Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January-August 2020.

BACKGROUND: Understanding the impact of the burden of COVID-19 is key to successfully navigating the COVID-19 pandemic. As part of a larger investigation on COVID-19 mortality impact, this study aims to estimate the Potential Years of Life Lost (PYLL) in 17 countries and territories across the world (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States [USA]). METHODS: Age- and sex-specific COVID-19 death numbers from primary national sources were collected by an international research consortium. The study period was established based on the availability of data from the inception of the pandemic to the end of August 2020. The PYLL for each country were computed using 80 years as the maximum life expectancy. RESULTS: As of August 2020, 442,677 (range: 18-185,083) deaths attributed to COVID-19 were recorded in 17 countries which translated to 4,210,654 (range: 112-1,554,225) PYLL. The average PYLL per death was 8.7 years, with substantial variation ranging from 2.7 years in Australia to 19.3 PYLL in Ukraine. North and South American countries as well as England & Wales, Scotland and Sweden experienced the highest PYLL per 100,000 population; whereas Australia, Slovenia and Georgia experienced the lowest. Overall, males experienced higher PYLL rate and higher PYLL per death than females. In most countries, most of the PYLL were observed for people aged over 60 or 65 years, irrespective of sex. Yet, Brazil, Cape Verde, Colombia, Israel, Peru, Scotland, Ukraine, and the USA concentrated most PYLL in younger age groups. CONCLUSIONS: Our results highlight the role of PYLL as a tool to understand the impact of COVID-19 on demographic groups within and across countries, guiding preventive measures to protect these groups under the ongoing pandemic. Continuous monitoring of PYLL is therefore needed to better understand the burden of COVID-19 in terms of premature mortality.

Equidade na distribuição geográfica de médicos nos serviços da atenção primária à saúde em Cabo Verde / Equitable geographical distribution of medical services in primary health care in Cape Verde

Esta dissertação é um estudo sobre a distribuição geográfica de médicos nos Serviços de Atenção Primária à Saúde (APS) em Cabo Verde, no ano de 2007, tendo como base o princípio da equidade. Realça o papel dos médicos da APS no fortalecimento da atenção primária como uma estratégia para a construção de sistemas de saúde mais equitativos. Parte do pressuposto de que Cabo Verde apresenta características específicas principalmente de naturezas geográfica e sócio-econômica que colocam desafios acrescidos aos esforços na tentativa de uma distribuição geográfica equitativa de médicos da APS entre os municípios, e, por outro lado, da constatação de que tem havido uma tendência de acentuado aumento do número de médicos da APS no Serviço Nacional de Saúde (SNS), particularmente a partir do ano 2004. O estudo procurou responder ao questionamento se a distribuição dos médicos da APS em Cabo Verde, no ano 2007, se deu de forma equitativa e orientada pelas necessidades de saúde das populações. Analisa-se o quadro sócio-sanitário do país, o sistema nacional de saúde focalizando sua estrutura, gestão dos recursos humanos, a legislação sanitária, organização da APS. Recorreu-se à formulação de um Índice de Necessidade de Saúde a partir de indicadores demográficos e socioeconômicos para a determinação das necessidades relativas de médicos entre os municípios. A comparação da quantidade de médicos da APS observada em cada município no ano 2007 com a respectiva quantidade determinada segundo a respectiva necessidade relativa de médicos permitiu identificar as iniqüidades. Como resultado, o estudo evidenciou existência de iniqüidades na distribuição de médicos em 17 municípios, de um total de 22. Iniqüidades na distribuição de médicos da APS foram também identificadas quando os dados foram analisados por regiões, entre os grupos de municípios de Barlavento e de Sotavento.

This dissertation is an analysis of the geographic distribution of Primary Health Care (PHC) physicians in Cape Verde, in 2007, based on the principles of equity. It emphasizes the role of doctors in the strengthening of primary care actions as a strategy of building more equitable health systems. It assumes that Cape Verde has particular geographic and socioeconomic characteristics that increase the challenges to all efforts made in order to achieve a more equitable distribution of PHC doctors per county; and, on the other hand, it’s assumed that there has been a trend of sharp increasing of the number of PHC doctors working for the National Health Service (NHS), particularly since 2004. The study tried to answer whether the distribution of PHC’s physicians among Cape Verde’s municipalities, in the year of 2007, was equitably organized and oriented by the health necessities of the people. The social and sanitary conditions of the country are analyzed as well as the NSH focusing on its structure, administration of human resources, sanitary legislation and organization of PHC. We were able to formulate an Index of Health Needs from demographic and socioeconomic indicators for determining the relative needs of physicians among the municipalities. The comparison between the quantity of PHC doctors observed in each municipality in 2007 with the corresponding amount determined according to their relative needs allowed us to identify the inequities. As a result, the study revealed the existence of inequities in the distribution of doctors in 17 counties from a total of 22. Inequities in the distribution of physicians from PHC were also identified when the data were analyzed by regions, among groups of municipalities from Barlavento and Sotavento.