Population vulnerability to COVID-19 in Europe: a burden of disease analysis
Tóm tắt
Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19. Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability. Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden. Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.
Tài liệu tham khảo
Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press on behalf of the World Health Organization and the World Bank; 1996.
Klijs B, Nusselder WJ, Looman CW, Mackenbach JP. Contribution of chronic disease to the burden of disability. PLoS One. 2011;6(9):e25325 https://doi.org/10.1371/journal.pone.0025325.
Ebrahim SH, Ahmed QA, Gozzer E, Schlagenhauf P, Memish ZA. Covid-19 and community mitigation strategies in a pandemic. BMJ. 2020;368:m1066 https://doi.org/10.1136/bmj.m1066.
Matsushita K, Ding N, Kou M, Hu X, Chen M, Gao Y, et al. The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A systematic review and meta-analysis. medRxiv. 2020:20054155 https://doi.org/10.1101/2020.04.05.20054155.
Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HHX, Mercer SW et al. How many are at increased risk of severe COVID-19 disease? Rapid global, regional and national estimates for 2020. https://cmmid.github.io/topics/covid19/Global_risk_factors.html.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.
Brown GC. Living too long: the current focus of medical research on increasing the quantity, rather than the quality, of life is damaging our health and harming the economy. EMBO Rep. 2015;16(2):137–41.
Institute for Health Metrics and Evaluation. GBD Results Tool. Seattle: University of Washington; 2018. http://ghdx.healthdata.org/gbd-results-tool Accessed 10 Apr 2020.
Institute for Health Metrics and Evaluation. GBD 2017 causes of disease and injuries. Seattle: University of Washington; 2018. http://www.healthdata.org/sites/default/files/files/Projects/GBD/GBD_2017_heirarchies.zip Accessed 10 Apr 2020.
Public Health England. Guidance on social distancing for everyone in the UK. United Kingdom Government. https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults. Accessed 10 Apr 2020.
Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis. 2020:ciaa415 https://doi.org/10.1093/cid/ciaa415.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21 https://doi.org/10.1016/S2213-2600(20)30116-8.
Institute for Health Metrics and Evaluation. Global Health Data Exchange (GHDx). Seattle: University of Washington; 2020. http://ghdx.healthdata.org/ Accessed 10 Apr 2020.
European Centre for Disease Prevention and Control. Data on the geographic distribution of COVID-19 cases worldwide: European Union, 2020. https://www.ecdc.europa.eu/en/publications-data/download-todays-data-geographic-distribution-covid-19-cases-worldwide/. Accessed 28 Apr 2020.
State Chancellery of the Republic of Latvia. Press releases. https://mk.gov.lv/en/aktualitates/regarding-declation-emergency-situation. Accessed 28 Apr 2020.
Republic of Estonia Government. The government declared an emergency situation in Estonia until 1 May. https://www.valitsus.ee/en/news/government-declared-emergency-situation-estonia-until-1-may. Accessed 28 Apr 2020.
Steel N, Ford JA, Newton JN, Davis ACJ, Vos T, Naghavi M, et al. Changes in health in the countries of the UK and 150 English local authority areas 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2018;392(10158):1647–61 https://doi.org/10.1016/S0140-6736(18)32207-4.
Wyper GMA, Grant I, Fletcher E, McCartney G, Stockton DL. The impact of worldwide, national and sub-national severity distributions in burden of disease studies: a case study of cancers in Scotland. PLoS One. 2019;14(8):e0221026 https://doi.org/10.1371/journal.pone.0221026.
Wyper GMA, Grant I, Fletcher E, Chalmers N, McCartney G, Stockton DL. Prioritising the development of severity distributions in burden of disease studies for countries in the European region. Arch Public Health. 2020;78(3) https://doi.org/10.1186/s13690-019-0385-6.
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2016 (GBD 2016) Disability Weights. Seattle: United States: Institute for Health Metrics and Evaluation (IHME); 2017.