Determinants of excess mortality during the COVID-19 pandemic in 18 countries of the CMOR consortium

Abstract   Many countries suffered excess all-cause mortality during the COVID-19 pandemic. This study aims to identify factors associated with excess mortality rates (EMR) in partaking countries during 2020. Weekly all-cause death counts for 2015-2020 were extracted from national databases for Australia, Austria, Brazil, Cyprus, Denmark, Estonia, France, Georgia, Israel, Italy, Mauritius, Norway, Peru, Slovenia, Sweden, USA, Ukraine and UK. EMR per 100,000 population were gauged using a 5-year mean baseline. Separate OLS multiple linear regressions explored pre-pandemic country profiles including healthcare system, geographic, socio-economic and population factors. Feature selection methods detected the main factors contributing to 2020 EMR. The health system model showed that an extra nurse per 1,000 and a 1% increase in Healthcare Access and Quality Index reduces EMR by 41.7% (p = 0.019) and 0.48% (p = 0.034). The model was statistically significant (R^2=0.415,p=0.018). Although the geographical model suggested that a 1% increase in neighbouring countries increased EMR by 0.42% (p = 0.078), population density and the model itself were statistically insignificant (p > 0.05). The socio-economic and population model indicated a 1% increase in service employed (% of employed) and investment (% GDP) was linked with a 43.4% (p = 0.01) and 43.7% (p = 0.01) fall in EMR. The model was significant (R^2=0.488, p = 0.007). Death registration quality and population share over 70 years, improved model performance (R^2=0.632), but neither approached nominal significance. EMR during the COVID-19 pandemic benefited from higher ratios of nurses to population and able and prompt healthcare. The geographic traits were trivial in explaining EMR variation. Higher ratios of service employed, and investment (% of GDP) were linked to lower EMR. These results help to inform policies now and in future pandemics to strengthen resilience against EMR. Key messages • This study identified which pre-pandemic factors affected EMR in partaking countries, adding to a growing body of work on the COVID-19 pandemic. • Higher ratios of nurses to population, able and prompt healthcare, higher % employed, and investment (% of GDP) were linked to lower EMR.


Background:
Low birth weight (LBW) and preterm birth are associated with an increased risk of neonatal death and chronic conditions across the life course. Reducing LBW is a global public health priority and requires strategies to improve healthcare during pregnancy. We aimed to assess the effect of a health policy providing full coverage of illness-related costs from 13 weeks of gestation through 8 weeks postpartum on birth outcomes and neonatal mortality in Switzerland.

Methods:
We applied a regression discontinuity design to administrative data gathered as part of a Swiss research program (NCCR on the Move). We included all children (N = 166,709) born between March 1, 2013 and February 28, 2015. The outcomes were birth weight (BW), gestational age (GA), LBW (<2,500 g) and very low birth weight (VLBW; <1,500 g), preterm (<37 weeks of gestation), and extremely preterm (<28 weeks), and neonatal ( 28 days) death. Children were exposed to the policy if they were born from March 1, 2014 onwards. We estimated the intention-to-treat effect of the policy using parametric regression models. Results: Children had a mean BW of 3,291 g and mean GA of 275 days. The prevalence of LBW was 6.4%, VLBW 1%, preterm 7.2%, and extremely preterm 0.4%, respectively. Some 0.3% newborn died within one month. The policy increased BW (mean difference = 13 g [95% confidence interval (CI): 1, 25]) and decreased the risk of LBW (odds ratio [OR] = 0.89; 95% CI: 0.82, 0.98) and VLBW (OR = 0.81; 95% CI: 0.64, 1.01). Additionally, the policy slightly decreased the risk of preterm birth (OR = 0.94; 95% CI: 0.87, 1.03), while it did not affect GA. Effect estimates for extremely preterm and neonatal mortality were imprecise and inconclusive.

Conclusions:
This quasi-experimental and population based-study of 166,709 live births between 2013 and 2015 in Switzerland provides evidence of a reduction in the risk of LBW, VLBW and preterm birth thanks to a health policy that fully covered healthcare services during maternity. Key messages: Free access to healthcare during pregnancy may mitigate adverse newborn health outcomes. A Swiss health policy that fully covered healthcare services during pregnancy reduced the risk of low birth weight and preterm births. regressions explored pre-pandemic country profiles including healthcare system, geographic, socio-economic and population factors. Feature selection methods detected the main factors contributing to 2020 EMR. The health system model showed that an extra nurse per 1,000 and a 1% increase in Healthcare Access and Quality Index reduces EMR by 41.7% (p = 0.019) and 0.48% (p = 0.034). The model was statistically significant (R^2 = 0.415,p = 0.018). Although the geographical model suggested that a 1% increase in neighbouring countries increased EMR by 0.42% (p = 0.078), population density and the model itself were statistically insignificant (p > 0.05). The socio-economic and population model indicated a 1% increase in service employed (% of employed) and investment (% GDP) was linked with a 43.4% (p = 0.01) and 43.7% (p = 0.01) fall in EMR. The model was significant (R^2 = 0.488, p = 0.007). Death registration quality and population share over 70 years, improved model performance (R^2 = 0.632), but neither approached nominal significance. EMR during the COVID-19 pandemic benefited from higher ratios of nurses to population and able and prompt healthcare. The geographic traits were trivial in explaining EMR variation. Higher ratios of service employed, and investment (% of GDP) were linked to lower EMR. These results help to inform policies now and in future pandemics to strengthen resilience against EMR.

Key messages:
This study identified which pre-pandemic factors affected EMR in partaking countries, adding to a growing body of work on the COVID-19 pandemic.
Higher ratios of nurses to population, able and prompt healthcare, higher % employed, and investment (% of GDP) were linked to lower EMR.

Background:
The global population is ageing and the need to promote health and well-being of this generation is essential. Co-creative practices can be solutions to welfare challenges in the health care sector and local policies. However, literature addressing co-creation of activities to promote health and wellbeing is sparse. The review aimed to identify health promotive activities co-created between the public and older people, the influence of co-creative activities on health and well-being of older people, and facilitators and barriers for doing cocreation.

Methods:
We searched for peer-reviewed and grey literature in eight scientific and five non-scientific databases. Two reviewers independently screened publications for eligibility according to inclusion and exclusion criteria and extracted data. An inductive thematic content analysis was applied for the analysis.

Results:
We included nineteen publications. Four themes related to cocreative activities emerged: ''Social activities'', ''Activities to create age-friendly environments'', ''Discussions of healthy ageing'', and ''Physical activities''. The co-creative activities influenced the overall well-being, and promoted active and healthy ageing, physical functioning, and quality of life. Identified facilitators for co-creation were the role of the facilitator, a supportive environment, recognition of competencies, while the main barriers were time and resources, and recruitment of participants.

Conclusions:
Few studies have investigated co-creation of activities to promote health and well-being of older people. The included studies dealt with activities in any form and not merely social and physical activities co-created. Future co-creation of activities with older people should consider the role of facilitators, the environment in which the co-creation takes place and value time, resources, and competencies of participants.

Key messages:
Studies on co-creation of activities to promote health and well-being of older people is sparse and must be explored further. Future research may focus on co-creation of social and physical activities to promote health and well-being of older people and consider known facilitators for co-creation.

Background:
The effective reproduction number (Rt) represents the average number of secondary cases generated by an infected person. During an outbreak, near-real-time monitoring of Rt constitutes a key indicator for detecting changes in disease transmission and assessing the effectiveness of interventions.
The estimation of Rt usually requires identifying infected cases in the population which is in practice challenging from available data. The purpose of this study was to compare Rt estimates for COVID-19 surveillance in France based on three data sources of different sensitivity and specificity for identifying infected cases.

Methods:
By applying a statistical method developed by Cori et al., we estimated Rt using (1) confirmed cases identified from positive virological tests among the tested population (2) suspected cases recorded by a national network of emergency departments (3) hospital admissions for COVID-19 recorded by a national administrative system to manage hospital's organization.

Results:
From June 2020 to March 2022, the estimates of Rt in France showed similar temporal trends regardless of the dataset.
Estimates based on the daily number of confirmed cases