Background The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood. Objective To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations. Methods We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis. Results In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic. Conclusion The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.

Background-The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone. Especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. Objective-To estimate the excess deaths in the pandemic year of 2020 among the Kuwaitis and non-Kuwaiti migrants. Methods-We analyzed publicly available retrospective data on total annual mortality historically (2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis. Results-In the absence of the pandemic, we expect the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not had the pandemic. Conclusion-The mortality burden of the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.

Background: Generic medications are one of the most common solutions for bringing down pharmaceutical costs for both patients and health care providers. Efforts to increase uptake of generics include policies to support generic substitution and prescription. The aim of this study is to estimate the total cost of drugs prescribed by physicians in selected primary health care centers for managing hypertension and the potential cost savings from substituting generic drugs for branded ones. Methods and Findings: One thousand patients with hypertension were randomly selected from the Primary Care Information System database from among patients who sought treatment at three primary health care centers from Al-Jahra governorate in Kuwait from January to December 2018. Generic antihypertensive drugs were substituted for branded ones, and cost savings were calculated by referring to the International Drug Price Indicator Guide. The mean age of 1,000 patients was 57.01 (SD = 11.82) years. Most (57.4%) of the patients were females, and 50.2% were Kuwaitis. The mean number of drugs per prescription was 1.78 (SD = 1.25; range: 1 to 9 drugs). The total number of drugs prescribed was 1,781, with a total cost of KD 10,093 and with a mean of KD 10.09 (SD = 7.34). Only 71 generic drugs had been prescribed, making the generic prescription rate 4.0%. The total number of antihypertensive drugs prescribed was 1,206 (mean: 1.21; SD = 0.46), with a cost of KD 7,678.5 (mean = KD 7.68; SD = 4.06) and with ACE inhibitors as the most prescribed class at 32.19%. Eight hundred ninety antihypertensive drugs were substituted for 774 patients at estimated cost savings of KD 5,675; that is, substituting generic drugs reduced antihypertensive drug cost by 74%. Conclusion: Generic drug prescription appears to be low among primary care physicians in health care centers in Kuwait, but these centers could see substantial cost savings from substituting generic antihypertensive drugs for branded ones. Active interventions are needed to encourage generic prescription among health practitioners to reduce the overall pharmaceutical expenditures.