Longitudinal trends (2011-2020) of premature mortality and years of potential life loss (YPLL) and associated covariates of the 62 New York State counties.

BACKGROUND: New York State (NYS) is the 27th largest state and the 4th most populous state in the U.S., with close to 20 million people in 62 counties. Territories with diverse populations present the best opportunity to study health outcomes and associated covariates, and how these differ across different populations and groups. The County Health Ranking and Roadmaps (CHR&R) ranks counties by linking the population's characteristics and health outcomes and contextual factors in a synchronic approach. METHODS: The goal of this study is to analyze the longitudinal trends in NYS counties of age-adjusted premature mortality rate and years of potential life loss rate (YPLL) from 2011-2020 using (CHR&R) data to identify similarities and trends among the counties of the state. This study used a weighted mixed regression model to analyze the longitudinal trend in health outcomes as a function of the time-varying covariates and clustered the 62 counties according to the trend over time in the covariates. RESULTS: Four clusters of counties were identified. Cluster 1, which represents 33 of the 62 counties in NYS, contains the most rural counties and the least racially and ethnically diverse counties. Clusters 2 and 3 mirror each other in most covariates and Cluster 4 is comprised of 3 counties (Bronx, Kings/Brooklyn, Queens) representing the most urban and racial and ethnic diverse counties in the state. CONCLUSION: The analysis clustered counties according to the longitudinal trends of the covariates, and by doing so identified clusters of counties that shared similar trends among the covariates, to later examine trends in the health outcomes through a regression model. The strength of this approach lies in the predictive feature of what is to come for the counties by understanding the covariates and setting prevention goals.

Observed and predicted premature mortality in Australia due to non-communicable diseases: a population-based study examining progress towards the WHO 25X25 goal.

BACKGROUND: The World Health Organization's (WHO) 25X25 goal aims for a 25% relative reduction in premature death due to four non-communicable diseases (NCD4)-cancer, cardiovascular disease, chronic respiratory diseases and diabetes-by 2025 compared to 2010. This study aimed to quantify the premature mortality in the Australian population due to NCD4, quantify the variation in mortality rates by age and sex, predict the premature mortality due to NCD4 in 2025 and evaluate the progress towards the WHO 25X25 goal. METHODS: A population-based study using cause-specific mortality data of all deaths which occurred in Australia from 2010 to 2016 and registered up to 2017, for adults aged 30-69 years, was conducted. Age-specific and age-standardised mortality rates (ASMR) and probability of death for NCD4 were calculated for each year. ASMRs in 2016 were calculated for men and women. Deaths and the probability of death in 2025 were predicted using Poisson regression based on data from 2006 to 2016. To assess the progress against the WHO 25X25 goal, the relative reduction in the probability of death from NCD4 conditions in 2025 compared to 2010 was calculated. RESULTS: ASMRs for NCD4 decreased from 2010 to 2016, except for diabetes which increased on average by 2.5% per year. Across sociodemographic factors, ASMRs were highest in males and increased with age. The projected probability of premature death in 2025 was 7.36%, equivalent to a relative reduction of 25.16% compared to 2010 levels. CONCLUSIONS: Premature mortality due to cancer, cardiovascular disease, respiratory diseases and diabetes declined in Australia from 2010 to 2016. This trend is consistent across age groups and by sex, and higher mortality rates were observed in males and at older ages. Nationally, if the current trends continue, we estimate that Australia will achieve a 25.16% relative reduction in premature deaths due to NCD4 in 2025 compared to 2010, signifying substantial progress towards the WHO 25X25 goal. Concerted efforts will need to continue to meet the 25X25 goal, especially in the context of the COVID-19 pandemic.

Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018-20.

BACKGROUND: Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To rectify this, the Ministry of Health and Sanitation of Sierra Leone launched the Sierra Leone Sample Registration System (SL-SRS) of births and deaths. Here, we report cause-specific mortality from the first SL-SRS round, representing deaths from 2018 to 2020. METHODS: The Countrywide Mortality Surveillance for Action platform established the SL-SRS, which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors, in teams of four or five, enrolled people and ascertained deaths of individuals younger than 70 years in 2019-20, capturing verbal autopsies on deaths from 2018 to 2020. Centrally, two trained physicians independently assigned causes of death according to the International Classification of Diseases (tenth edition). SL-SRS death proportions were applied to 5-year mortality averages from the UN World Population Prospects (2019) to derive cause-specific death totals and risks of death nationally and in four Sierra Leone regions, with comparisons made with the Western region where Freetown, the capital, is located. We compared SL-SRS results with the cause-specific mortality estimates for Sierra Leone in the 2019 WHO Global Health Estimates. FINDINGS: Between Sept 1, 2019, and Dec 15, 2020, we enrolled 343 000 people and ascertained 8374 deaths of individuals younger than 70 years. Malaria was the leading cause of death in children and adults, nationally and in each region, representing 22% of deaths under age 70 years in 2020. Other infectious diseases accounted for an additional 16% of deaths. Overall maternal mortality ratio was 510 deaths per 100 000 livebirths (95% CI 483-538), and neonatal mortality rate was 31·1 deaths per 1000 livebirths (95% CI 30·4-31·8), both among the highest rates in the world. Haemorrhage was the major cause of maternal mortality and birth asphyxia or trauma was the major cause of neonatal mortality. Excess deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. If the Northern, Eastern, and Southern regions of Sierra Leone had the lower death rates observed in the Western region, about 20 000 deaths (just over a quarter of national total deaths in people younger than 70 years) would have been avoided. WHO model-based data vastly underestimated malaria deaths and some specific causes of injury deaths, and substantially overestimated maternal mortality. INTERPRETATION: Over 60% of individuals in Sierra Leone die prematurely, before age 70 years, most from preventable or treatable causes. Nationally representative mortality surveys such as the SL-SRS are of high value in providing reliable cause-of-death information to set public health priorities and target interventions in low-income countries. FUNDING: Bill & Melinda Gates Foundation, Canadian Institutes of Health Research, Queen Elizabeth Scholarship Program.

Inequalities in excess premature mortality in England during the COVID-19 pandemic: a cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity.

OBJECTIVES: To examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity. DESIGN: A statistical model to estimate increased mortality in population subgroups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous 5 years. SETTING: Information on deaths registered in England since 2015 was used, including age, sex, area of residence and cause of death. Ethnicity was obtained from Hospital Episode Statistics records linked to death data. PARTICIPANTS: Population study of England, including all 569 824 deaths from all causes registered between 21 March 2020 and 26 February 2021. MAIN OUTCOME MEASURES: Excess mortality in each subgroup over and above the number expected based on trends in mortality in that group over the previous 5 years. RESULTS: The gradient in excess mortality by area deprivation was greater in the under 75s (the most deprived areas had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the black and Asian groups, all area deprivation quintiles had significantly larger excesses than white groups in the most deprived quintiles and there were no clear gradients across quintiles. Among the white group, only those in the most deprived quintile had more excess deaths than deaths directly involving COVID-19. CONCLUSION: The COVID-19 pandemic has widened inequalities in premature mortality by area deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of area deprivation, and the white group the most deprived areas. Statistics limited to deaths directly involving COVID-19 understate the pandemic's impact on inequalities by area deprivation and ethnic group at younger ages.

Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden.

OBJECTIVE: It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020. METHODS: Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends. RESULTS: Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome. CONCLUSIONS: Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact.

'Trend in premature mortality from four major NCDs in Nanjing, China, 2007-2018'.

BACKGROUND: This study aims to analyze the trends of premature mortality caused from four major non-communicable diseases (NCDs), namely cardiovascular disease (CVD), cancer, chronic respiratory diseases, and diabetes in Nanjing between 2007 and 2018 and project the ability to achieve the "Healthy China 2030" reduction target. METHODS: Mortality data of four major NCDs for the period 2007-2018 were extracted from the Death Information Registration and Management System of Chinese Center for Disease Control and Prevention. Population data for Nanjing were provided by the Nanjing Bureau of Public Security. The premature mortality was calculated using the life table method. Joinpoint regression model was used to estimate the average annual percent changes (AAPC) in mortality trends. RESULTS: From 2007 to 2018, the premature mortality from four major NCDs combined in Nanjing decreased from 15.5 to 9.5%, with the AAPC value at - 4.3% (95% CI [- 5.2% to - 3.4%]). Overall, it can potentially achieve the target, with a relative reduction 28.6%. The premature mortality from cancer, CVD, chronic respiratory diseases and diabetes all decreased, with AAPC values at - 4.2, - 5.0%, - 5.9% and - 1.6% respectively. A relative reduction of 40.6 and 41.2% in females and in rural areas, but only 21.0 and 12.8% in males and in urban areas were projected. CONCLUSION: An integrated approach should be taken focusing on the modifiable risk factors across different sectors and disciplines in Nanjing. The prevention and treatment of cancers, diabetes, male and rural areas NCDs should be enhanced.

Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries.

OBJECTIVE: To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. DESIGN: Time series analysis. SETTING: 37 upper-middle and high income countries or regions with reliable and complete mortality data. PARTICIPANTS: Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex. MAIN OUTCOME MEASURES: Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table. RESULTS: Reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia (men: -2.33, 95% confidence interval -2.50 to -2.17; women: -2.14, -2.25 to -2.03), the United States (men: -2.27, -2.39 to -2.15; women: -1.61, -1.70 to -1.51), Bulgaria (men: -1.96, -2.11 to -1.81; women: -1.37, -1.74 to -1.01), Lithuania (men: -1.83, -2.07 to -1.59; women: -1.21, -1.36 to -1.05), Chile (men: -1.64, -1.97 to -1.32; women: -0.88, -1.28 to -0.50), and Spain (men: -1.35, -1.53 to -1.18; women: -1.13, -1.37 to -0.90). Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730), Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990), Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980), the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550), Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040), and Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240). The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000. CONCLUSION: More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.

The cost of lost productivity due to premature mortality associated with COVID-19: a Pan-European study.

BACKGROUND: Economic cost estimates have the potential to provide a valuable alternative perspective on the COVID-19 burden. We estimate the premature mortality productivity costs associated with COVID-19 across Europe. METHODS: We calculated excess deaths between the date the cumulative total of COVID-19 deaths reached 10 in a country to 15th May 2020 for nine countries (Belgium, France, Germany, Italy, The Netherlands, Portugal, Spain, Sweden and Switzerland). Gender- and age-specific excess deaths and Years of Potential Productive Life Lost (YPPLL) between 30 and 74 years were calculated and converted into premature mortality productivity costs €2020 for paid and unpaid work using the Human Capital and the Proxy Good Approaches. Costs were discounted at 3.5%. RESULTS: Total estimated excess deaths across the nine countries were 18,614 (77% in men) and YPPLL were 134,190 (77% male). Total paid premature mortality costs were €1.07 billion (87% male) with Spain (€0.35 billion, 33.0% of total), Italy (€0.22 billion; 20.6%) and The Netherlands (€0.19 billion; 17.5%) ranking highest. Total paid and unpaid premature mortality costs were €2.89 billion (77% male). Premature mortality costs per death ranged between €40,382 (France) and €350,325 (Switzerland). Spain experienced the highest premature mortality cost as a proportion of Gross Domestic Product (0.11%). CONCLUSION: Even in the initial period of the pandemic in Europe, COVID-19-related premature mortality costs were significant across Europe. We provide policy makers and researchers with a valuable alternative perspective on the burden of the virus and highlight potential economic savings that may be accrued by applying timely public health measures.

Interventions to suppress the coronavirus pandemic will increase unemployment and lead to many premature deaths.

BACKGROUND AND AIMS: Interventions to suppress the coronavirus pandemic have led to economic recession and higher unemployment, which will increase mortality and decrease quality of life. The aim of this article is to estimate the consequences on mortality and life expectancy of increased unemployment rates due to the coronavirus pandemic in Sweden and other countries. METHODS: Based on recent increases and expected future unemployment rates due to the coronavirus pandemic, results from a systematic review and data from vital statistics in Sweden, the number of premature deaths due to unemployment in Sweden have been estimated. RESULTS: Based on our assumptions, the calculations show that if the number of unemployed persons in Sweden increases by 100,000, one may expect some 1800 more premature deaths during the following 9 years. If the duration of the recession is limited to 4 years, excess deaths due to unemployment may be around 800. On average, the unemployed will lose 2 years of their remaining life expectancy. In many other countries unemployment rates have or are estimated to rise more than in Sweden, sometimes two- or threefold, suggesting hundreds of thousands of excess deaths due to unemployment. CONCLUSIONS: Interventions to suppress the coronavirus pandemic include the shut-down of economic activities and lead to increased all-cause mortality. These public health effects must be considered in the decision-making process and should be added to overall estimates of the effects of the pandemic on public health.

Impact of COVID-19 infection on life expectancy, premature mortality, and DALY in Maharashtra, India.

BACKGROUND: The COVID-19 infections and deaths have largely been uneven within and between countries. With 17% of the world's population, India has so far had 13% of global COVID-19 infections and 8.5% of deaths. Maharashtra accounting for 9% of India's population, is the worst affected state, with 19% of infections and 33% of total deaths in the country until 23rd December 2020. Though a number of studies have examined the vulnerability to and spread of COVID-19 and its effect on mortality, no attempt has been made to understand its impact on mortality in the states of India. METHOD: Using data from multiple sources and under the assumption that COVID-19 deaths are additional deaths in the population, this paper examined the impact of the disease on premature mortality, loss of life expectancy, years of potential life lost (YPLL), and disability-adjusted life years (DALY) in Maharashtra. Descriptive statistics, a set of abridged life tables, YPLL, and DALY were used in the analysis. Estimates of mortality indices were compared pre- and during COVID-19. RESULT: COVID-19 attributable deaths account for 5.3% of total deaths in the state and have reduced the life expectancy at birth by 0.8 years, from 73.2 years in the pre-COVID-19 period to 72.4 years by the end of 2020. If COVID-19 attributable deaths increase to 10% of total deaths, life expectancy at birth will likely reduce by 1.4 years. The probability of death in 20-64 years of age (the prime working-age group) has increased from 0.15 to 0.16 due to COVID-19. There has been 1.06 million additional loss of years (YPLL) in the state, and DALY due to COVID-19 has been estimated to be 6 per thousand. CONCLUSION: COVID-19 has increased premature mortality, YPLL, and DALY and has reduced life expectancy at every age in Maharashtra.

Unprecedented reduction in air pollution and corresponding short-term premature mortality associated with COVID-19 lockdown in Delhi, India.

Countries around the world introduced strict restrictions on movement and activities known as 'lockdowns' to restrict the spread of the novel coronavirus disease (COVID-19) from the end of 2019. A sudden improvement in air quality was observed globally as a result of these lockdowns. To provide insight into the changes in air pollution levels in response to the COVID-19 restrictions we have compared surface air quality data in Delhi during four phases of lockdown and the first phase of the restriction easing period (25 March to 30 June 2020) with data from a baseline period (2018-2019). Simultaneously, short-term exposure of PM2.5 and O3 attributed premature mortality were calculated to understand the health benefit of the change in air quality. Ground-level observations in Delhi showed that concentrations of PM10, PM2.5 and NO2 dropped substantially in 2020 during the overall study period compared with the same period in previous years, with average reductions of ~49%, ~39%, and ~39%, respectively. An overall lower reduction in O3 of ~19% was observed for Delhi. A slight increase in O3 was found in Delhi's industrial and traffic regions. The highest peak of the diurnal variation decreased substantially for all the pollutants at every phase. The decrease in PM2.5 and O3 concentrations in 2020, prevented 904 total premature deaths, a 60% improvement when compared to the figures for 2018-2019. The restrictions on human activities during the lockdown have reduced anthropogenic emissions and subsequently improved air quality and human health in one of the most polluted cities in the world.Implications: I am submitting herewith the manuscript entitled "Unprecedented Reduction in Air Pollution and Corresponding Short-term Premature Mortality Associated with COVID-19 Forced Confinement in Delhi, India" for potential publishing in your journal.The novelty of this research lies in: (1) we utilized ground-level air quality data in Delhi during four phases of lockdown and the first phase of unlocking period (25th March to 30th June) for 2020 as well as data from the baseline period (2018-2019) to provide an early insight into the changes in air pollution levels in response to the COVID-19 pandemic, (2) Chatarize the change of diurnal variation of the pollutants and (3) we assess the health risk due to PM2.5 and O3. Results from ground-level observations in Delhi showed that concentrations of PM10, PM2.5 and NO2 substantially dropped in 2020 during the overall study period compared to the similar period in previous years, with an average reduction of ~49%, ~39%, and ~39%, respectively. In the case of O3, the overall reduction was observed as ~19% in Delhi, while a slight increase was found in industrial and traffic regions. And consequently, the highest peak of the diurnal variation decreased substantially for all the pollutants. The health impact assessment of the changes in air quality indicated that 904 short-term premature deaths (~60%) were prevented due to the decline in PM2.5 and O3 concentrations in the study period. The restrictions on human activities during the lockdown have reduced the anthropogenic emissions and subsequently improved air quality and human health in one of the most polluted cities in the world.

Depending on the income of older adults and the coronavirus: orphans or newly poor? / Os dependentes da renda dos idosos e o coronavírus: órfãos ou novos pobres?

The objective of this study is to show the impact of the early death of the elderly, especially those who are financially responsible for families, on the income of other family members. It is considered to be premature, because death occurs at an age where life expectancy is positive and different from zero. The concern arises from the finding that 74.7% of the deaths recorded by Covid-19 until 8/13/2020 occurred in individuals aged 60 years or older, of which 56.4% were men. For example, at age 60 a male individual could still expect to live another 18.1 years, given the health conditions prevailing in 2018.

O objetivo deste trabalho é mostrar o impacto da morte precoce de idosos, em especial dos que são responsáveis financeiros da família, na renda desta. Considera-se como precoce, porque o óbito ocorre a uma idade onde a expectativa de vida é positiva e diferente de zero. A preocupação surge da constatação de que 74,7% das mortes registradas por Covid-19 até 13/08/2020 ocorreram em Indivíduos com 60 anos ou mais, dos quais 56,4% eram homens. Por exemplo, aos 60 anos um Indivíduo do sexo masculino ainda poderia esperar viver mais 18,1 anos, dadas as condições de saúde vigentes em 2018.

Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study.

BACKGROUND: In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic Asian or Pacific Islander (NHAPI) population. Our objectives were to examine variation in age-specific COVID-19 mortality rates by racial/ethnicity and to calculate the impact of this mortality using years of potential life lost (YPLL). METHODS AND FINDINGS: This cross-sectional study used the recently publicly available data on US COVID-19 deaths with reported race/ethnicity, for the time period February 1, 2020, to July 22, 2020. Population data were drawn from the US Census. As of July 22, 2020, the number of COVID-19 deaths equaled 68,377 for NHW, 29,476 for NHB, 23,256 for Hispanic, 1,143 for NHAIAN, and 6,468 for NHAPI populations; the corresponding population sizes were 186.4 million, 40.6 million, 2.6 million, 19.5 million, and 57.7 million. Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.8; p < 0.001) for NHB, 2.8 (95% CI 2.7, 3.0; p < 0.001) for Hispanic, 2.2 (95% CI 1.8, 2.6; p < 0.001) for NHAIAN, and 1.6 (95% CI 1.4, 1.7; p < 0.001) for NHAP populations. By contrast, NHB rate ratios relative to NHW were 7.1 (95% CI 5.8, 8.7; p < 0.001) for persons aged 25-34 years, 9.0 (95% CI 7.9, 10.2; p < 0.001) for persons aged 35-44 years, and 7.4 (95% CI 6.9, 7.9; p < 0.001) for persons aged 45-54 years. Even at older ages, NHB rate ratios were between 2.0 and 5.7. Similarly, rate ratios for the Hispanic versus NHW population were 7.0 (95% CI 5.8, 8.7; p < 0.001), 8.8 (95% CI 7.8, 9.9; p < 0.001), and 7.0 (95% CI 6.6, 7.5; p < 0.001) for the corresponding age strata above, with remaining rate ratios ranging from 1.4 to 5.0. Rate ratios for NHAIAN were similarly high through age 74 years. Among NHAPI persons, rate ratios ranged from 2.0 to 2.8 for persons aged 25-74 years and were 1.6 and 1.2 for persons aged 75-84 and 85+ years, respectively. As a consequence, more YPLL before age 65 were experienced by the NHB and Hispanic populations than the NHW population-despite the fact that the NHW population is larger-with a ratio of 4.6:1 and 3.2:1, respectively, for NHB and Hispanic persons. Study limitations include likely lag time in receipt of completed death certificates received by the Centers for Disease Control and Prevention for transmission to NCHS, with consequent lag in capturing the total number of deaths compared to data reported on state dashboards. CONCLUSIONS: In this study, we observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone. These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available.

Short-term and long-term health impacts of air pollution reductions from COVID-19 lockdowns in China and Europe: a modelling study.

BACKGROUND: Exposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact. METHODS: For this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016-20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020). FINDINGS: The lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 µg m-3 across China (-29·7%) and 2·2 µg m-3 across Europe (-17·1%), with unprecedented reductions of 40 µg m-3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380-26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960-2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600-86 900) to 287 000 (233 700-328 300) for China, and from 13 600 (11 900-15 300) to 29 500 (25 800-33 300) for Europe, depending on the future scenarios of economic recovery adopted. INTERPRETATION: These results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted. FUNDING: None.

Potential Years of Life Lost Due to COVID-19 in the United States, Italy, and Germany: An Old Formula with Newer Ideas.

Today, the world is facing the challenge of a major pandemic due to COVID-19, which has caused more than 6.1 million cases of infection and nearly 370,000 deaths so far. Most of the deaths from the disease are clustered in the older population, but the young and children are not spared. In this context, there is a critical need to revisit the formula for calculating potential years of life lost (PYLL). Data on age-specific deaths due to COVID-19 in three countries, including the United States (US), Italy, and Germany, were evaluated. New York State, as a significant outlier within the US, was also included. PYLLs in the US were five times as high as those of Italy. Compared with Germany, PYLLs in Italy were 4 times higher, and the rates in the US were 23, 25, and 18 times higher when using upper age limits of 70, 75, and 80, respectively. Standardized PYLLs in New York were 2 times as high as the rates in Italy, and 7 to 9 times as high as PYLLs in Germany. The revised formula of PYLL, using an upper limit of age 80, is recommended to accurately measure premature deaths due to a major disastrous disease such as COVID-19.

Impact of the Burden of COVID-19 in Italy: Results of Disability-Adjusted Life Years (DALYs) and Productivity Loss.

The WHO declared the novel coronavirus disease a pandemic, with severe consequences for health and global economic activity and Italy is one of the hardest hit countries. This study aims to assess the socio-economic burden of COVID-19 pandemic in Italy through the estimation of Disability-Adjusted Life Years (DALYs) and productivity loss. The observational study was based on data from official governmental sources collected since the inception of epidemic until 28 April 2020. DALYs for a disease combines the years of life lost due to premature mortality in the population and the years lost due to disability of the disease. In addition to DALYs, temporary productivity loss due to absenteeism from work and permanent productivity loss due to premature mortality were estimated using the Human Capital Approach. The total DALYs amount to 2.01 per 1000 persons. The total permanent productivity loss was around EUR 300 million while the temporary productivity loss was around EUR 100 million. This evaluation does not consider other economic aspects related to lockdown, quarantine of contacts, healthcare direct costs etc. The burden of disease methodology is functional metric for steering choices of health policy and allowing the government to be accountable for the utilization of resources.