Population Health Metrics最新文献

Background: Climatic factors have been associated with the occurrence of several diseases known as climate-sensitive diseases (CSDs). We selected the following categories of disease to represent CSDs for this study: vector-borne diseases (dengue, leishmaniasis, malaria, schistosomiasis, yellow fever, and zika), infectious-diseases (respiratory infections), non-communicable diseases (chronic respiratory and cardiovascular diseases) and water-borne diseases (diarrhea). This study aimed to describe the historical trends and spatial distribution of mortality and morbidity of these selected Climate Sensitive Diseases in Brazil between 1990 and 2017. The analysis is based on findings obtained by the 2017 Brazilian Global Burden of Diseases (GBD) Study.

Methods: Yearly CSD data was taken from the 2017 Brazilian GBD Study for the years between 1990 and 2017. This data was organized by age group and sex at the country level, for 26 states and one Federal District (known as Federative Units), and at the regional level.

Results: Cardiovascular and respiratory diseases presented the greatest disability adjusted life-years (DALYs) in Brazil, followed by chronic and infectious respiratory diseases, although only a small fraction could be attributed to climate changes. Among the vector-borne diseases, the burden of leishmaniasis and malaria have decreased since 1990, while the burden of dengue has increased. The burden of other vector-borne diseases (malaria and yellow fever) increased since 2015, in addition to the recent introduction of zika virus in Brazil. The GBD rates of infectious diseases were greater in predominately the Amazon and northeast regions. This finding contrasts with dengue and zika for which an increase in DALYs rate was observed southeast and central-west, besides the northeast region. The lowest DALYs rates for dengue were observed in the south region, which also experiences the lowest temperatures.

Conclusions: The burden of CSDs in Brazil has increased since 1990 considering non-communicable and communicable diseases. The potential impact of climate change on such diseases must be evaluated considering disease dynamics and spatial specificities, such as land cover and climate patterns. The main challenges in Brazil related to CSDs are the investments needed for research regarding the increase in the burden of CSDs, for vector control and social health determinants mitigation.

Background: The COVID-19 pandemic has significantly increased mortality rates, disrupting historical trends and making it challenging to forecast future life expectancy levels. São Paulo, the first city in Brazil to report a COVID-19 case and death, saw a decrease of over four years in life expectancy at birth for males and over three years for females between 2019 and 2021. São Paulo has been at the forefront of the demographic transition in the country and experienced a nonlinear mortality decline over the twentieth century. The city's historical mortality trajectory and the disruptive effects of COVID-19 have introduced challenges to mortality forecasting.

Methods: In this study, we used a unique dataset dating 1920-2022 to forecast life expectancy in São Paulo until 2050 using the Lee-Carter and Lee-Miller methods. Mortality rates were obtained from a combination of deaths gathered by the SEADE Foundation (SEADE) and population collected by the Brazilian Institute of Geography and Statistics. To mitigate the dependency on the fitting period's choice and better incorporate the effects of the recent mortality shock, we used different baseline periods, using all years from 1920 to 1995 as the starting year of the analysis and six scenarios for post-pandemic mortality levels. Prediction intervals were derived from simulated trajectories of the models' time indices. Based on 73,200 simulations for each year between 2023 and 2050, we synthesized the resulting life expectancy forecasts into median values and 95% prediction intervals (PI).

Results: By 2050, we predict that life expectancy at birth in São Paulo will reach approximately 81.4 years for men and 88.3 years for women. Also, within the 95% PI, we estimated that by 2045, male life expectancy could reach the levels of best-performing countries.

Conclusions: Our approach is among the first attempts to forecast mortality in the presence of shocks. Additionally, by evaluating different baseline periods, we advocate for the adoption of more accurate forecasting strategies, particularly in contexts of recent mortality decline. These findings provide valuable resources for policymakers and researchers working to address public health challenges arising from the pandemic and plan for the future well-being of many populations.

Background: The COVID-19 pandemic profoundly disrupted workplace attendance, yet its impact on cause-specific work absence remains largely unexplored.

Aim: To estimate the cause-specific excess/reduced work absence associated with COVID-19 in Poland.

Methods: Following the concept of excess mortality, we define excess work absence as the difference between observed and expected absence, where the latter reflects the level anticipated in the absence of the pandemic. Using time-series analysis (Seasonal Autoregressive Integrated Moving Average) on pre-pandemic (2012-2019) quarterly (Q) social insurance data, we forecasted absence rates for disease groups (classified by ICD-10 chapters) and caregiving-related absenteeism. Forecasted absence rates were then compared to observed values during 2020-2024, allowing for the identification of excess or reduced work absence.

Results: We observed notable deviations in work absence rates during the pandemic period (until the end of Q1-2022). The highest excess absence was identified in caregiving-related absenteeism at the pandemic's onset, exceeding expected levels by over fivefold. A mental health crisis that began with the pandemic resulted in four consecutive quarters of excess absence, reaching a 54% excess in Q2-2020. We identified a notable excess absence in three ICD-10 chapters that reflect the indirect effects of the pandemic, such as increased diagnostic uncertainty, modified coding practices during early COVID-19 waves, and widespread implementation of public health interventions. Absence rates were lower than expected in neoplasms, endocrine and digestive diseases until the end of the pandemic period, likely reflecting reduced healthcare accessibility. Similarly, absence related to injuries and poisoning was below the expected level until mid-2022, indicating decreased social mobility.

Conclusions: COVID-19 substantially reshaped work absence patterns in Poland, particularly during the early pandemic phase. Pronounced increases and decreases were identified across disease categories. These diverging trends plausibly reflect both the COVID-19's effects on the development of other conditions and disruptions in healthcare access. These findings highlight the need for disease-specific policy responses to mitigate future health crises and ensure continuity of care during pandemics.

Background: Previous research has explored the association between the ratio of high-density lipoprotein cholesterol to C-reactive protein (HDL-C/CRP) and the mortality risk in individuals with heart failure. This study aims to investigate the correlation between HDL-C/CRP ratio and all-cause mortality through the analysis of extensive data derived from the general public.

Methods: This study analyzed NHANES data and surveyed 28,544 adults from America. Survival outcomes were evaluated using Kaplan-Meier curves, while a survey-weighted multivariable Cox proportional hazards model was employed. Restricted cubic splines (RCS) and hierarchical analysis were used to investigate associations and interactions, respectively. Additionally, the ability of lnHDL-C/CRP to predict all-cause death was assessed using receiver operating characteristic curves.

Results: During a mean follow-up period of 156.5 months, 5965 (20.9%) died from any cause. Weighted RCS analysis revealed an L-shaped association between HDL-C/CRP ratio and all-cause mortality. Below a lnHDL-C/CRP of 6.65 (HDL-C/CRP ratio of 773), the likelihood of all-cause death decreased by 14% with every 1-point rise in lnHDL-C/CRP [HR (95% CI) 0.86 (0.81, 0.90)]. Including lnHDL-C/CRP in the baseline risk model significantly enhanced its predictive power for mortality. Consistent findings were observed in subgroups, with individuals under 60 years or with a BMI over 30 showing a stronger correlation between HDL-C/CRP ratio and overall mortality risk.

Conclusions: The association between HDL-C/CRP ratio and overall mortality in the general US adult population is non-linear, particularly significant in adults under 60 years old and obese individuals. HDL-C/CRP ratio could be regarded as a potential marker for assessing mortality risk.

Purpose: The worldwide population is facing the aging issue. Additionally, the COVID-19 pandemic has decreased the living standards of elders. Therefore, understanding the impact factors changing the quality of life of the elderly, and considering the effects of the COVID-19 pandemic, has become a focus for central and local governments, as well as individual families.

Methods: This study analyses newly designed comprehensive relationship networks related to the quality of life of elders in association with the COVID-19 phenomenon. Construct validity was assessed using exploratory factor analysis and confirmatory factor analysis. A partial least squares structural equation model was employed to identify the path relationships. Multiple logistic regression was conducted to investigate the impact of demographic information on the quality of life of the elderly.

Results: The findings indicate that the quality of life is directly and strongly influenced by factors such as psychological distress, COVID-19, quality of daily living, and group and individual activities. Companionship particularly affects the latter two factors for elderly individuals. Additionally, COVID-19 significantly impacts companionship due to the perceived isolation it brings to the elderly. Furthermore, the medical condition factor affects psychological distress, suggesting that the health status of the elderly influences their mental well-being. Moreover, the good diet quality factor strongly influences the spiritual and material aspects of life as well as the mental and physical health of elders. Other factors influencing the physical health of elders include demographics, gender, age, marital status, and homeownership status.

Conclusion: These findings show the necessity of taking care of, accompanying, and improving the medication conditions of the elderly, especially during the period of COVID-19.

The global COVID-19 pandemic has presented healthcare systems and economies with unprecedented challenges. Like many other countries, Egypt has experienced the pandemic's multifaceted effects. As new variants continue to emerge, countries are enhancing their preparedness and response strategies in anticipation of possible future outbreaks. This review article focuses on Egypt and discusses the impact of the COVID-19 pandemic on the country's economy. It also examines the country's preparedness for a potential resurgence of COVID-19. Further, it explores Egypt's vaccination campaign, discussing the progress in achieving population immunity and the potential challenges encountered. It also extends to the public health communication strategies employed by the government, investigating their efficacy in disseminating accurate information and fostering public adherence to safety measures. While recognizing progress, the article also flags possible gaps and opportunities for improvement in Egypt's pandemic preparedness.

Background: Measurement of excess mortality attributable to the COVID-19 pandemic is essential for quantifying the direct and indirect effects on mortality and informing future public health control strategies. This study assessed the impact of COVID-19 on excess mortality and life expectancy at birth in rural northern Ghana.

Methods: Data was obtained from the Navrongo Health and Demographic Surveillance System (NHDSS) in Ghana. We computed the number of deaths and person-years contributed from January 1, 2015, to December 31, 2021, and estimated mortality rates for each year, age group, and gender. Mortality rate differences were calculated by comparing the period before (2018-2019) and during (2020-2021) the pandemic. To estimate excess mortality, a generalised additive model was fitted to the historical data from 2015 to 2019 to predict the expected mortality rates in the COVID-19 period (2020-2021). A Cox proportional hazards model was fitted to assess the risk factors associated with mortality, adjusting for socio-demographic variables. Conventional life table techniques were used to estimate period life expectancy at birth for males and females.

Results: Overall, 12,413 deaths and 1,227,115 person-years were included in the analysis. This consists of 5,930 (49%) deaths and 572,963 person-years for the pre-pandemic period (2015-2019) and 6,483 (52%) deaths and 654,153 person-years for the pandemic period (2020-2021). From 2020 to 2021, the crude mortality rate was 23.9 deaths per 1000 person-years compared with 20.7 deaths per 1000 person-years predicted if COVID-19 had not occurred. COVID-19 also caused a decline in life expectancy at birth, especially in males, by 3.4 years. In addition, the adjusted risk of dying during the pandemic was higher in males (12.1%) compared to females and higher in the 65 + years age group (69.2%) compared to the younger population.

Conclusion: The COVID-19 pandemic caused an increase in deaths and a decrease in life expectancy in the NHDSS population in Ghana, particularly among men and those aged 65 years and older. These results reinforce the critical role of routine surveillance data in assessing the impact of public health emergencies such as the COVID-19 pandemic and informing public health strategies.

Background: Globally, the COVID-19 pandemic greatly interrupted healthcare programmes, and resulted in excess deaths. The age-specific mortality profile of the COVID-19 disease indicates that older people and those with comorbidities, specifically diabetes and hypertension, face a higher risk of mortality. In South Africa, excess deaths from natural causes in 2020 and 2021 were estimated to be nearly three times higher than the reported COVID-19 deaths. The study aims to characterise and compare mortality changes over the period 2015-2021 among individuals receiving care for HIV, hypertension and diabetes, in a rural South African setting.

Methods: Data from the Agincourt Health and Demographic Surveillance System and the Hospital-Clinic link system was used to characterise the sex and age-specific mortality patterns for HIV, hypertension, and diabetes for the period before (2015-2019) and during the COVID-19 pandemic (2020-2021). Cox regression model was used to investigate the risk factors associated with death before and during the COVID-19 period for individuals receiving care for these three major chronic conditions of interest in South Africa.

Results: Among individuals receiving care for chronic conditions in primary healthcare facilities there was a general increase across the years from 2015 to 2021; HIV from 23.3 to 48.8%; for hypertension from 31.1 to 46.1%; and for diabetes from 5.1 to 6.4%. Mortality rates, particularly among females, as well as individuals, aged 65+, increased from 2019 to 2021 (during the pandemic) reversing the progressive declining trend from 2016 to 2019. Mortality rate among persons with HIV, and diabetes or hypertension increased by up to 26% and 70%, respectively during the COVID-19 pandemic period, particularly among women. Differences were noted across individual and household factors, with age, sex, and education being associated with mortality risk for persons living with HIV, hypertension and/or diabetes.

Conclusions: This study shows increased mortality during the COVID-19 pandemic for individuals with chronic conditions in a rural South African setting, particularly among the elderly with hypertension, and diabetes, as well as those with comorbidity. The findings highlight the need to strengthen HIV, diabetes, and hypertension screening and care programmes to improve survival outcomes, especially in times of pandemics like COVID-19.

Background: Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual's COVID-19 vulnerability, based on a scoring algorithm developed in South Africa.

Methods: The analysis was undertaken using data from a health and demographic surveillance system (HDSS) in Soweto and Thembelihle, Gauteng, South Africa. Health and demographic population-based data have been collected from the HDSS area since 2018. Using indicators included in a COVID-19 Vulnerability Index, previously developed in South Africa, the current study established a composite COVID-19 vulnerability index, stratified into tertiles. The risk of death pre-COVID-19 (1 January 2018-28 February 2020) and during the COVID-19 period (1 March 2020-31 December 2021) was analysed. A Cox proportional hazard model was used to compare the risk of death between the two time periods. Statistical analyses were conducted using Stata software version 17.

Results: Before COVID-19, overall mortality rates were 8.1 (95% CI 7.6-8.8), 7.0 (95% CI 6.4-7.7) and 6.1 (95% CI 5.5-6.7) per 1000 person-years in the lowest, middle, and highest tertile of vulnerability index, respectively. All cause-mortality across all tertiles more than doubled during the COVID-19 period compared to pre-COVID-19 (15.5 against 7.2). The mortality rates during the COVID-19 era were 17.1 (95% CI 16.3-18.0), 14.5 (95% CI 13.4-15. 7) and 13.7 (95% CI 12.8-14.7) per 1000 person-years in the lowest, middle, and highest tertiles, respectively. Overall, individuals in the highest tertile of COVID-19 vulnerability were at a significantly lower risk of death relative to those in the lowest tertile (aHR 0.9, 95% CI 0.8-1.0, p < 0.05). The risk of dying during the COVID-19 period for vulnerable individuals was at least double compared to the pre-COVID-19 period for each of the individual vulnerability indicators.

Conclusions: All-cause mortality during the COVID-19 era was significantly higher than the pre- COVID-19 period, with the increase observed across all vulnerability tertiles. It is important to identify vulnerable individuals and communities during the early stages of a pandemic to inform prioritisation of public health intervention.

Background: Single-child families represent an expanded phenomenon in recent years due to prevailing socio-economic challenges. The single childbirth phenomenon can potentially cause negative population growth and undesirable effects on families. Thus, this study aimed to determine the prevalence (percent) of single-child families with an emphasis on interfering associated factors.

Methods: For paper collection, valid databases of PubMed, Embase, ScienceDirect, Web of Science, Scopus, and Google Scholar search engine were systematically searched. All relevant studies were transferred to EndNote software (v.8) for duplicate detection. Primary and secondary screenings were applied and eligible studies enrolled for meta-analysis (CMA v.2). In this regard, the random effect model was employed and the I² index was used for heterogeneity assessment.

Results: Following the examination of 33 studies, the prevalence (percent) of single-child families was found 41.3% (95% CI:33.1-49.9%). Meta-regression analysis revealed that following the acceleration in sample size and year of paper publication, the prevalence (percent) of single-child family increases and decreases (p < 0.05). Additionally, various influential factors effective on single-child families were listed as income status, financial difficulties, religious beliefs, educational level, and employment status.

Conclusion: According to the relatively high prevalence (percent) of single-child families and the influential impacts on families and communities, the findings of this study can provide valuable insights for policymakers to design appropriate policies and achieve demographic balance.