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ObjectiveWe studied the association between the coronavirus disease 2019 (COVID-19) pandemic, including the restrictive measures, and metabolic risk factors for cardiovascular disease (CVD) in women and men. Next, we analysed whether changes in these metabolic risk factors were mediated by psychological and behavioural mechanisms. DesignIn this natural experiment, we assessed changes from baseline in metabolic CVD risk factors in the exposed group (whose follow-up measurements were taken during the pandemic), and compared these to the changes in the control group (whose follow-up measurements were taken before the pandemic). ParticipantsThis study used data from 6962 participants from six different ethnic groups (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan) of the HELIUS study, based in Amsterdam, the Netherlands. We included women and men without prior CVD, who participated in both the baseline (2011-2015) and follow-up measurements (2019-2021). Outcome measuresChanges between baseline and follow-up measurements in six metabolic CVD risk factors were calculated for systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), fasting plasma glucose (FPG), haemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR). ResultsThe exposed group experienced somewhat less favourable changes over time in SBP, DBP and FPG (the latter only in women) than the control group, while temporal changes in HbA1c and eGFR were more favourable among the control group. For instance, SBP was 1.119 mmHg [0.046, 2.193] higher in exposed than non-exposed women, and 1.380 [0.288, 2.471] in men. Changes in SBP and DBP were partially mediated by changes in behavioural factors, most notably BMI and alcohol consumption. ConclusionsThe COVID-19 pandemic, including the restrictive lockdown measures, is associated with a deterioration of several CVD risk factors in women and men. These findings may aid in decision making concerning the management of and the recovery following the pandemic. Article SummaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThe COVID19 pandemic lockdown measures led to a pause in the data collection for the prospective, population-based HELIUS study, which shaped a natural experiment. C_LIO_LINatural experiments, as quasi-experimental designs, are generally considered stronger than cross-sectional studies. C_LIO_LIThrough inverse-probability weighting, this study aimed to account for baseline differences between the control and exposed group. C_LIO_LIWe could not adjust for differences in follow-up time that occurred as a result of the restrictive measures, which may have affected estimates of variables that change with age. C_LIO_LIThe effects of certain mediators may be underestimated, as the data available for defining these variables were largely based on self-reports. C_LI
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BACKGROUND: Under-5 mortality is unacceptably high in many countries, the burden of which is mainly borne by the poor. Whereas country characteristics are known to influence under-5 mortality, it is unknown whether these have a different impact on the poor and the rich. We aimed to describe how the association between under-5 mortality and socioeconomic, political, and health care factors varies in strength between richer and poorer children. METHODS: Cross-national analysis of 43 developing countries using wealth-group specific under-5 mortality rates as outcome. Relative effects were estimated using OLS regression; differences in associations between wealth groups were tested. RESULTS: Higher national incomes were associated with lower under-5 mortality rates. This association was significantly weaker for the poor compared with the rich (P = 0.014). Ethnic fragmentation was significantly more strongly associated with higher under-5 mortality among the poor compared with the rich (P = 0.027). The association between public spending on health and under-5 mortality was stronger for the poor (P = 0.0001). Skilled delivery attendance and immunization coverage among the poor were significantly more strongly related to public spending on health than such health care use among the rich (P = 0.0001 and P = 0.045, respectively). No differentials in the relative effect of female literacy, democracy, and state strength were observed. CONCLUSION: Our results suggest that economic growth is associated with widening poor-rich disparities in under-5 mortality. Increased public spending on health might partly remedy this effect.
