Characteristics of Respiratory Syncytial Virus versus Influenza Infection in Hospitalized Patients of Peru: A Retrospective Observational Study.

Respiratory syncytial virus (RSV) and influenza infections are important causes of respiratory illness associated with hospitalizations in children in Peru; however, comparisons of RSV and influenza hospitalization across all age groups are not available in Peru. Therefore, we conducted an observational, retrospective study between May 2015 and October 2021 using hospitalization from RSV and influenza infection data obtained from SUSALUD (open data) in Peru to compare the baseline characteristics of sex, age, region, and infection type. For the study, 2696 RSV-infected and 1563 influenza-infected hospitalized patients from different age groups were included. Most hospitalizations from RSV infection and the influenza virus occurred in children <5 years of age (86.1% vs. 32.2%, respectively). Compared with influenza infection, RSV infection was less likely to occur in individuals ≥5 years of age (adjusted odds ratio (aOR) = 0.07; 95% confidence interval (CI), 0.06−0.08; p < 0.0001; compared to <5 years of age), and more likely to occur in highlands (aOR = 1.75; 95% CI, 1.46−2.07; p < 0.0001, compared to coast region), and jungle region (aOR = 1.75; 95% CI, 1.27−2.41; p = 0.001, compared to coast region). Among the respiratory complications, RSV pneumonia was less likely to occur between different age groups (aOR = 0.29; 95% CI, 0.22−0.37; p < 0.0001, compared to <5 years of age), compared with influenza pneumonia. These findings on the RSV-hospitalization and its complications are helpful for health services planning and may increase awareness of the Peruvian population's RSV and influenza disease burden.

Analysis of Excess All-Cause Mortality and COVID-19 Mortality in Peru: Observational Study.

During the COVID-19 pandemic, an excess of all-cause mortality has been recorded in several countries, including Peru. Most excess deaths were likely attributable to COVID-19. In this study, we compared the excess all-cause mortality and COVID-19 mortality in 25 Peruvian regions to determine whether most of the excess deaths in 2020 were attributable to COVID-19. Excess deaths were calculated as the difference between the number of observed deaths from all causes during the COVID-19 pandemic (in 2020) and the number of expected deaths in 2020 based on a historical from recent years (2017-2019). Death data were retrieved from the Sistema Informatico Nacional de Defunciones (SINADEF) at the Ministry of Health of Peru from January 2017 to December 2020. Population counts were obtained from projections from Peru's Instituto Nacional de Estadística e Informática (INEI). All-cause excess mortality and COVID-19 mortality were calculated by region per 100,000 population. Spearman's test and linear and multiple regression models were used to estimate the correlation between excess all-cause mortality and COVID-19 mortality per 100,000 population. Excess all-cause death rates varied widely among regions (range: 115.1 to 519.8 per 100,000 population), and COVID-19 mortality ranged between 83.8 and 464.6 per 100,000 population. There was a correlation between the all-cause excess mortality and COVID-19 mortality (r = 0.90; p = 0.00001; y = 0.8729x + 90.808; R2 = 0.84). Adjusted for confounding factors (mean age in the region, gender balance, and number of intensive care unit (ICU) beds), the all-cause excess mortality rate was correlated with COVID-19 mortality rate (ß = 0.921; p = 0.0001). These findings suggest that most of the excess deaths in Peru are related to COVID-19. Therefore, these findings can help decision-makers to understand the high COVID-19 mortality rates in Peru.

Excess all-cause deaths stratified by sex and age in Peru: a time series analysis during the COVID-19 pandemic.

BACKGROUND: In this study, we estimated excess all-cause deaths and excess death rates during the COVID-19 pandemic in 25 Peruvian regions, stratified by sex and age group. DESIGN: Cross-sectional study. SETTING: Twenty-five Peruvian regions with complete mortality data. PARTICIPANTS: Annual all-cause official mortality data set from SINADEF (Sistema Informático Nacional de Defunciones) at the Ministry of Health of Peru for 2017-2020, disaggregated by age and sex. MAIN OUTCOME MEASURES: Excess deaths and excess death rates (observed deaths vs expected deaths) in 2020 by sex and age (0-29, 30-39, 40-49, 50-59, 60-69, 70-79 and ≥80 years) were estimated using P-score. The ORs for excess mortality were summarised with a random-effects meta-analysis. RESULTS: In the period between January and December 2020, we estimated an excess of 68 608 (117%) deaths in men and 34 742 (69%) deaths in women, corresponding to an excess death rate of 424 per 100 000 men and 211 per 100 000 women compared with the expected mortality rate. The number of excess deaths increased with age and was higher in men aged 60-69 years (217%) compared with women (121%). Men between the ages of 40 and 79 years experienced twice the rate of excess deaths compared with the expected rate. In eight regions, excess deaths were higher than 100% in men, and in seven regions excess deaths were higher than 70% in women. Men in eight regions and women in one region had two times increased odds of excess death than the expected mortality. There were differences in excess mortality according to temporal distribution by epidemiological week. CONCLUSION: Approximately 100 000 excess all-cause deaths occurred in 2020 in Peru. Age-stratified excess death rates were higher in men than in women. There was strong excess in geographical and temporal mortality patterns according to region.

Sex differences in the incidence, mortality, and fatality of COVID-19 in Peru.

BACKGROUND: There is a worrying lack of epidemiological data on the sex differential in COVID-19 infection and death rates between the regions of Peru. METHODS: Using cases and death data from the national population-based surveillance system of Peru, we estimated incidence, mortality and fatality, stratified by sex, age and geographic distribution (per 100,000 habitants) from March 16 to November 27, 2020. At the same time, we calculated the risk of COVID-19 death. RESULTS: During the study period, 961894 cases and 35913 deaths were reported in Peru. Men had a twofold higher risk of COVID-19 death within the overall population of Peru (odds ratio (OR), 2.11; confidence interval (CI) 95%; 2.06-2.16; p<0.00001), as well as 20 regions of Peru, compared to women (p<0.05). There were variations in incidence, mortality and fatality rates stratified by sex, age, and region. The incidence rate was higher among men than among women (3079 vs. 2819 per 100,000 habitants, respectively). The mortality rate was two times higher in males than in females (153 vs. 68 per 100,000 habitants, respectively). The mortality rates increased with age, and were high in men 60 years of age or older. The fatality rate was two times higher in men than in women (4.96% vs. 2.41%, respectively), and was high in men 50 years of age or older. CONCLUSIONS: These findings show the higher incidence, mortality and fatality rates among men than among women from Peru. These rates vary widely by region, and men are at greater risk of COVID-19 death. In addition, the mortality and fatality rates increased with age, and were most predominant in men 50 years of age or older.

Sex differences in COVID-19 fatality rate and risk of death: An analysis in 73 countries, 2020-2021.

There is a worrying lack of epidemiological data on the sex differential in COVID-19 fatality rates. We examined the Global Health 50/50 tracks of sex-disaggregated infection and mortality COVID-19 data from 73 countries through May 20, 2021. We compared the infection fatality rate (IFR) in men vs. women and risk of death from COVID-19 by country. Of all cases in 73 countries, 42,933,757 were in women and 40,187,894 in men; 1,274,663 men and 971,899 women died. The IFR was higher in males (3.17%) than in women (2.26%). The IFR in males vs. females varied from country to country, and it was higher in men in Brazil, Yemen, Mexico, Ecuador, Scotland, Peru, Guatemala, North Macedonia and Afghanistan. Overall, men had a higher odd of death from COVID-19 (OR, 1.22; 95% CI, 1.13-1.32; =0.00001) and in 49 countries, compared to women. Men in Albania and Guatemala had twice the risk of death from COVID-19. Our findings show higher fatality rates among men than among women. These rates vary widely by country, and men have a higher odd of death from COVID-19.

Trends in mortality burden of hepatocellular carcinoma, cirrhosis, and fulminant hepatitis before and after roll-out of the first pilot vaccination program against hepatitis B in Peru: An analysis of death certificate data.

The first pilot vaccination program against hepatitis B in Peru was implemented in the hyperendemic Abancay province in 1991. To assess the impact of vaccination on mortality rates of hepatitis B-related hepatocellular carcinoma (HCC), cirrhosis, and fulminant hepatitis, we compared mortality trends before (1960-1990) and after (1991-2012) roll-out of the vaccination program, using death certificate data from the Municipalidad Provincial de Abancay. Our results showed that, following program roll-out, the overall mortality rates (per 100,000 population) decreased from 9.20 to 3.30 for HCC (95% CI, 1.28-10.48%; P<0.014), from 16.0 to 6.3 for cirrhosis (95% CI, 3.20-16.10%; P<0.004), and from 34.80 to 1.28 for fulminant hepatitis (95% CI, 16.70-50.30%; P<0.001). The absolute number of deaths attributable to cirrhosis (10 [8.80%] vs. 0.0%; P<0.001) and fulminant hepatitis (83 [40.0%] vs. 5 [19.20%]; P<0.026) decreased in 5-14-year-old children following vaccination. These findings showed reduced mortality rates of hepatitis B-related liver diseases, particularly cirrhosis and fulminant hepatitis in children under 15years, following implementation of the vaccination program against hepatitis B.