Dataset Information

COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study.

ABSTRACT:

Background

Peru has experienced unprecedented mortality and economic toll due to the COVID-19 (Coronavirus disease 2019) pandemic in 2020. We aimed to assess the association between socioeconomic factors and excess death rate, and to explore the relative contribution of these factors to the differences in excess death rate during January-December 2020.

Methods

Different national secondary data sources were used to describe excess death rates and different determinants, from distal to proximal. A confounding-adjusted multilevel mixed-effects linear regression was used to assess the association between these variables and excess death rates. Their relative contributions to the differences in excess death rate between the periods with the highest and lowest excess death rates were analyzed through regression-based Oaxaca-Blinder decomposition methods.

Findings

The excess death rate showed an increasing trend in all regions, with different slopes. The confounding-adjusted multilevel analysis showed that higher healthcare access was associated with lower excess death rates (difference (95%CI) -0.004 (-0.005, -0.002)), whereas COVID-19 incidence was associated with higher excess death rates (difference (95%CI) 0.052 (0.042, 0.063)). The decomposition analysis showed COVID-19 incidence (41.9%), per capita income (19.4%) and unemployment rate (14.6%) as the main risk factors, while the main protective factors included per capita health expenditure (44.7%), healthcare access (33.2%) and health insurance (12.1%).

Interpretation

Our study suggests that the excess death rate during the COVID-19 pandemic in Peru may have been influenced by other factors besides COVID-19 incidence, from distal to proximal drivers, including socioeconomic determinants, factors outside and within the health sector, and susceptibility factors. Further studies at individual level are needed to corroborate our findings.

SUBMITTER: Cajachagua-Torres KN

PROVIDER: S-EPMC9710104 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study.

Cajachagua-Torres Kim N KN Quezada-Pinedo Hugo G HG Huayanay-Espinoza Carlos A CA Obeso-Manrique Jordan A JA Peña-Rodríguez Víctor A VA Vidal Elisa E Huicho Luis L

Heliyon 20221130 12

<h4>Background</h4>Peru has experienced unprecedented mortality and economic toll due to the COVID-19 (Coronavirus disease 2019) pandemic in 2020. We aimed to assess the association between socioeconomic factors and excess death rate, and to explore the relative contribution of these factors to the differences in excess death rate during January-December 2020.<h4>Methods</h4>Different national secondary data sources were used to describe excess death rates and different determinants, from distal ...[more]

PMID: 36466573

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Project description:BackgroundThe COVID-19 pandemic has affected the world in multiple ways and has been a challenge for the health systems of each country. From the beginning, risk factors for the severity and mortality of the disease were considered, as the spread of the virus was related to the living conditions of each population.MethodsIn this ecological study we have evaluated the role of geography, precisely the altitude above sea level in the incidence and mortality of COVID-19 in Peru. Incidence and mortality data were taken from the open-access database of the government of Peru until March 2021. COVID-19 cases and COVID-19 mortality were treated as cases/density population and 1000 x cases/inhabitants while altitude was treated as continuous and as a categorical variable divided in 7 categories. The relationship between COVID-19 cases or deaths for COVID-19 and altitude as continuous variable was determined using Spearman correlation test. Meanwhile when altitude was considered as a categorical variable, Poisson regression or negative binomial analyses were applied.ResultsA significant inverse correlation was found between COVID-19 cases by population density and altitude (r=-0.37 p < 0.001). By altitude categories, the lowest risk for infection was observed between 3,000 and 3,500 m (IRR 0.08; 95% CI 0.05,0.12). Moreover, we found an inverse correlation between altitude and COVID-19 mortality (r=-0.39 p < 0.001). Also, the lowest risk for mortality was observed between 3,000 and 3,500 m (IRR 0.12; 95%CI 0.08; 0.18). Similar results were found when analyses were adjusted for inhabitants and stratified by sex.ConclusionThis study reports an inverse relationship between COVID-19 incidence and mortality with respect to the altitude of residence, particularly, a u-shaped protection is shown, with a highest benefit between 3000 and 3500 m. The possibility of using hypoxia as an alternative treatment requires more complex studies that should allow knowing the physiological and environmental mechanisms of the protective role.

Project description:ObjectiveDuring the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity and minimise the inpatient risk of contracting COVID-19. This study aims to identify the excess death rate in this population during the first wave of the pandemic.DesignA longitudinal cohort study of patients with fragility fractures identified by specific International Classification of Diseases (ICD)-10 codes. The first wave of the pandemic was defined as the 3-month period between 1 March and 1 June 2020. The control group presented between 1 March and 1 June 2019.SettingTwo acute National Health Service hospitals within the East Midlands region of England.Participants1846 patients with fragility fractures over the aforementioned two specified matched time points.Primary and secondary outcome measuresFour-month mortality of all patients with fragility fractures with a subanalysis of patients with fragility hip fractures.Results832 patients with fragility fracture were admitted during the pandemic period (104 diagnosed with COVID-19). 1014 patients presented with fragility fractures in the control group. Mortality in patients with fragility fracture without COVID-19 was significantly higher among pandemic period admissions (14.7%) than the pre-pandemic cohort (10.2%) (HR=1.86; 95% CI 1.41 to 2.45; p<0.001) adjusted for age and sex. Length of stay was shorter during the pandemic period (effect size=-4.2 days; 95% CI -5.8 to -3.1, p<0.001). Subanalysis of patients with fragility hip fracture revealed a mortality of 8.4% in the pre-pandemic cohort, and 15.48% during pandemic admissions with no COVID-19 diagnosis (HR=2.08; 95% CI 1.11 to 3.90; p=0.021).ConclusionsThere is a significant increase in excess death, not explained by confirmed COVID-19 infections. Altered care pathways and aggressive discharge criteria during the pandemic are likely responsible for the increase in excess deaths.

Project description:The Coronavirus Disease 2019 (COVID-19) pandemic has had a variable worldwide impact, likely related to country-level characteristics. In this ecological study, we explored the association of COVID-19 case rates (per 100,000 people) and death rates (per 100,000 people) with country-level population health characteristics, economic and human development indicators, and habitat-related variables. To calculate country-level COVID-19 case and death rates, the number of cases and deaths were extracted from the Johns Hopkins Coronavirus Resource Center through September 30, 2021. Country-level population health characteristics, economic, human development, and habitat-related indicators were extracted from several publicly available online sources of international organizations. Results were tabulated according to world zones and country economies. Unadjusted and adjusted multiple imputation linear regression analyses were performed to examine the association between country-level variables (per 1-standard deviation [SD] increase) and COVID-19 case and death rates. To satisfy the linear regression model assumptions of normality of residuals, we used the square root transformation of both outcomes. A total of 187 countries and territories were analyzed, with a median (25th, 75th percentiles) aggregate COVID-19 case rate of 3,605 (463, 8,228) per 100,000, a COVID-19 death rate of 45.9 (8.9, 137.1) per 100,000, and a case-fatality rate of 1.6% (1.2%, 2.6%). On multivariable analyses, each country-level 1-SD higher percentage of adults with obesity (β coefficient 13.7; 95% confidence interval [CI] 13.7; 8.9, 18.4), percentage of smokers (5.8; 95% CI 1.2, 10.5), percentage of adults with high blood pressure (4.9; 95% CI 0.3, 9.6), and gross national income (GNI) per capita (9.5; 95% CI 4.6, 14.5) was independently associated with higher square root of COVID-19 case rate, while average household size (-1.7; 95% CI -12.3, -3.2) was independently associated with lower square root of COVID-19 case rate. Similarly, each 1-SD higher percentage of adults with obesity (1.76; 95% CI 0.99, 2.52), percentage of adults with high blood pressure (1.11; 95% CI 0.48, 1.74), percentage of adults with physical inactivity (1.01; 95% CI 0.10, 1.191), and travel & tourism competitiveness index (1.05; 95% CI 0.06, 2.04) was independently associated with higher square root of COVID-19 death rate, whereas GNI per capita (-0.92; 95% CI -1.81, -0.03), and average household size (-1.07; 95% CI -1.87, -0.27) was independently associated with lower square root of COVID-19 death rate. This ecological study informs the need to develop country-specific public health interventions to better target populations at high risk for COVID-19, and test interventions to prevent transmission of SARS-CoV-2, taking into consideration cross-country differences in population health characteristics, and economic, human development and habitat-related factors.

Dataset Information

COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study.

Background

Methods

Findings

Interpretation

Publications

COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study.

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