The top three causes of prematuremortality in Belgrade 2020

Abstract Background Analysis of years of life lost (YLL) due to premature deaths during the COVID-19 pandemic can direct decision-makers towards specific public health recommendations in order to improve health and lives of people. Our study aimed to examine the existence of age- and sex-specific patterns of the three most common causes of premature death in Belgrade during the first year of the COVID-19 epidemic. Methods Mortality data disaggregated by age, sex and cause of death, as well as the estimated number of inhabitants and remaining life-expectancy by age-groups for Belgrade was provided by the Statistical Office of the Republic of Serbia. YLLs were calculated using the methods of the Global Burden of Disease Study, without garbage code redistribution. Mortality rates were standardized according to the European Standard Population. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network. Results In 2020 in Belgrade, according to the share in all-cause YLLs, cardiovascular diseases ranked first (36.2%), followed by neoplasms (25.7%) and COVID-19 (11.1%). However, on average, COVID-19 generated higher number of YLLs per death case (11.9) than cardiovascular diseases (9.2), but fewer than neoplasms (13.9). In total of 31,943 YLLs due to COVID-19, men had 1.7 times more YLLs than women. By age groups, the highest YLL share due to COVID-19 was among men aged 45-49 (16%) and 70-74 (16%) and among women aged 20-25 (33%) and 25-29. years (29%). In men, COVID-19 YLL rate was 2,488 per 100,000 and was higher after standardization (2,714). In women, COVID-19 YLL rate was 1346 per 100,000 and was lower after standardization (1,245). Conclusions In Belgrade, COVID-19 was the third cause of premature mortality in 2020. The difference between COVID-19 YLL rates in men and women were even more prominent after standardization. Future research is needed to determine the synergistic impact of COVID-19 and other causes of premature death. Key messages • In 2020, COVID-19 was among the top three causes of premature mortality among male and female contingents of the Belgrade population. • Assessing the causes of premature mortality is important for determining community health priorities.

Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities -4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic.

Key messages:
CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. Addequate trainning and work environment are essencial for proper work development.

Conclusions:
In Belgrade, COVID-19 was the third cause of premature mortality in 2020. The difference between COVID-19 YLL rates in men and women were even more prominent after standardization. Future research is needed to determine the synergistic impact of COVID-19 and other causes of premature death.

Key messages:
In 2020, COVID-19 was among the top three causes of premature mortality among male and female contingents of the Belgrade population. Assessing the causes of premature mortality is important for determining community health priorities.

Lessons:
There is a sizeable amount of people living without registration or/and health insurance. It is therefore critical not to forget these people when organizing public health measures, especially when addressing a pandemic or other infectious diseases (HIV, Hep C). Non-insurance is a known issue for universal access to care.