Estimating Subnational Excess Mortality in Times of Pandemic. An application to French<i>départements</i>in 2020

Bonnet, Florian; Camarda, Carlo Giovanni

doi:10.1101/2022.12.12.22283346

Cited by 5 publications

(7 citation statements)

References 44 publications

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“…Dealing with yearly mortality data, we place greater emphasis on refining the time windows employed in forecasting expected mortality in the absence of a pandemic. Sensitivity analyses and comparisons of various alternative approaches for estimating baseline mortality levels have been proposed across diverse data structures [36, 37, 38, 39]. Exploring these alternatives could provide additional insights.…”

Section: Discussionmentioning

confidence: 99%

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Beyond Borders: Spatial Disparities in the Mortality Burden of the Covid-19 pandemic across 569 European Regions (2020-2021)

Bonnet,

Grigoriev,

Sauerberg

et al. 2023

Preprint

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This article presents a detailed analysis of the global mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost (ASYLL) in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a robust forecasting approach that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). Most importantly, we estimate that eight regions suffered losses exceeding 20 years of life per 1,000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic’s impact.

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Section: Discussionmentioning

confidence: 99%

“…The starting year with the lowest deviance value was selected for the final analysis. More information about this approach can be found in [39].…”

Section: Methodsmentioning

confidence: 99%

Beyond Borders: Spatial Disparities in the Mortality Burden of the Covid-19 pandemic across 569 European Regions (2020-2021)

Bonnet,

Grigoriev,

Sauerberg

et al. 2023

Preprint

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“…It is noteworthy that the whole procedure can be performed for any given age and regardless of the mortality indicator selected for estimating excess mortality (e.g., life expectancy or age-standardized death rate). More details on this approach can be found in [27]. All calculations are performed in R [32].…”

Section: Methodsmentioning

confidence: 99%

“…In dealing with small geographical areas, we focus on point-estimates as much as on uncertainty quantification. In order to obtain the mortality levels that would have been observed in 2020 in the absence of the pandemic, we took a robust forecasting approach that accounts for regional diversity and delivers analytic confidence intervals that account for all sources of uncertainty [27]. Furthermore, this study also identifies geographical clusters of high and low losses of life expectancy.…”

Section: Introductionmentioning

confidence: 99%

Spatial variation in excess mortality across Europe: a cross-sectional study of 561 regions in 21 countries

Bonnet

Grigoriev

Sauerberg

et al. 2023

Preprint

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Objective: To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. Design: Statistical and demographic analyses of regional all-cause mortality data. Setting: The vital statistics systems of 21 European countries. Participants: The entire population of 561 spatial units in 21 European countries. Main Outcome Measures: Losses of life expectancy at ages 0 and 60 for males and females. Results: Evidence was found of a loss in life expectancy in 391 regions, while only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years, and three regions showed losses greater than 3 years. Geographic clusters of high mortality were found in Northern Italia, Spain and Poland, while clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden. Conclusions: Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.

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“…These national estimates, however, hide an uneven impact of the pandemic across subnational populations [8]. Indeed, previous studies have shown important inequalities in the mortality impact of COVID-19 by region [8][9][10][11][12], sex [13][14][15], socio-economic status [16][17][18], and race [17][18][19], and generally, higher case-fatality rates have been reported among older age groups [14,20]. Still, however, more work is needed to obtain a detailed picture of the mortality impact of the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

Marinetti,

Jdanov,

Grigoriev

et al. 2023

PLoS ONE

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The mortality impact of COVID-19 has mainly been studied at the national level. However, looking at the aggregate impact of the pandemic at the country level masks heterogeneity at the subnational level. Subnational assessments are essential for the formulation of public health policies. This is especially important for federal countries with decentralised healthcare systems, such as Germany. Therefore, we assess geographical variation in the mortality impact of COVID-19 for the 16 German federal states in 2020 and 2021 and the sex differences therein. For this purpose, we adopted an ecological study design, using population-level mortality data by federal state, age, and sex, for 2005–2021 obtained from the German Federal Statistical Office. We quantified the impact of the pandemic using the excess mortality approach. We estimated period life expectancy losses (LE losses), excess premature mortality, and excess deaths by comparing their observed with their expected values. The expected mortality was based on projected age-specific mortality rates using the Lee-Carter methodology. Saxony was the most affected region in 2020 (LE loss 0.77 years, 95% CI 0.74;0.79) while Saarland was the least affected (-0.04, -0.09;0.003). In 2021, the regions with the highest losses were Thuringia (1.58, 1.54;1.62) and Saxony (1.57, 1.53;1.6) and the lowest in Schleswig-Holstein (0.13, 0.07;0.18). Furthermore, in 2021, eastern regions experienced higher LE losses (mean: 1.13, range: 0.85 years) than western territories (mean: 0.5, range: 0.72 years). The regional variation increased between 2020 and 2021, and was higher among males than among females, particularly in 2021. We observed an unequal distribution of the mortality impact of COVID-19 at the subnational level in Germany, particularly in 2021 among the male population. The observed differences between federal states might be partially explained by the heterogeneous spread of the virus in 2020 and by differences in the population’s propensity to follow preventive guidelines.

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Estimating Subnational Excess Mortality in Times of Pandemic. An application to Frenchdépartementsin 2020

Cited by 5 publications

References 44 publications

Beyond Borders: Spatial Disparities in the Mortality Burden of the Covid-19 pandemic across 569 European Regions (2020-2021)

Beyond Borders: Spatial Disparities in the Mortality Burden of the Covid-19 pandemic across 569 European Regions (2020-2021)

Spatial variation in excess mortality across Europe: a cross-sectional study of 561 regions in 21 countries

Effects of the COVID-19 pandemic on life expectancy and premature mortality in the German federal states in 2020 and 2021

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