Excess deaths by cause and place of death in England and Wales during the first year of COVID-19.

Using officially registered weekly mortality data, we estimate a counterfactual death count in the absence of the pandemic and we calculate the number of excess deaths in England and Wales during 2020 after the pandemic onset. We also break down those figures by region, age, gender, place of death, and cause of death. Our results suggest that there were 82,428 (95% Confidence interval [CI]: 78,402 to 86,415) excess deaths, and 88.9% (95% CI: 84.8%-93.5%) of them was due to COVID-19, suggesting that non-COVID-19 excess mortality may have been slightly higher that what has been previously estimated. Regarding deaths not due to COVID-19, persons older than 45 years old who died at their homes, mainly from heart diseases and cancer, were the most affected group. Across all causes of death, there was increased excess mortality from dementia and Alzheimer's disease, diabetes, Parkinson's disease and heart-related disease, while at the same period there was a reduction in deaths from pneumonia and influenza, stroke as well as infectious diseases and accidents. Supported by regional panel event estimates, our results highlight how measures to mitigate the pandemic spread and ease the pressure on healthcare service systems may adversely affect out-of-hospital mortality from other causes.

Summertime and the drivin' is easy? Daylight saving time and vehicle accidents.

We investigate how exogenous variation in daylight caused by Daylight Saving Time affects road safety as measured by the count of vehicle crashes. We use administrative daily data from Greece covering the universe of all types of recorded vehicle accidents during the 2006-2016 period. Our regression discontinuity estimates support an ambient light mechanism that reduces the counts of serious vehicle accidents during the Spring transition and increases the count of minor ones during the Fall transition. The effects are driven from the hour intervals that are mostly affected from seasonal clock changes. We then discuss the potential cost implications of those seasonal transitions. In light of the talks about abolishing seasonal clock changes in the European Union (EU), our findings are policy relevant and can inform the public debate as empirical evidence for the block is scarce.

The short-term impact of the 2020 pandemic lockdown on employment in Greece.

This paper analyzes the short-term employment impact of the COVID-19 lockdown in Greece during the first few months following the pandemic onset. During the initial lockdown period, aggregate employment was lower by almost 9 percentage points than it would have been expected based on pre-pandemic employment trends. However, due to a government intervention that prohibited layoffs, this was not due to higher separation rates. The overall short-term employment impact was due to lower hiring rates. To uncover the mechanism behind this, we use a difference-in-differences framework, and show that tourism-related activities, which are exposed to seasonal variation, had significantly lower employment entry rates in the months following the pandemic onset compared to non-tourism activities. Our results highlight the relevance of the timing of unanticipated shocks in economies with strong seasonal patterns, and the relative effectiveness of policy interventions to partly absorb the consequences of such shocks.

Retirement and Household Expenditure in Turbulent Times.

We examine how expenditure changes at retirement during an institutionally and economically uncertain period when a series of pension reforms and cuts were implemented. Overall, we fail to confirm that consumption declines at retirement using data from Greece (2008-2018). Any estimated declines come from turbulent years when major pension cuts were applied. Expenditure drops at retirement were due to pension income shocks, especially for those who were particularly dependent on pension income. Further checks support the presence of an income shock mechanism for retirees who are relatively more treated during the crisis sub-period. Given an aging population and the ongoing global turbulence, our results offer valuable insights.

Religion, social interactions, and COVID-19 incidence in Western Germany.

This paper investigates how social interactions, as shaped by religious denomination, are related to COVID-19 incidence and associated mortality in Western Germany. We observe that the number of infections and deaths during the early pandemic phase were much higher in predominantly Catholic counties with arguably stronger family and social ties. The relationship was confirmed at the county level through numerous robustness checks, and after controlling for a series of characteristics and county fixed effects. At the individual level, we confirmed that Catholics, relative to non-Catholics, have tighter and more frequent interactions with their family and friends. Moreover, the intensity of social interaction was able to partially explain the relationship between COVID-19 incidence and share of Catholics at the county level. Our results highlight the number of dimensions that have to be taken into account when designing and implementing mitigation measures in the early stages of disease outbreaks.

Crises and mortality: Does the level of unemployment matter?

The relationship between mortality and economic fluctuations has been a topic of long interest, which intensified following the 2008 global financial crisis. We study whether mortality responds non-linearly and asymmetrically to unemployment in the context of national economic crises. Although these assumptions have been challenged in other domains, they have been neglected in the mortality literature. Greece offers an ideal setting as unemployment was decreasing until mid-2008, but then it was sharply increased as a result of a severe economic crisis. We use quarterly data on regional unemployment and mortality from 1999 to 2013, giving a balanced panel of 780 observations. We find evidence of a countercyclical total mortality, especially for the older groups, and a further deteriorating crisis effect. We provide evidence that the relationship is non-linear and asymmetric, suggesting that the effect on death rates changes for very high values of unemployment and depends on its direction. Both non-linearity and asymmetry are mainly driven by those above 65 years old. The results suggest that the mechanisms explaining these effects are likely to vary across age groups. Our findings have important methodological implications and suggest that empirical investigations on fluctuations, recessions and mortality should not ignore possible non-linear and asymmetric behaviours, especially during turbulent times.

Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme.

This paper evaluates the impact of the 2008 Rapid Improvement Programme that aimed at promoting normal birth and reducing caesarean section rates in the English National Health Service. Using Hospital Episode Statistics maternity records for the period 2001-2013, a panel data analysis was performed to determine whether the implementation of the programme reduced caesarean sections rates in participating hospitals. The results obtained using either the unadjusted sample of hospitals or a trimmed sample determined by a propensity score matching approach indicate that the impact of the programme was small. More specifically there were 2.3 to 3.4 fewer caesarean deliveries in participating hospitals, on average, during the postprogramme period offering a limited scope for cost reduction. This result mainly comes from the reduction in the number of emergency caesareans as no significant effect was uncovered for planned caesarean deliveries.

Cancelled Procedures in the English NHS: Evidence from the 2010 Tariff Reform.

This paper explores the role of incentives in the English National Health Service. Until financial year 2009/2010, elective procedures that were cancelled after admission received a fixed reimbursement associated with a specific healthcare resource group code. We investigate whether this induced trusts to admit and then cancel, rather than cancel before admission and/or to cancel low fee over high fee work. As the tariff was ended in April 2010, we conduct an interrupted time series analysis to examine if their behaviour was affected after the tariff removal. The results indicate a small, yet statistically significant, decline in the probability of a last minute cancellation in the post-tariff period, especially for certain types of patients and diagnoses. Copyright © 2017 John Wiley & Sons, Ltd.

Total and cause-specific mortality before and after the onset of the Greek economic crisis: an interrupted time-series analysis.

BACKGROUND: Greece was one of the countries hit the hardest by the 2008 financial crisis in Europe. Yet, evidence on the effect of the crisis on total and cause-specific mortality remains unclear. We explored whether the economic crisis affected the trend of overall and cause-specific mortality rates. METHODS: We used regional panel data from the Hellenic Statistical Authority to assess mortality trends by age, sex, region, and cause in Greece between January, 2001, and December, 2013. We used Eurostat data to calculate monthly age-standardised mortality rates per 100 000 inhabitants for each region. Data were divided into two subperiods: before the crisis (January, 2001, to August, 2008) and after the onset of the crisis (September, 2008, to December, 2013). We tested for changes in the slope of mortality by doing an interrupted time-series analysis. FINDINGS: Overall mortality continued to decline after the onset of the financial crisis (-0·065, 95% CI -0·080 to -0·049), but at a slower pace than before the crisis (-0·13, -0·15 to -0·10; trend difference 0·062, 95% CI 0·041 to 0·083; p<0·0001). The trend difference was more evident for females (0·087, 95% CI 0·064-0·11; p<0·0001) than for males (0·040, 0·013-0·066; p=0·007). Those aged at least 75 years experienced more negative effects (trend difference 0·056, 95% CI 0·042 to 0·071; p<0·0001) than did those aged 20-34 years, in whom mortality trends improved (-0·0074, -0·0089 to -0·0059; p<0·0001). Deaths by diseases of the circulatory system declined more slowly after the onset of compared with before the crisis (trend difference 0·043, 95% CI 0·024 to 0·063; p<0·0001), whereas deaths from vehicular accidents declined faster (-0·0062, -0·0090 to -0·0033; p<0·0001), most prominently among men aged 20-34 years (-0·0065, -0·0085 to -0·0044; p<0·0001). Conversely, deaths from suicides (trend difference 0·0021, 95% CI 0·00092-0·0033; p=0·002), diseases of the nervous system (0·0036, 0·0016-0·0056; p=0·002), and mental health problems (0·00073, 0·000047-0·0014 p=0·038) increased after the onset of the crisis. Also, deaths due to adverse events during medical treatment increased significantly after the onset of the crisis (trend difference 0·0020, 95% CI 0·0012-0·0028; p<0·0001). By comparing the expected values of the period after the onset of the crisis with extrapolated values based on the period before the crisis, we estimate that an extra 242 deaths per month occurred after the onset of the crisis. INTERPRETATION: Mortality trends have been interrupted after the onset of compared with before the crisis, but changes vary by age, sex, and cause of death. The increase in deaths due to adverse events during medical treatment might reflect the effects of deterioration in quality of care during economic recessions. FUNDING: None.

The native flora of Mountain Panachaikon (Peloponnese, Greece): new records and diversity.

BACKGROUND: This study presents the native flora of Mountain Panachaikon (N.W. Peloponnese, Greece), after extensive field work (from ~700 to 1900 m) and critical literature review. RESULTS: The vascular native flora of Mt. Panachaikon comprises 757 taxa, 95 of which are Greek endemics, 79 are Balkan endemics, while 229 taxa are reported here for the first time. The known distribution of the Greek endemics Alyssum montanum subsp. montanum var. graecum, Carum heldreichii, Cirsium heldreichii, Genista milii, Minuartia eurytanica and Seseli parnassicum is expanded, being reported for the first time for the floristic region of Peloponnese, and the number of the known populations of the Near Threatened Gymnospermium altaicum subsp. peloponnesiacum is increased. CONCLUSIONS: The study area appears to have the second highest endemism and the highest one in W. Greece, compared with other mountains of N. Peloponnese and Sterea Ellada, while 22.10% of the endemics are protected and/or evaluated as Near Threatened to Endangered. It also exhibits a rather high proportion of Balkan endemics, in relation to its geographic location, and some genuine arctic-alpine taxa. These indicate that Mt. Panachaikon can be rendered as a plant diversity hotspot in the Peloponnese.