeping troubles. Conclusion: Older people were the most exposed to death risk and were affected psychologically by the COVID-19 epidemiological situation;yet control measures were protective (or neutral) to their mental health condition.

Does working at home compromise mental health? A study on European mature adults in COVID times.

INTRODUCTION: The COVID-19 pandemic has transformed working at home (WAH) into the exclusive mode of working for many European workers. Although WAH will likely remain after COVID-19, its consequences on workers' health are unclear. This study examines the association of WAH and the change of four mental health (MH) domains. METHODS: We used data from the last wave of the Survey on Health, Aging, and Retirement in Europe, collected in June and July 2020 on European people aged 50 and older. We restricted our analysis to people aged 50-65 who were working before COVID-19 (N = 7065). We modeled the risk of worsening of depression and anxiety feelings, sleeping trouble, and feelings of loneliness as a function of the working situation (usual setting, at home and usual setting, at home only), using logistic regressions. A first model adjusted for sociodemographic variables, a second one adding country fixed effects, and the last one adding the stringency of COVID-19-related restrictions. RESULTS: WAH was significantly associated with a worsening of all MH symptoms. Nevertheless, when the stringency index was factored in, no significant association of WAH was found with any of the health outcomes except for anxiety feelings (+4.3% points). However, the increased anxiety feelings among people in WAH were not greater than the one observed among nonworkers. DISCUSSION: Our findings show that WAH was not a major cause of mental health deterioration among European mature adults during the first month of the pandemic. Further evidence is needed on WAH under post-COVID-19 "normal" circumstances.