Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

Productivity losses from short-term work absence due to neoplasms in Poland.

Previous evidence on productivity losses from neoplasms focuses mostly on the economic burden from mortality, covers single cancer diagnoses and neglects non-malignant neoplasms. This study aims to broaden this perspective by analysing losses resulting from work absence and all neoplasm diagnoses. The analysis applies the human capital method and social insurance data to estimate productivity losses attributable to neoplasm-related short-term work absence in Poland in the period 2012-2022. The productivity losses due to work absence attributable to all neoplasms in Poland were €583 million in 2012 (0.143% of gross domestic product) and they increased to €969 million in 2022 (0.164%). Around 60% of the losses were associated with cancers while the remaining part of the burden was due to non-malignant neoplasms. The neoplasms that led to the highest losses were benign neoplasms, breast cancer, colorectum cancer and prostate cancer. The cancer sites characterised by the greatest losses per absence episode were brain cancer, lung cancer and oesophageal cancer. For most of the neoplasms, we observed increasing losses in an 11-year period analysed. Investing in effective public health policies that tackle neoplasms has the potential to reduce both the health burden and economic losses resulting from these diseases.

Production losses due to mortality associated with modifiable health risk factors in Poland.

BACKGROUND: Epidemiological burden of modifiable mortality risk factors is recognized in literature; however, less is known on the economic losses due to a range of such risks. AIM: To estimate production losses (indirect cost) of mortality associated with risk factors as classified in Global Burden of Disease 2019 Study in Poland in years 2000, 2010, and 2017. METHODS: We relied on the human capital method and societal perspective and used sex-, age-, region-, and risk-specific data on mortality due to modifiable risk factors and a set of socio-economic measures. RESULTS: The production losses due to mortality attributable to all investigated risk factors accounted for 19.6-21.0 billion PLN (Polish zloty; 2017 exchange rate: 1€ = 4.26 PLN) and 1.44-2.45% of gross domestic product, depending on year. Behavioural factors were the most important contributor to overall burden (16.7-18.2 billion PLN), followed by metabolic factors (6.8-7.6 billion PLN) and environmental and occupational factors (3.0-3.5 billion PLN). Of disaggregated risks, alcohol and tobacco, high systolic blood pressure, and dietary risks proved to lead to the highest losses. Cost per death was greatest for child and maternal malnutrition, followed by intimate partner violence and childhood sexual abuse and bullying. Moreover, a notable regional variation of indirect cost was identified with losses ranging from 1.21 to 1.81% of regional gross domestic product in 2017. CONCLUSION: Our findings provide economically hierarchised list of modifiable risk factors and they contribute to inform policy-makers in prioritizing programmes to improve health.

Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions.

Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999-2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0-9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians' density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.

Production losses attributable to suicide deaths in European Union.

BACKGROUND: Suicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015. METHODS: The study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat's data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates. RESULTS: The production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28's GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71-91%) were due to men's deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario. CONCLUSION: Public health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.

Sociodemographic and Health-Related Factors Associated with Severity of Cognitive Impairment in Elderly Patients Hospital-ized in a Geriatric Clinic.

Identification of risk factors for cognitive impairment is crucial for providing proper care and treatment. The aim of the study was to investigate the relationship between sociodemographic and health-related factors and the severity of cognitive impairment in elderly patients. In this retrospective study, we assessed the medical documentation of 323 patients aged 60+ years hospitalized in a geriatric clinic of university hospital. The patients were classified into five groups of cognitive impairment severity based on the Mini Mental State Examination and Clock Drawing Test. Kruskal-Wallis and Chi square tests and multivariate ordinal logistic regression were used to assess relationships involved. Cognitive impairment was identified in 84.2% of subjects. The following factors were indicative for higher level of cognitive disorders: primary and vocational education, older age, presence of vascular brain injury, and inability of walking independently. On the other hand, the factors associated with lower severity of cognitive impairment were co-morbid anxiety disorders, ischemic heart disease, and a higher BMI index. Dementia is one of the leading causes of disability and mortality in the elderly. Enhancing knowledge about the risk factors that worsen cognition is particularly relevant for accelerating the diagnosis of dementia and improving patient care.

Production losses associated with premature mortality in 28 European Union countries.

BACKGROUND: There has been a growing interest in the economic burden of mortality; however, a majority of evidence is concerned with particular diseases. Less is known on the overall cost of all-cause early deaths, principally in international context. Therefore, this study aims to estimate production losses of premature mortality across 28 European Union (EU-28) countries in 2015. METHODS: The human capital method was applied to estimate the production losses (indirect costs) of all-cause deaths occurring at working age. The sex- and age-specific data on the number of deaths were taken from Eurostat's database and a set of labour market measures was used to determine time of work during whole lifespan in particular countries. RESULTS: The total production losses of all-cause premature mortality in EU-28 in 2015 were €174.6 billion, adjusted for purchasing power parity. The per capita production losses associated with early deaths were €342.39 for the whole EU-28 population on average; Lithuania experienced the highest per capita burden (€643.68), while the average costs were lowest in Greece (€188.69). These figures translated to an economic burden of 1.179% of gross domestic product in EU-28 and this share ranged from 0.679% in Luxembourg to 3.176% in Latvia. Most of the losses were due to men's deaths and the proportion of losses associated with male mortality ranged from 64.7% in the Netherlands to 81.2% in Poland. CONCLUSIONS: Premature mortality is a considerable economic burden for European societies; however, the production losses associated with early deaths vary notably in particular countries.

Production Losses Associated with Alcohol-Attributable Mortality in the European Union.

The economic aspects of alcohol misuse are attracting increasing attention from policy makers and researchers but the evidence on the economic burden of this substance is hardly comparable internationally. This study aims to overcome this problem by estimating production losses (indirect costs) associated with alcohol-attributable mortality in 28 European Union (EU) countries in the year 2016. This study applies the prevalence-based top-down approach, societal perspective and human capital method to sex- and age-specific data on alcohol-related mortality at working age. The alcohol-attributable mortality data was taken from estimates based on the Global Burden of Disease Study 2016. Uniform data on labor and economic measures from the Eurostat database was used. The total production losses associated with alcohol-related deaths in the EU in 2016 were €32.1 billion. The per capita costs (share of costs in gross domestic product (GDP)) were €62.88 (0.215%) for the whole EU and ranged from €17.29 (0.062%) in Malta to €192.93 (0.875%) in Lithuania. On average, 81% of the losses were associated with male deaths and mortality among those aged 50-54 years generated the highest burden. Because alcohol is a major avoidable factor for mortality, public health community actions aimed at limiting this substance misuse might not only decrease the health burden but also contribute to the economic welfare of European societies.

Prevalence, Reasons, and Predisposing Factors Associated with 30-day Hospital Readmissions in Poland.

There is a growing interest in quality issues associated with hospital care, with readmissions (rehospitalizations) being one of the main areas of interest. Retrospective data from a 914-bed university hospital in Bydgoszcz, Poland, was used to identify 30-day readmissions in 2015. We developed a catalogue of reasons for rehospitalization and differentiated between planned and unplanned readmissions, as well as those related and unrelated to index (initial) hospitalization. Multilevel logistic regression was used to determine factors associated with readmission risk. A total of 12.5% of patients were readmitted within 30 days of being discharged. The highest readmission rates were identified in pediatric, transplantation, and urology patients. The highest share of readmissions was due to the specific nature of a disease and its routine treatment practice. Almost two-thirds of readmission cases were classified as unplanned and related to the index hospitalization. The following characteristics were associated with a higher risk of rehospitalization: female gender, residing >35 km from the hospital, longer than average and very short stays at index admission, higher comorbidity score, and admission to a high-volume hospital sector. Due to the importance of quality issues in health policy, the topic should be further pursued to identify evidence-based practices that would improve hospitals' performance.

Indirect costs and incidence of caregivers' short-term absenteeism in Poland, 2006-2016.

BACKGROUND: There is a growing interest in the costs of informal care; however, the results of previous studies mostly rely on self-reported data, which is subject to numerous biases. The aim of this study is to contribute to the topic by estimating the indirect costs of short-term absenteeism associated with informal caregiving in Poland with the use of social insurance data on care absence incidence. METHODS: The human capital method was used to estimate the indirect costs of caregiving from a societal perspective. The incidence of caregiving was identified based on the Social Insurance Institution's data on absence days attributable to care provided to children and other family members. Gross domestic product (GDP) per worker was used as a proxy of labour productivity. Deterministic one-way sensitivity analysis was performed. RESULTS: The indirect costs of short-term caregivers' absenteeism in Poland was €306.2 million (0.116% of GDP) in 2006 and increased to €824.0 million in 2016 (0.180% of GDP). The number of care absence days grew from 5.9 million (0.45 days per worker) in 2006 to 10.6 million (0.70 days per worker) in 2016. Approximately 85% of the total costs were attributable to child care. The results of the sensitivity analysis show that the indirect costs varied from the base scenario by - 30.8 to + 15.8%. CONCLUSION: Informal short-term caregiving leads to substantial productivity losses in the Polish economy, and the dynamic upward trend of care absence incidence suggests that the costs of caregiving are expected to rise in the future.

Indirect costs and public finance consequences of heart failure in Poland, 2012-2015.

BACKGROUND: As a consequence of unfavourable epidemiological trends and the development of disease management, the economic aspects of heart failure (HF) have become more and more important. The costs of treatment (direct costs) appear to be the most frequently addressed topic in the economic research on HF; however, less is known about productivity losses (indirect costs) and the public finance burden attributable to the disease. Therefore, the aim of this study was to estimate the indirect costs and public finance consequences of HF in Poland in the period 2012-2015. METHODS: The study uses a societal perspective and a prevalence-based top-down approach to estimate the following components of HF indirect costs: absenteeism of the sick and their caregivers, presenteeism of the sick, disability, and premature mortality. The human capital method has been chosen to identify the value of productivity losses attributable to HF and the public finance consequences of the disease. Deterministic sensitivity analysis was performed to assess the robustness of the results. RESULTS: The total indirect costs of HF in Poland were €871.9 million in 2012, and they increased to €945.3 million in 2015. In the period investigated, these costs accounted for 0.212-0.224% of GDP, an equivalent of 22.63€-24.59€ per capita. Mortality proved to be the main driver of productivity losses, with 59.3-63.4% of the total costs depending on year, followed by presenteeism (21.1-22.5%), disability (11.1-14.2%) and the sick's absenteeism (3.3-4.0%). The cost of caregivers' absenteeism was unimportant. The social insurance expenditure for benefits associated with HF accounted for €40.7 million in 2012 and €45.6 million in 2015 (0.56-0.59% expenditure for all diseases). The potential public revenue losses associated with HF were €262.7-€287.9 million. Sensitivity analysis showed that the costs varied by - 12.1% to + 28.8% depending on the model parameter values. CONCLUSION: HF is a substantial burden on the economy and public finance in Poland. By confronting the disease more effectively, the length and quality of life for those affected by HF could be improved, but society as a whole could also benefit from the increased economic output.

Economic situation and occupational accidents in Poland: 2002-2014 panel data regional study.

OBJECTIVES: Occupational accidents constitute a substantial health and economic burden for societies around the world and a variety of factors determine the frequency of accidents at work. The aim of this paper is to investigate the relationship between the economic situation and the rate of occupational accidents in Poland. MATERIAL AND METHODS: The analysis comprised data for 66 Polish sub-regions taken from the Central Statistical Office's Local Data Bank. The regression analysis with panel data for period 2002-2014 was applied to identify the relationships involved. Four measures of accidents were used: the rates of total occupational accidents, accidents among men and women separately as well as days of incapacity to work due to accidents at work per employee. Four alternative measures assessed the economic situation: gross domestic product (GDP) per capita, average remuneration, the unemployment rate and number of dwelling permits. The confounding variables included were: employment in hazardous conditions and the size of enterprises. RESULTS: The results of the regression estimates show that the number of occupational accidents in Poland exhibits procyclical behavior, which means that more accidents are observed during the times of economic expansion. Stronger relationships were observed in the equations explaining men's accident rates as well as total rates. A weaker and not always statistically significant impact of economic situation was identified for women's accident rates and days of incapacity to work. CONCLUSIONS: The results have important implications for occupational health and safety actions. In the periods of higher work intensity employers should focus on appropriate training and supervision of inexperienced workers as well as on ensuring enough time for already experienced employees to recuperate. In terms of public health actions, policy makers should focus on scrutinizing working conditions, educating employers and counteracting possible discrimination of injured employees. Int J Occup Med Environ Health 2018;31(2):151-164.

Productivity losses and public finance burden attributable to breast cancer in Poland, 2010-2014.

BACKGROUND: Apart from the health and social burden of the disease, breast cancer (BC) has important economic implications for the sick, health system and whole economy. There has been a growing interest in the economic aspects of breast cancer and analyses of the disease costs seem to be the most explored topic. However, the results from these studies are hardly comparable. With this study we aim to contribute to the field by providing estimates of productivity losses and public finance burden attributable to BC in Poland. METHODS: We used retrospective prevalence-based top-down approach to estimate the productivity losses (indirect costs) of BC in Poland in the period 2010-2014. Human capital method (HCM) and societal perspective were used to estimate the costs of: absenteeism of the sick and caregivers, presenteeism of the sick and caregivers, disability, and premature mortality. We also used figures illustrating public finance burden attributable to the disease. Deterministic sensitivity analysis was performed to assess the stability of the estimates. A variety of data sources were used with the social insurance system and Polish National Cancer Registry being the most important ones. RESULTS: Productivity losses associated with BC in Poland were €583.7 million in 2010 and they increased to €699.7 million in 2014. Throughout the period these costs accounted for 0.162-0.171% of GDP, an equivalent of 62,531-65,816 per capita GDP. Losses attributable to disability and premature mortality proved to be the major cost drivers with 27.6%-30.6% and 22.0%-24.6% of the total costs respectively. The costs due to caregivers' presenteeism were negligible (0.1% of total costs). Public finance expenditure for social insurance benefits to BC sufferers ranged from €50.2 million (2010) to €56.6 million (2014), an equivalent of 0.72-0.79% of expenditures for all diseases. Potential losses in public finance revenues accounted for €173.9 million in 2010 and €211.0 million in 2014. Sensitivity analysis showed that the results were robust to changes in the model parameters. CONCLUSIONS: The productivity losses attributable to BC in Poland were a sizable burden for the society. They contributed both to decreased economy output and to public finance deficit.

Gender bias and sex-based differences in health care efficiency in Polish regions.

BACKGROUND: Health differences between sexes are relatively well recognized, though less is known about the specificity of women's and men's health responsiveness to medical care. Applying data from Polish regions, this study identifies sex-based differences in medical care efficiency and investigates the reasons for these disparities in the gender bias context. METHODS: The study estimates sex-specific health production functions for regional data from Poland (1999-2013). Using panel-data regression, male and female life expectancies at ages 0, 15, 30, 45, 60 and 65 are regressed on a set of socioeconomic factors, with the primary interest in medical care proxied by doctor density. RESULTS: The results show that in Poland the association between life expectancy and doctor density was positive for both men and women; however, the coefficients for medical care were insignificant for those at birth and at the age of 30 for both sexes. The magnitude of health care for longevity was higher for men comparing to women at every age, though the difference between sexes was not statistically significant. The sex-based disparities in medical care efficiency were more pronounced at younger ages and they diminished with age. The inspection of data on the health system in Poland shows that male patients seemed to be in an advantageous position: the mean reimbursement per service for men was higher in most medical care areas; men reported less problems with access to health care; and their mortality trend exhibited more favorable evolution over time. Additionally, the association between other socioeconomic factors and health also differed across sexes, and several of these factors were more important for life expectancy than health care. CONCLUSION: Polish medical care suffers from gender bias, which possibly makes men more responsive to medical care. The disparities in the operation of medical care in Poland should be challenged to achieve more equal access to services between sexes and possibly to gain more health from the treatment of female patients.