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PLoS Med ; 19(2): e1003904, 2022 02.
Article in English | MEDLINE | ID: covidwho-1686090


BACKGROUND: Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. METHODS AND FINDINGS: We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. CONCLUSIONS: In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.

COVID-19/mortality , Adult , Aged , Cardiovascular Diseases/mortality , Cause of Death , Diabetes Mellitus/mortality , England/epidemiology , Female , Health Status Disparities , Humans , Interrupted Time Series Analysis , Life Expectancy , Male , Middle Aged , Neoplasms/mortality , Residence Characteristics , Respiratory Tract Diseases/mortality , Socioeconomic Factors , Wales/epidemiology
Can J Cardiol ; 37(10): 1502-1503, 2021 10.
Article in English | MEDLINE | ID: covidwho-1439941

COVID-19 , Humans , SARS-CoV-2
Lancet Reg Health Eur ; 7: 100144, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1260817


BACKGROUND: Excess deaths during the COVID-19 pandemic compared with those expected from historical trends have been unequally distributed, both geographically and socioeconomically. Not all excess deaths have been directly related to COVID-19 infection. We investigated geographical and socioeconomic patterns in excess deaths for major groups of underlying causes during the pandemic. METHODS: Weekly mortality data from 27/12/2014 to 2/10/2020 for England and Wales were obtained from the Office of National Statistics. Negative binomial regressions were used to model death counts based on pre-pandemic trends for deaths caused directly by COVID-19 (and other respiratory causes) and those caused indirectly by it (cardiovascular disease or diabetes, cancers, and all other indirect causes) over the first 30 weeks of the pandemic (7/3/2020-2/10/2020). FINDINGS: There were 62,321 (95% CI: 58,849 to 65,793) excess deaths in England and Wales in the first 30 weeks of the pandemic. Of these, 46,221 (95% CI: 45,439 to 47,003) were attributable to respiratory causes, including COVID-19, and 16,100 (95% CI: 13,410 to 18,790) to other causes. Rates of all-cause excess mortality ranged from 78 per 100,000 in the South West of England and in Wales to 130 per 100,000 in the West Midlands; and from 93 per 100,000 in the most affluent fifth of areas to 124 per 100,000 in the most deprived. The most deprived areas had the highest rates of death attributable to COVID-19 and other indirect deaths, but there was no socioeconomic gradient for excess deaths from cardiovascular disease/diabetes and cancer. INTERPRETATION: During the first 30 weeks of the COVID-19 pandemic there was significant geographic and socioeconomic variation in excess deaths for respiratory causes, but not for cardiovascular disease, diabetes and cancer. Pandemic recovery plans, including vaccination programmes, should take account of individual characteristics including health, socioeconomic status and place of residence. FUNDING: None.

CJC Open ; 3(5): 627-630, 2021 May.
Article in English | MEDLINE | ID: covidwho-1039311


BACKGROUND: The ongoing COVID-19 pandemic has exposed a work-life (im)balance that has been present but not openly discussed in medicine, surgery, and science for decades. The pandemic has exposed inequities in existing institutional structure and policies concerning clinical workload, research productivity, and/or teaching excellence inadvertently privileging those who do not have significant caregiving responsibilities or those who have the resources to pay for their management. METHODS: We sought to identify the challenges facing multidisciplinary faculty and trainees with dependents, and highlight a number of possible strategies to address challenges in work-life (im)balance. RESULTS: To date, there are no Canadian-based data to quantify the physical and mental effect of COVID-19 on health care workers, multidisciplinary faculty, and trainees. As the pandemic evolves, formal strategies should be discussed with an intersectional lens to promote equity in the workforce, including (but not limited to): (1) the inclusion of broad representation (including equal representation of women and other marginalized persons) in institutional-based pandemic response and recovery planning and decision-making; (2) an evaluation (eg, institutional-led survey) of the effect of the pandemic on work-life balance; (3) the establishment of formal dialogue (eg, workshops, training, and media campaigns) to normalize coexistence of work and caregiving responsibilities and to remove stigma of gender roles; (4) a reevaluation of workload and promotion reviews; and (5) the development of formal mentorship programs to support faculty and trainees. CONCLUSIONS: We believe that a multistrategy approach needs to be considered by stakeholders (including policy-makers, institutions, and individuals) to create sustainable working conditions during and beyond this pandemic.

CONTEXTE: La pandémie de COVID-19 a mis en lumière le déséquilibre entre travail et vie personnelle qui règne depuis des décennies dans les milieux de la médecine, de la chirurgie et des sciences, mais dont on ne parlait pas ouvertement. La pandémie a en effet mis au jour des iniquités dans la structure et les politiques des établissements en matière de charge de travail clinique, de productivité de la recherche et d'excellence en enseignement, qui favorisent par inadvertance les personnes qui n'ont pas de responsabilités familiales importantes ou qui ont les ressources nécessaires pour leur prise en charge. MÉTHODOLOGIE: Nous avons tenté de cerner les difficultés auxquelles font face les enseignants multidisciplinaires et les stagiaires ayant des personnes à charge, et nous proposons un certain nombre de stratégies possibles pour faciliter la conciliation travail-vie personnelle. RÉSULTATS: À ce jour, il n'existe pas de données canadiennes permettant de quantifier les répercussions physiques et mentales de la pandémie de COVID-19 sur les travailleurs de la santé, les enseignants multidisciplinaires et les stagiaires. Au fil de l'évolution de la pandémie, il conviendrait de formuler des stratégies officielles à la lumière des commentaires d'intervenants des différents secteurs concernés, afin de promouvoir l'équilibre au sein des effectifs; ces stratégies pourraient notamment inclure ce qui suit (sans toutefois s'y limiter) : 1) l'inclusion d'une vaste représentation (y compris une représentation égale des femmes et des autres personnes marginalisées) pour la réponse à la pandémie dans les établissements, la planification du rétablissement et la prise de décisions; 2) une évaluation (p. ex. au moyen d'un sondage mené sous la direction des établissements) des répercussions de la pandémie sur la conciliation travail-vie personnelle; 3) l'établissement d'un dialogue formel (p. ex. ateliers, activités de formation et campagnes dans les médias) afin de normaliser la coexistence des responsabilités professionnelles et familiales et d'éliminer la stigmatisation associée aux rôles des sexes; 4) une réévaluation de la charge de travail et des promotions; et 5) la mise sur pied de programmes formels de mentorat pour soutenir les enseignants et les stagiaires. CONCLUSIONS: Nous croyons que les intervenants (décideurs, établissements et personnes) devraient envisager une approche multistratégie afin d'instaurer des conditions de travail viables pendant la pandémie et par la suite.