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Pre-print, version 2.2 Standardisation de la mortalité en Belgique, 2020
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Abstract
To compare mortality in different years, the use of the standardized mortality rate is the method of choice. The direct standardisation method is used, according to the Belgian population profile in 2020, the fictitious European population profile established in 1990 and the fictitious world population profile established in 2001. The years 2000 to 2019 were observed for this comparison with the year 2020, which is characterised by two epidemic phases of sars-cov-2 and significant mortality linked to a summer heat wave.
The years of the decade '2000' show all mortality clearly higher than 2020, except for the year 2009, which is equivalent. As in 2020, 2003 shows a specific mortality rate for the 85+ age group. For the decade '2010', the results, on the Belgian profile, show an under-mortality in the year 2020 for the age group 0-24 years for both sexes compared to all other years studied. Mortality in the 25-44 age group is fairly equivalent between the years. Mortality in the 45-64 age group shows an increase in mortality in the years 2010 and 2012 compared to the other years that remain grouped together. For the 65-74 and 75-84 age groups, the mortality of the year 2020 is similar to the mortality of the years 2010 and 2012, while the year 2015 becomes intermediate. Mortality in the 85+ age group shows an increase for the year 2020 compared with the other years. It is in this respect that the year 2020 is specific compared to previous years.
The analysis of the data on the European and world profile confirms the results on the Belgian profile and shows how important the structure of the age pyramid is for understanding the Belgian situation in 2020, to such an extent that, a contrario, the analysis on the world profile largely eliminates the excess mortality in that year.
In conclusion, the observation of mortality in 2020 shows a morbid episode essentially linked to the ageing of the population. Poor health management as an aggravating factor cannot be ruled out. It is therefore reasonable to point out the uselessness of the social control measures that were taken regardless of age groups and the need for coherent care in terms of the individual health of our elderly.
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Background and Aims
The most restrictive non‐pharmaceutical interventions (NPIs) for controlling the spread of COVID‐19 are mandatory stay‐at‐home and business closures. Given the consequences of these policies, it is important to assess their effects. We evaluate the effects on epidemic case growth of more restrictive NPIs (mrNPIs), above and beyond those of less restrictive NPIs (lrNPIs).
Methods
We first estimate COVID‐19 case growth in relation to any NPI implementation in subnational regions of 10 countries: England, France, Germany, Iran, Italy, Netherlands, Spain, South Korea, Sweden, and the US. Using first‐difference models with fixed effects, we isolate the effects of mrNPIs by subtracting the combined effects of lrNPIs and epidemic dynamics from all NPIs. We use case growth in Sweden and South Korea, two countries that did not implement mandatory stay‐at‐home and business closures, as comparison countries for the other 8 countries (16 total comparisons).
Results
Implementing any NPIs was associated with significant reductions in case growth in 9 out of 10 study countries, including South Korea and Sweden that implemented only lrNPIs (Spain had a non‐significant effect). After subtracting the epidemic and lrNPI effects, we find no clear, significant beneficial effect of mrNPIs on case growth in any country. In France, e.g., the effect of mrNPIs was +7% (95CI ‐5%‐19%) when compared with Sweden, and +13% (‐12%‐38%) when compared with South Korea (positive means pro‐contagion). The 95% confidence intervals excluded 30% declines in all 16 comparisons and 15% declines in 11/16 comparisons.
Conclusions
While small benefits cannot be excluded, we do not find significant benefits on case growth of more restrictive NPIs. Similar reductions in case growth may be achievable with less restrictive interventions.