No CrossRef data available.
Article contents
Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic
Published online by Cambridge University Press: 19 February 2024
Abstract
Objective:
The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education.
Methods:
An observational study was carried out, using linked populations and deaths’ data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017–2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison.
Results:
All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25–64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people.
Conclusion:
Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
- Type
- Original Research
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc
References
Kumar, A, Arora, A, Sharma, P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14:535-545.CrossRefGoogle ScholarPubMed
Pranata, R, Lim, MA, Huang, I, et al. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21:1470320320926899.CrossRefGoogle ScholarPubMed
Banerjee, A, Chen, S, Pasea, L, et al. Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic. Eur J Prev Cardiol. 2021;28:1599-1609.CrossRefGoogle ScholarPubMed
Sharma, R, Kuohn, LR, Weinberger, DM, et al. Excess cerebrovascular mortality in the United States during the COVID-19 Pandemic. Stroke. 2021;52:563-572.CrossRefGoogle ScholarPubMed
Maringe, C, Spicer, J, Morris, M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020;21:1023-34.CrossRefGoogle Scholar
Dubé, JP, Smith, MM, Sherry, SB, et al. Suicide behaviors during the COVID-19 pandemic: a meta-analysis of 54 studies. Psychiatry Res. 2021;301:113998.CrossRefGoogle ScholarPubMed
Rodríguez-Fernández, P, González-Santos, J, Santamaría-Peláez, M, et al. Psychological effects of home confinement and social distancing derived from COVID-19 in the general population-a systematic review. Int J Environ Res Public Health. 2021;18:6528.CrossRefGoogle ScholarPubMed
Nguyen, T, Buxton, JA. Pathways between COVID-19 public health responses and increasing overdose risks: a rapid review and conceptual framework. Int J Drug Policy. 2021;93:103236
CrossRefGoogle ScholarPubMed
Faust, JS, Krumholz, HM, Du, C, et al. All-cause excess mortality and COVID-19-related mortality among US Adults aged 25-44 years, March-July 2020. JAMA. 2021;325:785-787.CrossRefGoogle ScholarPubMed
Yasin, YY, Grivna, MG, Abu-Zidan, FM. Global impact of COVID-19 pandemic on road traffic collisions. Worl J Emerg Surg. 2021;16:51.CrossRefGoogle ScholarPubMed
Webman, F, Ketrakazas, C. Did the COVID-19 pandemic influence traffic fatalities in 2020? A presentation of first findings. IATSS Res. 2021;45:469-484.Google Scholar
Baek, EM, Kim, W-Y. The impact of COVID-19 pandemic on workplace accidents in Korea. Int J Environ Res Public Health. 2021:18:8407.CrossRefGoogle ScholarPubMed
Kuo, LW, Fu, CY, Liao, CA, et al. How much could a low COVID-19 pandemic change the injury trends? A single-institute, retrospective cohort study. BMJ Open. 2021;11:e046405.CrossRefGoogle ScholarPubMed
Ahmed, F, Ahmed, N, Pissarides, C, et al. Why inequality could spread COVID-19. Lancet Public Health. 2020;5:E240.CrossRefGoogle ScholarPubMed
Galea, S. The art of medicine. Compassion in a time of COVID-19. Lancet. 2020;395:1897-1898.CrossRefGoogle Scholar
Mamot, M, Allen, J. COVID-19: exposing and amplifying inequalities. J Epidemiol Community Health. 2020;74:681-682.Google Scholar
Burströn, B, Tao, W. Social determinants of health and inequalities in COVID-19. Eur J Public Health. 2020;30:617-618.CrossRefGoogle Scholar
Abrams, EM, Sxefler, SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. 2020;8:659-661.CrossRefGoogle ScholarPubMed
Mathew, J, Cummings, MJ, Matthew, R, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395:1763-1770.Google Scholar
Yoshikawa, Y, Kawachi, I. Association of socioeconomic characteristics with disparities in COVID-19 outcomes in Japan. JAMA Netw Open. 2021;4:e2117060.CrossRefGoogle ScholarPubMed
Ribeiro, KB, Ribeiro, AF, Veras, MASM, et al. Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil. Int J Epidemiol. 2021;50:732-742.CrossRefGoogle ScholarPubMed
Feldman, JM, Bassett, MT. Variation in COVID-19 mortality in the US by race and ethnicity and educational attainment. JAMA Netw Open. 2021;4:e2135967.CrossRefGoogle ScholarPubMed
Riou, J, Panczak, R, Althaus, CL, et al. Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis. Lancet Public Health. 2021;6:e683-e691.CrossRefGoogle ScholarPubMed
Drefahl, S, Wallace, M, Mussuno, E, et al. A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden. Nat Commun. 2020;11:5097.CrossRefGoogle ScholarPubMed
Troumbis, AY. Testing the socioeconomic determinants of COVID-19 pandemic hypothesis with aggregated Human Development Index. J Epidemiol Community Health. 2021:75:414-415.CrossRefGoogle Scholar
Shajbazi, F, Khazaei, S. Socio-economic inequality in global incidence and mortality rates from coronavirus disease 2019: an ecological study. New Microbes New Infect. 2020;38:100762.CrossRefGoogle Scholar
Buheji, M, Alderazi Am, Ahemed D, et al. The association between the initial outcomes of COVID-19 and the human development index: an ecological study. Hum Syst Manag. 2022;41:303-313.CrossRefGoogle Scholar
Mirahmadizadeh, A, Ghelichi-Ghojogh, M, Vali, M, et al. Correlation between human development index and its components with COVID-19 indices: a global level ecologic study. BMC Public Health. 2022;22:1549.CrossRefGoogle ScholarPubMed
Liu, K, Mu, H, Zhuang, Z, et al. Unexpected positive correlation between human development index and risk of infections and deaths of COVID-19 in Italy. One Health. 2020;10:100174.CrossRefGoogle ScholarPubMed
Groppo, MF, Groppo, FC, Figueroba, SR, et al. Influence of population size, the Human Development Index and the Gross Domestic Product on mortality by COVID-19 in the Southeast Region of Brazil. Int J Environ Res Public Health. 2022;19:1445.CrossRefGoogle ScholarPubMed
Palamin, CVC, Boschiero, MN, Valencise, FE. Human Development Index Is associated with COVID-19 case fatality rate in Brazil: an ecological study. Int J Environ Res Public Health. 2022;19:5306.CrossRefGoogle Scholar
Rai, A. The effect of region’s socio-economic and demographic characteristics on Covid-19 confirmed cases and deaths. J Indones Appl Econ. 2022;10:17-24.CrossRefGoogle Scholar
Martínez-Riseño, D, Pérez-Padilla, R, Fernández-Plata, R, et al. The impact of altitude on mortality rates from COVID-19 in Mexico. Arch Bronconeumol. 2022:830-833.CrossRefGoogle Scholar
The Organization for Economic Cooperation and Development (OECD). Health at a glance 2021: OECD Indicators. Paris: OECD Publishing; 2021. https://doi.org/10.1787/ae3016b9-en. Accessed March 16, 2022.CrossRefGoogle Scholar
Costa-Font, J, Jiménez Martin, S, Viola, A. Fatal underfunding? Explaining COVID-19 mortality in Spanish nursing homes. J Aging Health. 2021;33:607-617.CrossRefGoogle ScholarPubMed
Instituto Nacional de Estadística. Demography and population. Demographic phenomena, Life Tables. Results. https://www.ine.es/en/index.htm_do. Accessed March, 30, 2022.Google Scholar
McGowan, VJ, Bambra, C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health. 2022;7:e966-e975.CrossRefGoogle ScholarPubMed
Zaldo-Aubanell, Q, Campillo, I, López, F, et al. Community risk factors in the COVID-19 incidence and mortality in Catalonia (Spain). A population-based study. Int J Environ Res Public Health. 2021;18.Google ScholarPubMed
García, CN. Socioeconomic, demographic and healthcare determinants of the COVID-19 paìndemic: an ecological study of Spain. BMC Public Health. 2021;21:606.CrossRefGoogle ScholarPubMed
Vachtler, B, Michalski, N, Nowssadeck, E, et al. Socioeconomic inequalities in the risk of SARS-CoV-2 infection- First results from an analysis of surveillance data forma Germany. J Health Monitor. 2020;5(S7):18-28.Google Scholar
Carrat, F, de Lamballerie, X, Rahib, D, et al. Antibody status and cumulative incidence of SARS-CoV-2 infection among adults in three regions of France following the first lockdown and associated risk factors: a multicohort study. Int J Epidemiol. 2021;50:1458-1432.CrossRefGoogle ScholarPubMed
Pérez-Gómez, B, Pastor-Barriuso, R, Fernández-de-Larrea, N, et al. SARS-CoV-2 infection during the first and second pandemic waves in Spain: the ENE–COVID study. Am J Public Health. 2023;5:533-544.CrossRefGoogle Scholar
Lostao, L, Blane, D, Gimeno, G, et al. Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care. Health Place. 2014;25:19-25.CrossRefGoogle Scholar
Marí-Dell’Olmo, M, Gotsens, M, Pasarín, MI, et al. Socioeconomic Inequalities in COVID-19 in a European Urban Area: two waves, two patterns. Int J Environ Res Public Health. 2021;18(3):1256.CrossRefGoogle Scholar
Soriano, V, Ganado-Pinilla, P, Sanchez-Santos, M, et al. Main differences between the first and second waves of COVID-19 in Madrid, Spain. Int J Infect Dis. 2021;105:374-376.CrossRefGoogle ScholarPubMed
Glodeanu, A, Gullón, P, Bilal, U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70:102580.CrossRefGoogle ScholarPubMed
Aguilar-Palacio, I, Maldonado, L, Malo, S, et al. COVID-19 Inequalities: individual and area socioeconomic factors (Aragón, Spain). Int J Environ Res Public Health. 2021;18:6607.CrossRefGoogle ScholarPubMed
Instituto de Salud Carlos III. National Study of SARS-CoV-2 sero-Epidemiology in Spain (ENE-COVID). Fourth round report. https://portalcne.isciii.es/enecovid19/informes/informe_cuarta_ronda.pdf. Accessed March, 30, 2022.Google Scholar
Esteve, A, Permanyer, I, Boertien, D, et al. National age and co-residence patterns shape COVID-19 vulnerability. Proc Natl Acad Sci USA. 2020;117:16118-1612.CrossRefGoogle Scholar
Giorgi, J, Boertien, D. The potential impact of co-residence structures on socio-demographic inequalities in COVID-19 mortality. Genus. 2021;77:20.CrossRefGoogle ScholarPubMed
Madewell, ZJ, Yang, Y, Longini, IM Jr, et al. Household transmission of SARS-CoV-2: a systematic review and meta-analysis. JAMA Netw Open. 2020;3:e2031756.CrossRefGoogle ScholarPubMed
Li, W, Zhang, B, Lu, J, et al. Characteristics of household transmission of COVID-19. Clin Infect Dis. 2020;71:1943-1946.CrossRefGoogle ScholarPubMed
Thompson, HA, Mousa, A, Dighe, A, et al. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) setting-specific transmission rates: a systematic review and meta-analysis. Clin Infect Dis. 2021;73:e754-764.CrossRefGoogle Scholar
Instituto Nacional de Estadística. Population and housing censuses. Results, Tables Query. https://www.ine.es/censos2011/tablas/Inicio.d. Accessed March, 30, 2022.Google Scholar
Barnard, S, Fryers, P, Fitzpatrick, J, et al. Inequalities in excess premature mortality in England during the COVID-19 pandemic: a cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity. BMJ Open. 2021;11:e052646.CrossRefGoogle ScholarPubMed
Mena, GE, Martinez, PP, Mahmud, AS, et al. Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile. Sci. 2021;372:5298.CrossRefGoogle ScholarPubMed
Antonio-Villa, NE, Bello-Chavolla, OY, Fermín-Martínez, CA, et al. Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico. Int J Epidemiol. 2022;51:1711-1721.CrossRefGoogle ScholarPubMed
Alfaro, T, Martines-Folgar, K, Vives, A, et al. Excess mortality during the COVID-19 pandemic in cities of Chile: magnitude, inequalities, and urban determinants. J Urban Health. 2022;99:922-935.CrossRefGoogle ScholarPubMed
Chen, YH, Matthay, EC, Chen, R, et al. Excess mortality in California by education during the COVID-19 pandemic. Am J Prev Med. 2022;63:827-836.CrossRefGoogle ScholarPubMed
Oh, J, Min, J, Kang, C, et al. Excess mortality and the COVID-19 pandemic: causes of death and social inequalities. BMC Public Health. 2022;22:2293.CrossRefGoogle ScholarPubMed
Nannoni, S, de Groot, R, Bell, S, et al. Stroke in COVID-19: a systematic review and meta-analysis. Int J Stroke. 2021;16:137-149.CrossRefGoogle ScholarPubMed
Hessami, A, Shamshirian, A, Heydari, K, et al. Cardiovascular diseases burden in COVID-19: systematic review and meta-analysis. Am J Emerg Med. 2021;46:382-391.CrossRefGoogle ScholarPubMed
Strang, P, Hedman, C, Adlitzer, H, et al. Dying from cancer with COVID-19: age, sex, socioeconomic status, and comorbidities. Acta Oncol. 2021;60:1019-1024.CrossRefGoogle ScholarPubMed
Lee, AJX, Purshouse, K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer. 2021;124:1777-1784.CrossRefGoogle ScholarPubMed
Arons, MM, Hatfield, KM, Reddy, SC, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med. 2020;28:382:2081-2090.CrossRefGoogle Scholar
Kosar, CM, White, EM, Feifer, RA, et al. COVID-19 mortality rates among nursing home residents declined from March to November 2020. Health Aff (Millwood). 2021;40:655-663.CrossRefGoogle Scholar
Akhtar-Danesh, Baumann A, Crea-Arsenio, M, et al. COVID-19 excess mortality among long-term care residents in Ontario, Canada. PLoS One. 2022;17:e0262807.CrossRefGoogle ScholarPubMed
Schultze, A, Nightingale, E, Evans, D, et al. Mortality among care home residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65. Lancet Reg Health Eur. 2022;10(14):100295.CrossRefGoogle Scholar
Instituto Nacional de Estadística. Observational study of 4.3 million adults over the age of 65. Lancet Reg Health Eur. 2022;10(14):10029. https://www.ine.es/en/index.htmdo. Accessed March, 30, 2022.Google Scholar
Pulido et al. supplementary material
Pulido et al. supplementary material
File
28.4 KB