Cause-specific mortality in Spain during the pandemic: educational differences and its impact on life expectancy.

BACKGROUND: Life expectancy in Spain fell by 1 year between 2018/19 and 2020. Yet, little is known on the impact on cause-of-death (COD) dynamics and educational inequalities therein. METHODS: We use individual-level death counts data by age, sex, education and multiple causes of death (MCOD) and the corresponding population exposures from national registers in Spain. Deaths were examined both as underlying cause of death (UCOD) and as contributory cause. We estimated life expectancies and lifespan inequalities by subpopulation groups and decomposed life expectancy differences between 2018/19 and 2020 by age groups and COD to assess the impact of COVID-19 (as MCOD) and major UCOD. RESULTS: COVID-19 contributed to a decline in male and female life expectancy in Spain between 2018/19 and 2020 (respectively, -1.7 and -1.4 years). Conversely, cancer, respiratory and circulatory system diseases and ill-defined causes as UCOD contributed to life expectancy increases. Life expectancy declines equalled -1.4 years among the low-educated in both sexes (population 30+), -1.0 and -0.7 years among middle-educated and -1.1 and -0.9 years among high-educated men and women. Without COVID-19, educational inequalities in life expectancy would have remained at similar levels, whereas lifespan variation would have been lower (-22% for women and -8% for men). CONCLUSIONS: Life expectancy declines in Spain in 2020 were mainly driven by COVID-19, with possible substitution effects, especially for respiratory system diseases (fewer deaths compared to 2018/19 when coded as UCOD but more as contributing cause). We therefore advocate analysing MCOD when studying changing COD patterns during the pandemic.

The impact of Covid-19 on demographic components in Spain, 2020-31: A scenario approach.

While considerable attention has been paid to the impact of Covid-19 on mortality and fertility, few studies have attempted to evaluate the pandemic's effect on international migration. We analyse the impact of Covid-19 on births, deaths, and international migration in Spain during 2020, comparing observed data with estimated values assuming there had been no pandemic. We also assess the consequences of three post-pandemic scenarios on the size and structure of the population to 2031. Results show that in 2020, excess mortality equalled 16.2 per cent and births were 6.5 per cent lower than expected. Immigration was the most affected component, at 36.0 per cent lower than expected, while emigration was reduced by 23.8 per cent. If net migration values recover to pre-pandemic levels in 2022, the size and structure of the population in 2031 will be barely affected. Conversely, if levels do not recover until 2025, there will be important changes to Spain's age structure.

Sociodemographic determinants of intraurban variations in COVID-19 incidence: the case of Barcelona.

BACKGROUND: Intraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography. METHODS: This cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables. RESULTS: Neighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index. CONCLUSION: Like other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.

The influence of social and economic ties to the spread of COVID-19 in Europe.

By late January 2020, the 2019 novel coronavirus (SARS-CoV-2) had reached Europe and most European countries had registered cases by March 1. However, the spread of the virus has been uneven in both prevalence and speed of propagation. We analyse the association of social, economic, and demographic factors in the initial spread of the coronavirus disease COVID-19 across 23 European countries between March 1 and April 30, 2020. Diagnosed COVID-19 cases from Johns Hopkins University and data from the European Social Survey and other sources were used to estimate bivariate associations between cumulative reported case numbers at ten-day intervals and nine social, demographic, and economic variables. To avoid overfitting, we first reduce these variables to three factors by factor analysis before conducting a multiple regression analysis. We also perform a sensitivity analysis using rates and new cases between two time periods. Results showed that social and economic factors are strongly and positively associated with COVID-19 throughout the studied period, while the association with population density and cultural factors was initially low, but by April, was higher than the earlier mentioned factors. For future influenza-like pandemics, implementing strict movement restrictions from early on will be crucial to curb the spread of such diseases in economically, socially, and culturally vibrant and densely populated countries. Supplementary Information: The online version contains supplementary material available at 10.1007/s12546-021-09257-1.