Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic.

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.

Avoidable mortality for causes amenable to medical care and suicide in physicians in Spain.

OBJECTIVE: To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. METHODS: All people aged 25-64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. RESULTS: The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. CONCLUSION: Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain.

[Magnitude and factors associated with the solitary death phenomenon of the elderly in the Valencian Community.] / Magnitud y factores asociados al fenómeno de la muerte solitaria del anciano en la Comunidad Valenciana.

OBJECTIVE: In the Valencian Community 23% of the elderly people live alone, representing the solitary death among aged persons an unwanted effect of aging. Our aim was to determine the magnitude of this phenomenon and its risk factors in the population over 64 years of the CV during the period 2015-2017. METHODS: Cross-sectional study was carried out. Household deaths of residents over 64 years of the CV during the 2015-2017 period were analyzed, with records on medical and judicial death certificates. Adjusted incidence rates, sociodemographic characteristics and causes of death were described. For the analysis of risk factors, a multivariate logistic regression was performed, taking the adjusted Odds Ratio (OR) as an association measure. A significance level α=0.05 and 95% confidence intervals (CI) were used. RESULTS: 417 cases were found. The adjusted rates were: in 2015, 17.3 (95% CI: 14.7-20.2); in 2016, 14.5 (95% CI: 12.1-17.2); and in 2017, 13.2 (95% CI: 11,0-15.8). The most frequent causes were circulatory (52.5%) and external (19.2%). After adjustment, gender (OR M / H: 2.40; 95% CI: 1.87-3.06), age (OR ≥76 / <76: 4.56; 95% CI: 3.53 -5.90), disability (OR No / Yes: 0.51; 95% CI: 0.31-0.85), season (ref: spring; summer OR: 2.34; 95% CI: 1.63-3 , 37) and population nucleus (rural / urban OR: 2.20; 95% CI 1.58-3.08), remained associated whit the MSA. CONCLUSIONS: The solitary death among aged persons is a phenomenon scarcely studied in our environment from public health. The magnitude in the CV is relevant, with a greater risk in men and at younger ages, as well as in summer and urban areas. Presenting disability represents a certain protection.

OBJETIVO: En la Comunidad Valenciana un 23% de los ancianos viven solos, representando la muerte solitaria del anciano un efecto indeseado del envejecimiento. Nuestro objetivo fue determinar la magnitud de este fenómeno y sus factores de riesgo en la población mayor de 64 años de la CV durante el período 2015-2017. METODOS: Estudio observacional, transversal. Se analizaron las defunciones domiciliarias de residentes mayores de 64 años de la CV durante el período 2015-2017, con datos de los certificados médicos y judiciales de defunción. Se describieron las tasas de incidencia ajustadas, características sociodemográficas y causas de muerte. Para el análisis de factores de riesgo se realizó una regresión logística multivariante tomando como medida de asociación la Razón de Odds (OR) ajustada. Se usó un nivel de significación α=0,05 y unos IC del 95%. RESULTADOS: Se encontraron 417 casos. Las tasas ajustadas fueron: en 2015, 17,3 (IC95%: 14,7-20,2); en 2016, 14,5 (IC95%: 12,1-17,2); y en 2017, 13,2 (IC95%: 11,0-15,8). Las causas más frecuentes fueron circulatorias (52,5%) y externas (19,2%). Los factores asociados a la MSA fueron el sexo (OR M/H: 2,40; IC95%: 1,87-3,06), edad (OR ≥76/<76: 4,56; IC95%: 3,53-5,90), discapacidad (OR No/Sí: 0,51; IC95%: 0,31-0,85), estación (ref: primavera; OR verano: 2,34; IC95%: 1,63-3,37) y núcleo de población (OR rural/urbano: 2,20; IC95%1,58-3,08). CONCLUSIONES: La magnitud de la muerte en solitario en la Comunidad Valenciana es relevante, existiendo un mayor riesgo en hombres y a edades más tempranas, así como en verano y áreas urbanas. Presentar discapacidad representa una cierta protección.