Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium.

BACKGROUND: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.

Counting the non-existing: causes of death of undocumented migrants in Brussels-Capital Region (Belgium), 2005-2010.

BACKGROUND: So far knowledge about undocumented migrant health status is poor. The objective of this study is to compare patterns in causes of death between undocumented migrants and legal residents, of both migrant and non-migrant origin. METHOD: Using cause-of-death data, we compared undocumented migrants with Belgian residents and documented migrants through logistic regression analyses.. RESULTS: This study shows that male undocumented migrants have a significantly higher risk of death from cardiovascular diseases compared to male Belgian residents (OR: 1.37) and documented migrants (OR: 2.17). Male undocumented migrants also have an increased risk of dying from external causes of death compared to documented migrants (OR: 1.93). Furthermore, we found a lower risk of suicidal death in undocumented migrants compared to Belgian residents (OR men: 0.29, OR women: 0.15). CONCLUSIONS: We found important differences in underlying causes of death between undocumented migrants and residents in Belgium. These findings urge us to claim improved healthcare provision for undocumented migrants in Belgium. TRIAL REGISTRATION: Medical ethics committee UZ Jette, Brussels, Belgium - Registration date: 18/05/2016 - Registration number: B.U.N. 143201628279.

Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes.

BACKGROUND: Since most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study aims to examine past trends and future projections of place of death. METHODS: Analysis of death certificates (decedents aged ≥ 1 year) in Belgium (Flanders and Brussels Capital region) 1998-2007. Trends in place of death were adjusted for cause of death, sociodemographic characteristics, environmental factors, numbers of hospital beds, and residential and skilled nursing beds in care homes. Future trends were based on age- and sex-specific mortality prognoses. RESULTS: Hospital deaths decreased from 55.1% to 51.7% and care home deaths rose from 18.3% to 22.6%. The percentage of home deaths remained stable. The odds of dying in a care home versus hospital increased steadily and was 1.65 (95%CI:1.53-1.78) in 2007 compared to 1998. This increase could be attributed to the replacement of residential beds by skilled nursing beds. Continuation of these trends would result in the more than doubling of deaths in care homes and a decrease in deaths at home and in hospital by 2040. CONCLUSIONS: Additional end-of-life care resources in care homes largely explain the decrease in hospital deaths. Care homes will become the main locus of end-of-life care in the future. Governments should provide sufficient skilled nursing resources in care homes to fulfil the end-of-life care preferences and needs of patients.