The disproportionate excess mortality risk of COVID-19 in younger people with diabetes warrants vaccination prioritisation.
Ontology highlight
ABSTRACT:
SUBMITTER: McGovern AP
PROVIDER: S-EPMC7885981 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
The disproportionate excess mortality risk of COVID-19 in younger people with diabetes warrants vaccination prioritisation.
McGovern Andrew P AP Thomas Nick J NJ Vollmer Sebastian J SJ Hattersley Andrew T AT Mateen Bilal A BA Dennis John M JM
Diabetologia 20210216 5
Similar Datasets
Project description:BackgroundExcess mortality in people with vs without type 2 diabetes (T2DM) has fallen, but it is unclear whether men/women at all ages have benefited and which causes of death have driven these trends.MethodsAll-cause and cause-specific mortality rates and excess mortality [by mortality rate ratios (MRRs) relative to the non-diabetic general population] were examined in 1 268 018 Australians with T2DM registered on the National Diabetes Services Scheme (2002-2014).ResultsAge-standardized mortality decreased in men (-2.2%/year; Ptrend < 0.001) and women with T2DM (-1.3%/year; Ptrend < 0.001) throughout 2002-14, which translated to declines in the MRRs (from 1.51 to 1.45 in men; 1.59 to 1.46 in women; Ptrend < 0.05 for both). Declining mortality rates in T2DM were observed in men aged 40+ years and women aged 60+ years (Ptrends <0.001), but not at younger ages. However, the only age group in which excess mortality declined relative to those without diabetes was 80+ years (Ptrends < 0.05); driven by reductions in excess cancer-related deaths in men and cardiovascular disease (CVD) in women. Among age groups <80 years, CVD and cancer MRRs remained similar or increased over time, despite falls in both CVD and cancer mortality rates. MRRs for non-CVD/non-cancer-related deaths increased in 60-79 year-olds, but were otherwise unchanged.ConclusionsDeclining excess mortality attributable to T2DM from 2002-14 was driven entirely by reductions in those aged 80+ years. Declines in total mortality among those with T2DM were apparent in more age groups, but often to a lesser extent than in the general population, thereby serving to increase the excess risk associated with T2DM.
| S-EPMC10452956 | biostudies-literature
Project description:Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which sociodemographic subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities. Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups categorized by age, sex, nativity, country of birth, educational attainment, occupation, and combinations of these factors. Our results indicate that during the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or a Central American country (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations. In sum, the COVID-19 pandemic has disproportionately impacted mortality among Latino immigrants, especially those in unprotected essential jobs. Interventions to reduce these inequities should include targeted vaccination, workplace safety enforcement, and expanded access to medical care and economic support.
| S-EPMC8283318 | biostudies-literature
Project description:PURPOSE:Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. METHODS:Hospitalised patients aged???70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. RESULTS:In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93-1.12) and controls (HR 1.99, 95% CI 1.46-2.72), with an interaction term (HR 0.51, 95% CI 0.37-0.71) in multivariable models. CONCLUSIONS:Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.
| S-EPMC7368630 | biostudies-literature
Project description:We study the role of education during the COVID-19 epidemic in Italy. We compare excess mortality in 2020 and 2021 compared to the pre-pandemic mortality between municipalities with different shares of educated residents. We find that education initially played a strong protective role, which however quickly faded out. After pondering several alternative explanations, we tentatively interpret this finding as the outcome of the interplay between education, information and public health communication, whose availability and coherence varied along the epidemic.
| S-EPMC9644421 | biostudies-literature
Project description: Not available
| S-EPMC9910844 | biostudies-literature
Project description: Not available
| S-EPMC9910840 | biostudies-literature
Project description:BackgroundIt has been claimed that COVID-19 vaccination is associated with excess mortality during the COVID-19 pandemic, a claim that contributes to vaccine hesitancy. We examined whether all-cause mortality has actually increased in Cyprus during the first two pandemic years, and whether any increases are associated with vaccination rates.MethodsWe calculated weekly excess mortality for Cyprus between January 2020 and June 2022, overall and by age group, using both a Distributed Lag Nonlinear Model (DLNM) adjusted for mean daily temperature, and the EuroMOMO algorithm. Excess deaths were regressed on the weekly number of confirmed COVID-19 deaths and on weekly first-dose vaccinations, also using a DLNM to explore the lag-response dimension.Results552 excess deaths were observed in Cyprus during the study period (95% CI: 508-597) as opposed to 1306 confirmed COVID-19 deaths. No association between excess deaths and vaccination rates was found overall and for any age group except 18-49 years, among whom 1.09 excess deaths (95% CI: 0.27-1.91) per 10,000 vaccinations were estimated during the first 8 weeks post-vaccination. However, detailed cause-of-death examination identified just two such deaths potentially linked to vaccination, therefore this association is spurious and attributable to random error.ConclusionsExcess mortality was moderately increased in Cyprus during the COVID-19 pandemic, primarily as a result of laboratory-confirmed COVID-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of COVID-19 vaccines.
| S-EPMC10066729 | biostudies-literature
Project description:Trust plays a crucial role in implementing public health interventions against the COVID-19 pandemic. We examined the prospective associations of interpersonal, institutional, and media trust with vaccination rates and excess mortality over time in two multinational studies. In study 1, we investigated the country-level relationships between interpersonal trust, vaccination rates, and excess mortality across 54 countries. Interpersonal trust at the country level was calculated by aggregating data of 80,317 participants from the World Values Survey in 2017-20. Data on vaccination rates and excess mortality were obtained from the World Health Organization. Our findings indicated that higher levels of interpersonal trust were linked to higher vaccination rates and lower excess mortality rates in both 2020 and 2021. In study 2, we collected data from 18,171 adults in 35 countries/societies, stratified by age, gender, and region of residence. At the country/society level, interpersonal trust and trust in local healthcare facilities, local healthcare services, and healthcare professionals were associated with higher vaccination rates and lower excess mortality, whereas social media trust was associated with lower vaccination rates and higher excess mortality across three time points over 2 years. Our findings are robust when controlling for country-level covariates of the government stringency index, population density, and medical resources (i.e. critical care beds) in both studies.
| S-EPMC10568527 | biostudies-literature
Project description:BackgroundEstimating the indirect mortality due to COVID-19 is of the utmost importance to develop adequate public health policy during future outbreaks.MethodsFrom province-wide administrative datasets, we identified British Columbians who tested negative for COVID-19 during the first wave and never tested positive throughout 2020. We obtained a pre-pandemic (2018) cohort matched on age, sex, history of non-communicable disorders (NCDs), multimorbidity, and severity/acuity, and implemented a doubly robust estimation of the effect of the first pandemic wave on mortality.ResultsThe adjusted odds ratio (AOR) of death was 3.2 times higher for a 2020 cohort who tested negative for COVID-19 (n = 123,133), compared to matched pre-pandemic controls. In both cohorts, a majority (72.5%) experienced at least one pre-existing NCD. Stratification by NCD shows an AOR of death ranges between 2-for people with substance use disorders- and 7-for people previously undiagnosed with NCDs (e.g., incident cases that went untreated). The largest subgroup was composed of people with mental disorders (47,413 people), with an AOR of death of 2.5. Though the COVID-19 direct mortality in the general population remained low (1.9 per 10,000), the excess mortality in this COVID-negative cohort was extremely high - 4,085 of the 123,133- which entails a minimum indirect excess mortality death rate of 6.5 per 10,000 in the general population.ConclusionsDuring the first pandemic year, mortality in COVID-negative adults was several times greater than before COVID-19, in people with matched NCD distribution and severity. Our findings suggest that low direct COVID-19 mortality was accompanied by less visible-but much higher- indirect mortality due to undiagnosed and/or untreated NCDs, highlighting the need to focus not only on mitigating the harms of new agents, but also of continuing service delivery for treatable conditions.
| S-EPMC11847353 | biostudies-literature
Project description:Risk factors for COVID-19-related outcomes have been variably reported. We used the standardised LACE index to examine admissions and in-hospital mortality associated with COVID-19. Data were collected in the pre-pandemic period (01-04-2019 to 29-02-2020) from 10,173 patients (47.7% men: mean age ± standard deviation = 68.3 years ± 20.0) and in the pandemic period (01-03-2019 to 31-03-2021) from 12,434 patients. With the latter, 10,982 were without COVID-19 (47.4% men: mean age = 68.3 years ± 19.6) and 1452 with COVID-19 (58.5% men: mean age = 67.0 years ± 18.4). Admissions and mortality were compared between pre-pandemic and pandemic patients, according to LACE index. Admission rates rose disproportionately with higher LACE indices amongst the COVID-19 group. Mortality rates amongst the pre-pandemic, pandemic non-COVID-19 and COVID-19 groups with LACE index scores < 4 were 0.7%, 0.5%, 0%; for scores 4-9 were 5.0%, 3.7%, 8.9%; and for scores ≥ 10 were: 24.2%, 20.4%, 43.4%, respectively. The area under the curve receiver operating characteristic for predicting mortality by LACE index was 76% for COVID-19 and 77% for all non-COVID-19 patients. The risk of age and sex-adjusted mortality did not differ from the pre-pandemic group for COVID-19 patients with LACE index scores < 4. However, risk increased drastically for scores from 4 to 9: odds ratio = 3.74 (95% confidence interval = 2.63-5.32), and for scores ≥ 10: odds ratio = 4.02 (95% confidence interval = 3.38-4.77). In conclusion, patients with LACE index scores ≥ 4 have disproportionally greater risk of COVID-19 hospital admissions and deaths, in support of previous studies in patients without COVID-19. However, of importance, our data also emphasise their increased risk in patients with COVID-19. Because the LACE index has a good predictive power of mortality, it should be considered for routine use to identify high-risk COVID-19 patients.
| S-EPMC9216304 | biostudies-literature