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1.
BMC Med ; 20(1): 57, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-2196267

ABSTRACT

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.


Subject(s)
COVID-19 , Noncommunicable Diseases , Adult , Aged , Australia/epidemiology , Cause of Death , Female , Goals , Humans , Male , Middle Aged , Mortality , Mortality, Premature , Pandemics , SARS-CoV-2 , World Health Organization
2.
J Gerontol B Psychol Sci Soc Sci ; 77(Suppl_2): S127-S137, 2022 05 27.
Article in English | MEDLINE | ID: covidwho-2188728

ABSTRACT

OBJECTIVES: Since the 1980s, life expectancy at birth (e0) in the United States has fallen steadily behind that of other high-income countries, widening the U.S. e0 disadvantage. We estimate how that disadvantage was affected by high mortality rates in 2020, the first full year of the coronavirus disease 2019 pandemic. METHODS: We contrast male and female e0 in the United States and 18 peer countries for years 1980, 1995, 2010, 2019, and 2020. Using Arriaga decomposition, we show how differences in age-specific death rates have contributed to U.S. e0 disadvantages. RESULTS: In 2020, U.S. male and female e0 changed by -2.33 (-2.50, -2.15) and -1.69 (-1.85, -1.53) years, respectively, whereas corresponding changes in peer countries averaged -0.67 (-0.82, -0.51) and -0.50 (-0.65, -0.35) years, respectively. This accelerated a longstanding and widening U.S. e0 disadvantage relative to its peers, which increased from 3.49 to 5.15 years in males and from 2.78 to 3.97 years in females between 2019 and 2020. Whereas deaths before age 65 accounted for 55% and 40% of declines in U.S. male and female life expectancy, respectively, they accounted for only 24% and 11% of the respective declines in peer countries. DISCUSSION: U.S. life expectancy declines in 2020 were larger than in peer countries and involved deaths across a broader age range, particularly among young and middle-aged adults. Both the longstanding U.S. e0 disadvantage and acute losses of life in 2020 signal the need for systemic policy changes in the United States.


Subject(s)
COVID-19 , Age Factors , Aged , Female , Humans , Life Expectancy , Male , Middle Aged , Mortality , Pandemics , Peer Group , United States/epidemiology
3.
JMIR Public Health Surveill ; 7(10): e32559, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-2141361

ABSTRACT

BACKGROUND: All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. OBJECTIVE: This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. METHODS: Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. RESULTS: Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. CONCLUSIONS: The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.


Subject(s)
COVID-19/epidemiology , Mortality , Adult , Aged , Female , Humans , Jordan/epidemiology , Male , Middle Aged , Pandemics , Young Adult
4.
PLoS One ; 17(11): e0277441, 2022.
Article in English | MEDLINE | ID: covidwho-2117825

ABSTRACT

Socioeconomic factors have exacerbated the impact of COVID-19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID-19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID-19 mortality in large urban centers in Brazil. We compiled weekly COVID-19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID-19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID-19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID-19, as supported by the observed associations in this study.


Subject(s)
COVID-19 , Social Segregation , Humans , Brazil/epidemiology , COVID-19/epidemiology , Income , Socioeconomic Factors , Mortality
5.
Health Aff (Millwood) ; 41(11): 1559-1561, 2022 11.
Article in English | MEDLINE | ID: covidwho-2114854

ABSTRACT

A detailed examination of deaths in the US by cause and age suggests that the 2020 recession did not contribute to excess deaths overall. However, high excess mortality occurred because of drug overdoses both from recession effects and from COVID-19 pandemic effects. Understanding the risk for heightened substance use mortality can help mitigate this risk in the next pandemic.


Subject(s)
COVID-19 , Drug Overdose , Humans , Pandemics , Public Health , Mortality
6.
Epidemiol Prev ; 46(5-6): In press, 2022.
Article in Italian | MEDLINE | ID: covidwho-2111276

ABSTRACT

BACKGROUND: as a result of the SARS-CoV-2 pandemic, a generalised mortality excess was recorded in 2020. However, the mortality for COVID-19 cannot fully explain the observed excesses. The analysis of cause-specific mortality could contribute to estimate the direct and indirect effects of the SARS-CoV-2 outbreak and to the monitoring mortality trends. OBJECTIVES: to describe the impact of the SARS-CoV-2 epidemic in overall and cause-specific mortality in population residing in the Agency for Health Protection (ATS) of Milan. Descriptive analysis of cause-specific mortality within thirty days of SARS-COV-2 infection. DESIGN: descriptive analysis of overall and cause-specific mortality in the ATS of Milan area in 2020 and comparison with a reference period (2015-2019). SETTING AND PARTICIPANTS: overall deaths in ATS of Milan in 2020 were collected, using the Local Registry of Causes of Death, and were classified according to the ICD-10 codes. MAIN OUTCOME MEASURES: total and weekly overall and cause-specific mortality, by age. RESULTS:  in 2020, 44,757 deaths for all causes were observed in people residing in the ATS of Milan with percentage change of 35%. The leading cause of death in 2020 were cardiovascular disease and neoplasm; COVID-19 infection was the third cause. An excess of mortality was observed for most of all causes of deaths. Starting from 40-49-year age group, an increase of mortality was observed; the largest increase was observed in the group 70+ years. The largest increases were observed for endocrine, respiratory, and hypertensive diseases. On the contrary, for neoplasm, infectious (not COVID-19) diseases, traffic-related mortality, and cerebrovascular disease and ictus, a decrease of mortality was observed. The greater mortality increase was observed during the first pandemic wave. The leading cause of death after positive swab was COVID-19 infection, with little variation with age class. Other frequent causes of death were respiratory diseases, cardiovascular diseases, and neoplasm. CONCLUSIONS: the study showed a generalised increase for most causes of death; observed mortality trends may indicate delay in access to health care system, in diagnosis and treatment.


Subject(s)
COVID-19 , Neoplasms , Humans , Cause of Death , SARS-CoV-2 , Italy/epidemiology , Mortality
7.
Soc Sci Med ; 313: 115397, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2121510

ABSTRACT

BACKGROUND: The rate of improvement in mortality slowed across many high-income countries after 2010. Following the 2007-08 financial crisis, macroeconomic policy was dominated by austerity as countries attempted to address perceived problems of growing state debt and government budget deficits. This study estimates the impact of austerity on mortality trends for 37 high-income countries between 2000 and 2019. METHODS: We fitted a suite of fixed-effects panel regression models to mortality data (period life expectancy, age-standardised mortality rates (ASMRs), age-stratified mortality rates and lifespan variation). Austerity was measured using the Alesina-Ardagna Fiscal Index (AAFI), Cyclically-Adjusted Primary Balance (CAPB), real indexed Government Expenditure, and Public Social Spending as a % of GDP. Sensitivity analyses varied the lag times, and confined the panel to economic downturns and to non-oil-dominated economies. RESULTS: Slower improvements, or deteriorations, in life expectancy and mortality trends were seen in the majority of countries, with the worst trends in England & Wales, Estonia, Iceland, Scotland, Slovenia, and the USA, with generally worse trends for females than males. Austerity was implemented across all countries for at least some time when measured by AAFI and CAPB, and for many countries across all four measures (and particularly after 2010). Austerity adversely impacted life expectancy, ASMR, age-specific mortality and lifespan variation trends when measured with Government Expenditure, Public Social Spending and CAPB, but not with AAFI. However, when the dataset was restricted to periods of economic downturn and in economies not dominated hydrocarbon production, all measures of austerity were found to reduce the rate of mortality improvement. INTERPRETATION: Stalled mortality trends and austerity are widespread phenomena across high-income countries. Austerity is likely to be a cause of stalled mortality trends. Governments should consider alternative economic policy approaches if these harmful population health impacts are to be avoided.


Subject(s)
Income , Life Expectancy , Male , Female , Humans , Developed Countries , England , Scotland , Mortality
8.
Health Aff (Millwood) ; 41(11): 1550-1558, 2022 11.
Article in English | MEDLINE | ID: covidwho-2109342

ABSTRACT

There were almost 700,000 excess deaths in the US from March 1, 2020, through February 28, 2021, resulting from two often counterbalancing mechanisms: those predicted by changes in unemployment rates occurring during this period, referred to here as the "recession effect," and those predicted by the "pandemic effect," which reflects direct consequences of SARS-CoV-2 infections and COVID-19, accompanying impacts on health and medical care, and other changes in mortality not caused by greater joblessness. Using data from the Centers for Disease Control and Prevention, this study decomposed total mortality in this period into pandemic and recession effects, with additional estimates by sex, race and ethnicity, age, and fourteen causes. Although the pandemic effect increased many types of mortality, the recession effect reduced most types of mortality. Without the recession effect, there would have been nearly 40,000 more deaths than actually occurred. However, there were disparate impacts, particularly for external causes. Vehicular and alcohol-related fatalities and homicides rose because of strong pandemic effects. In contrast, the recession effect accounted for a greater share of the rise in drug mortality. Offsetting pandemic and recession effects resulted in a decrease in the number of suicides. Understanding these diverse impacts provides useful lessons for policy efforts to mitigate the current and future health pandemics.


Subject(s)
COVID-19 , Suicide , Humans , Pandemics , SARS-CoV-2 , Cause of Death , Mortality
9.
Sci Rep ; 12(1): 18559, 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2106456

ABSTRACT

Both the USA and Europe experienced substantial excess mortality in 2020 and 2021 related to the COVID-19 pandemic. Methods used to estimate excess mortality vary, making comparisons difficult. This retrospective observational study included data on deaths from all causes occurring in the USA and 25 European countries or subnational areas participating in the network for European monitoring of excess mortality for public health action (EuroMOMO). We applied the EuroMOMO algorithm to estimate excess all-cause mortality in the USA and Europe during the first two years of the COVID-19 pandemic, 2020-2021, and compared excess mortality by age group and time periods reflecting three primary waves. During 2020-2021, the USA experienced 154.5 (95% Uncertainty Interval [UI]: 154.2-154.9) cumulative age-standardized excess all-cause deaths per 100,000 person years, compared with 110.4 (95% UI: 109.9-111.0) for the European countries. Excess all-cause mortality in the USA was higher than in Europe for nearly all age groups, with an additional 44.1 excess deaths per 100,000 person years overall from 2020-2021. If the USA had experienced an excess mortality rate similar to Europe, there would have been approximately 391 thousand (36%) fewer excess deaths in the USA.


Subject(s)
COVID-19 , Humans , United States/epidemiology , COVID-19/epidemiology , Pandemics , Europe/epidemiology , Public Health , Algorithms , Mortality
10.
NCHS Data Brief ; (448): 1-8, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2102673

ABSTRACT

Alcohol use is a known risk factor for mortality, and the rates of alcohol induced deaths have risen over the past several years (1). Alcohol use in the United States increased during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic, which may have affected mortality rates, especially for alcohol-induced deaths (2). Understanding trends in alcohol-induced mortality, with a particular focus on differences from 2019 to 2020, may help identify groups particularly affected during the COVID-19 pandemic. This report presents overall and sex-specific trends in alcohol-induced death rates from 2000 to 2020, and then focuses on the rates for 2019 and 2020 by sex, age group, and underlying cause of death.


Subject(s)
COVID-19 , Pandemics , Male , Female , United States/epidemiology , Humans , Alcohol Drinking/epidemiology , Risk Factors , Cause of Death , Mortality
11.
Risk Anal ; 42(7): 1571-1584, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2097864

ABSTRACT

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag-York-Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors.


Subject(s)
Air Pollution , COVID-19 , Aged , Air Pollution/adverse effects , England/epidemiology , Humans , Mortality , Risk Factors , SARS-CoV-2
12.
PLoS One ; 17(11): e0275967, 2022.
Article in English | MEDLINE | ID: covidwho-2098748

ABSTRACT

Accurately counting the human cost of the COVID-19 at both the national and regional level is a policy priority. The Russian Federation currently reports one of the higher COVID-19 mortality rates in the world; but estimates of mortality differ significantly. Using a statistical method accounting for changes in the population age structure, we present the first national and regional estimates of excess mortality for 2021; calculations of excess mortality by age, gender, and urban/rural status for 2020; and mean remaining years of life expectancy lost at the regional level. We estimate that there were 351,158 excess deaths in 2020 and 678,022 in 2021 in the Russian Federation; and, in 2020, around 2.0 years of life expectancy lost. While the Russian Federation exhibits very high levels of excess mortality compared to other countries, there is a wide degree of regional variation: in 2021, excess deaths expressed as a percentage of expected deaths at the regional level range from 27% to 52%. Life expectancy loss is generally greater for males; while excess mortality is greater in urban areas. For Russia as whole, an average person who died due to the pandemic in 2020 would have otherwise lived for a further 14 more years (and as high as 18 years in some regions), disproving the widely held view that excess mortality during the pandemic period was concentrated among those with few years of life remaining-especially for females. At a regional level, less densely populated, more remote regions, rural regions appear to have fared better regarding excess mortality and life expectancy loss-however, a part of this differential could be owing to measurement issues. The calculations demonstrate more clearly the true degree of the human cost of the pandemic in the Russian Federation.


Subject(s)
COVID-19 , Male , Female , Humans , Life Expectancy , Russia/epidemiology , Mortality
15.
PLoS One ; 17(10): e0275333, 2022.
Article in English | MEDLINE | ID: covidwho-2079743

ABSTRACT

BACKGROUND: The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. METHODS: This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. RESULTS: There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. CONCLUSIONS: Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.


Subject(s)
COVID-19 , Maternal Death , Female , Humans , Adult , Middle Aged , COVID-19/epidemiology , Pandemics , Brazil/epidemiology , Maternal Mortality , Mortality
16.
J Occup Environ Med ; 64(9): 726-730, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2077939

ABSTRACT

OBJECTIVE: The aim of the study is to determine relationships between lockdowns and excess mortality, unemployment, and employment growth. METHODS: Each US states' mortality data for 2020 were compared with the prior 3 years to determine excess mortality. Data were compared using measures of lockdowns, or state openness scores and adjusted for age, sex, race/ethnicity, and cardiovascular disease. Comparisons were made with unemployment rates and employment growth rates. RESULTS: The 2020 excess mortality ranged from -9% to 46%. The average openness score was not significant ( P = 0.20). However, openness was strongly associated with both unemployment ( P = 0.01) and employment growth ( P = 0.0008). CONCLUSIONS: There was no statistical relationship between excess mortality and openness scores, while there were strong relationships with employment measures. These results suggest that lockdowns are not sufficiently beneficial for future use in this pandemic and raise concerns for use in future pandemics.


Subject(s)
COVID-19 , Unemployment , Communicable Disease Control , Employment , Humans , Mortality , Pandemics
17.
NCHS Data Brief ; (446): 1-8, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2073865

ABSTRACT

COVID-19 was the underlying cause of death for a total of 350,381 deaths in the United States in 2020 (1). Although COVID-19 can affect people of any age, older adults were especially impacted during the first year of the pandemic: 81% of COVID-19 deaths in 2020 (282,836) occurred among those aged 65 and over. In this age group, COVID-19 was the third leading cause of death, after heart disease and cancer (1). This report describes COVID-19 mortality in 2020 by selected characteristics in the population aged 65 and over.


Subject(s)
COVID-19 , Neoplasms , United States/epidemiology , Humans , Aged , Pandemics , Mortality
18.
Am J Trop Med Hyg ; 107(1): 218, 2022 Jun 13.
Article in English | MEDLINE | ID: covidwho-2072014
19.
Health Policy ; 126(12): 1269-1276, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2069027

ABSTRACT

There is widespread debate on the drivers of heterogeneity of adverse COVID-19 pandemic outcomes and, more specifically, on the role played by context-specific factors. We contribute to this literature by testing the role of environmental factors as measured by environmentally protected areas. We test our research hypothesis by showing that the difference between the number of daily deaths per 1,000 inhabitants in 2020 and the 2018-19 average during the pandemic period is significantly lower in Italian municipalities located in environmentally protected areas such as national parks, regional parks, or Environmentally Protected Zones. After controlling for fixed effects and various concurring factors, municipalities with higher share of environmentally protected areas show significantly lower mortality during the pandemic than municipalities that do not benefit from such environmental amenities.


Subject(s)
COVID-19 , Humans , Pandemics , Cities/epidemiology , Italy/epidemiology , Mortality
20.
Int J Environ Res Public Health ; 19(19)2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2066070

ABSTRACT

Mortality related to chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic is possibly underestimated by sparse available data. The study aimed to assess the impact of the pandemic on COPD-related mortality by means of time series analyses of causes of death data. We analyzed the death certificates of residents in Veneto (Italy) aged ≥40 years from 2008 to 2020. The age-standardized rates were computed for COPD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple cause of death-MCOD). The annual percent change (APC) in the rates was estimated for the pre-pandemic period. Excess COPD-related mortality in 2020 was estimated by means of Seasonal Autoregressive Integrated Moving Average models. Overall, COPD was mentioned in 7.2% (43,780) of all deaths. From 2008 to 2019, the APC for COPD-related mortality was -4.9% (95% CI -5.5%, -4.2%) in men and -3.1% in women (95% CI -3.8%, -2.5%). In 2020 compared to the 2018-2019 average, the number of deaths from COPD (UCOD) declined by 8%, while COPD-related deaths (MCOD) increased by 14% (95% CI 10-18%), with peaks corresponding to the COVID-19 epidemic waves. Time series analyses confirmed that in 2020, COPD-related mortality increased by 16%. Patients with COPD experienced significant excess mortality during the first year of the pandemic. The decline in COPD mortality as the UCOD is explained by COVID-19 acting as a competing cause, highlighting how an MCOD approach is needed.


Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , Cause of Death , Female , Humans , Italy/epidemiology , Male , Mortality , Pandemics , Pulmonary Disease, Chronic Obstructive/epidemiology
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