Quantifying income inequality in years of life lost to COVID-19: a prediction model approach using Dutch administrative data.

BACKGROUND: Low socioeconomic status and underlying health increase the risk of fatal outcomes from COVID-19, resulting in more years of life lost (YLL) among the poor. However, using standard life expectancy overestimates YLL to COVID-19. We aimed to quantify YLL associated with COVID-19 deaths by sex and income quartile, while accounting for the impact of individual-level pre-existing health on remaining life expectancy for all Dutch adults aged 50+. METHODS: Extensive administrative data were used to model probability of dying within the year for the entire 50+ population in 2019, considering age, sex, disposable income and health care use (n = 6 885 958). The model is used to predict mortality probabilities for those who died of COVID-19 (had they not died) in 2020. Combining these probabilities in life tables, we estimated YLL by sex and income quartile. The estimates are compared with YLL based on standard life expectancy and income-stratified life expectancy. RESULTS: Using standard life expectancy results in 167 315 YLL (8.4 YLL per death) which is comparable to estimates using income-stratified life tables (167 916 YLL with 8.2 YLL per death). Considering pre-existing health and income, YLL decreased to 100 743, with 40% of years lost in the poorest income quartile (5.0 YLL per death). Despite individuals in the poorest quartile dying at younger ages, there were minimal differences in average YLL per COVID-19 death compared with the richest quartile. CONCLUSIONS: Accounting for prior health significantly affects estimates of YLL due to COVID-19. However, inequality in YLL at the population level is primarily driven by higher COVID-19 deaths among the poor. To reduce income inequality in the health burden of future pandemics, policies should focus on limiting structural differences in underlying health and exposure of lower income groups.

Health outcomes in Bulgaria: Simulated effects of obesogenic environmental changes in adulthood versus childhood.

OBJECTIVE: Bulgarian government efforts to tackle obesity are focused mainly on guidelines affecting children. However, it is unclear whether targeting children for obesity-related health policies yields better long-term health outcomes as opposed to changing the risk of obesity in adulthood. This study aims to evaluate where policy efforts should be directed to alleviate the health burden associated with obesity. METHODS: We compare the impact on population health of two simulated scenarios when (a) the prevalence of obesity upon entering adulthood is lowered; (b) the risk of getting an unhealthy weight as an adult is reduced. Additionally, we run (c) combinations of the two and (d) childhood obesity prevention on the one hand, and worsening (increasing) obesity incidence later in adulthood on the other. RESULTS: Our findings show that obesogenic environmental changes throughout adulthood have a stronger effect on life expectancy (LE), diabetes-free life expectancy (DFLE) and type 2 diabetes prevalence outcomes compared to lowering the proportion of individuals with obesity during adolescence. Nevertheless, a sizable reduction in the number of young adults with unhealthy weight has the potential to recover years of LE/DFLE that would be lost if the risk of obesity in adulthood would continue to grow in time. CONCLUSIONS: The two types of policies' (a-b) effects are not equivalent in strength and the best way forward is dependent on future obesity incidence trends.