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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-294139

ABSTRACT

We study the determinants of individual aversion to health and income inequality in three European countries and the effects of exposure to COVID-19 including the effect employment, income and health shocks using representative samples of the population in each country. Comparing levels of health- and income-inequality aversion in the UK between the years 2016 and 2020 we find a significant increase in inequality aversion in both income and health domains. Inequality aversion is higher in the income domain than in the health domain and inequality aversion in both income and health domains is increasing in age and education and decreasing in income and risk appetite. However, people directly exposed to major health shocks during the COVID-19 pandemic generally exhibited lower levels of aversion to both income and health inequality. But for those at high risk of COVID-19 mortality who experienced major health shocks during the pandemic, inequality aversion was significantly higher than for those of similar individuals experiencing a health shock prior to the pandemic.

4.
Lancet ; 397(10288): 1992-2011, 2021 05 22.
Article in English | MEDLINE | ID: covidwho-1218908

ABSTRACT

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.


Subject(s)
Health Policy , Health Workforce/statistics & numerical data , State Medicine/statistics & numerical data , COVID-19/psychology , Health Occupations/economics , Health Occupations/education , Health Workforce/economics , Humans , Occupational Stress , Personnel Selection , State Medicine/economics , United Kingdom
6.
J R Soc Med ; 114(4): 182-211, 2021 04.
Article in English | MEDLINE | ID: covidwho-1148193

ABSTRACT

OBJECTIVE: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. DESIGN: Causal mediation analysis. SETTING: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). PARTICIPANTS: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). MAIN OUTCOME MEASURES: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. RESULTS: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. CONCLUSION: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.


Subject(s)
COVID-19 , Family Characteristics/ethnology , Housing , Mortality/ethnology , Residence Characteristics/statistics & numerical data , Age Factors , Aged , COVID-19/mortality , COVID-19/prevention & control , Child , England/epidemiology , Family , Female , Health Status Disparities , Housing/standards , Housing/statistics & numerical data , Humans , Male , Risk Assessment , SARS-CoV-2 , Sex Factors , Socioeconomic Factors
7.
J Epidemiol Community Health ; 75(3): 213-223, 2021 03.
Article in English | MEDLINE | ID: covidwho-873569

ABSTRACT

BACKGROUND: Deaths during the COVID-19 pandemic result directly from infection and exacerbation of other diseases and indirectly from deferment of care for other conditions, and are socially and geographically patterned. We quantified excess mortality in regions of England and Wales during the pandemic, for all causes and for non-COVID-19-associated deaths. METHODS: Weekly mortality data for 1 January 2010 to 1 May 2020 for England and Wales were obtained from the Office of National Statistics. Mean-dispersion negative binomial regressions were used to model death counts based on pre-pandemic trends and exponentiated linear predictions were subtracted from: (i) all-cause deaths and (ii) all-cause deaths minus COVID-19 related deaths for the pandemic period (week starting 7 March, to week ending 8 May). FINDINGS: Between 7 March and 8 May 2020, there were 47 243 (95% CI: 46 671 to 47 815) excess deaths in England and Wales, of which 9948 (95% CI: 9376 to 10 520) were not associated with COVID-19. Overall excess mortality rates varied from 49 per 100 000 (95% CI: 49 to 50) in the South West to 102 per 100 000 (95% CI: 102 to 103) in London. Non-COVID-19 associated excess mortality rates ranged from -1 per 100 000 (95% CI: -1 to 0) in Wales (ie, mortality rates were no higher than expected) to 26 per 100 000 (95% CI: 25 to 26) in the West Midlands. INTERPRETATION: The COVID-19 pandemic has had markedly different impacts on the regions of England and Wales, both for deaths directly attributable to COVID-19 infection and for deaths resulting from the national public health response.


Subject(s)
COVID-19/epidemiology , Mortality/trends , Pandemics , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Causality , Cause of Death , Child , Child, Preschool , England , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Wales/epidemiology , Young Adult
8.
Mayo Clin Proc ; 95(10): 2110-2124, 2020 10.
Article in English | MEDLINE | ID: covidwho-664771

ABSTRACT

OBJECTIVE: To address the issue of limited national data on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. PATIENTS AND METHODS: All adult (≥18 years) deaths recorded in England and Wales (March 1, 2020, to May 12, 2020) were analyzed retrospectively. We compared the prevalence of underlying health conditions between COVID and non-COVID-related deaths during the COVID-19 pandemic and the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group. RESULTS: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID deaths. Women represented 43.2% (n=15,731) of COVID deaths compared with 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger than non-COVID deaths (82 vs 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30 and 79 years. A linear relationship was observed between ASMR and age among COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease, and diabetes, and these were higher among COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. CONCLUSION: In a nationwide analysis, COVID-19 infection was associated with higher age-standardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.


Subject(s)
Betacoronavirus , Coronavirus Infections/mortality , Healthcare Disparities/statistics & numerical data , Hospital Mortality/trends , Pneumonia, Viral/mortality , Adult , Age Distribution , Age Factors , Aged , COVID-19 , Cause of Death , England/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Sex Distribution , Socioeconomic Factors , Wales/epidemiology
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