Magali Barbieri’s research while affiliated with University of California System and other places

Background In countries with high life expectancy, a growing share of the population is living with several diseases, a situation referred to as multi-morbidity. In addition to health data, cause-of-death data, based on the information reported on death certificates, can help monitor and characterize this situation. This requires going beyond the underlying cause of death and accounting for all causes on the death certificates which may have played various roles in the morbid process, depending on how they relate to each other. Methods Apart from the underlying cause, the cause-of death data available in vital registration systems do not differentiate all other causes. We developed an algorithm based on the WHO rules that assigns a “role” to each entry on the death certificate. We distinguish between the following roles: originating (o), when the condition has initiated a sequence of events leading directly to death; precipitating (p), when it was caused by an originating condition or one of its consequences; associated (a), when it contributed to death but was not part of the direct sequence leading to death; ill-defined (i), i.e., conditions such as symptoms or signs or poorly informative causes. We applied this algorithm to all death records in four countries (Italy, France, Spain and the US) in 2017. Results The average number of originating causes is similar in the four countries. The proportion of death certificates with more than one originating cause—a situation typical of multi-morbidity—ranges from 10% in the US to 18% in Spain. All ages combined, the proportion of deaths with at least one associated cause is higher in Italy (41%) and in the US (42%) than in France (29%) and in Spain (27%). It is especially high in the US at all adult ages. Variations in the average number of causes between the four countries are mainly due to precipitating and ill-defined causes. Conclusions The output of our algorithm sheds light on cross-country differences in the average number of causes on death certificates. It also opens the door for improvements in the methods used for multiple cause-of-death analysis.

En janvier 2023, la France comptait 68 millions d’habitants, soit 200 000 de plus qu’en janvier 2022. Les naissances ont diminué et les décès augmenté : le solde naturel baisse, atteignant un niveau historiquement faible et inférieur au solde migratoire. En 2022, la France fait partie des 6 pays européens parmi les 27 dont le solde naturel est positif, mais son solde migratoire est relativement faible : l’accroissement de la population française est deux fois moindre que celui de l’UE27. En 2021, les flux d’entrées de personnes venant de pays tiers avec un titre de séjour augmentent par rapport à 2020, pour retrouver leur niveau d’avant la crise sanitaire. En 2022, l’indice conjoncturel de fécondité diminue (1,8 enfant par femme) et atteint son niveau le plus bas depuis 20 ans. Toutefois, le renouvellement des générations nées jusqu’en 1992 semble assuré. La fécondité des hommes est plus forte que celle des femmes, principalement du fait des enfants nés après leur 50 ans. Le recours à l’avortement est en augmentation entre 2021 et 2022, et plus fréquent dans les groupes d ‘âges auxquels la fécondité est élevée. La part des IVG réalisées par la méthode médicamenteuse continue sa progression, tout comme celles pratiquées par les sages-femmes. En 2022, le rattrapage des mariages qui n’ont pas pu être célébrés en 2020 et 2021 se poursuit. Le nombre de mariages augmente ; en revanche, le nombre de pacs diminue parmi les couples hétérosexuels. Cependant, le nombre de pacs augmente pour les couples de même sexe et n’a jamais été aussi élevé. L’écart d’âge entre les conjoints diminue légèrement, mais subsiste notamment pour les couples d’hommes. Le nombre de décès reste important en 2022 malgré une amélioration de la situation sanitaire : 2 épidémies de grippe et 3 épisodes caniculaires expliquent une surmortalité de 45 800 décès. L’espérance de vie à la naissance augmente en 2022 pour les hommes et pour les femmes, mais ne retrouve pas son niveau d’avant la pandémie. La France reste l’un des pays d’Europe de l’Ouest dont l’écart d’espérance de vie entre les hommes et les femmes est parmi les plus importants (6 ans), même si cet écart diminue constamment depuis 1980.

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017. Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0Š) followed by France (24.1Š) and Spain (17.3Š), and lowest in the United States (14.0Š). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions. Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population.

Objective The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. Methods We focus on five European countries and the United States. Using standardised and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, as well as demographic characteristics and seasonality patterns. Results Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analysed, but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared to women, men have higher COVID-19 mortality rates at most ages and in most seasons. Conclusions There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having specifically targeted those ages.

Les pratiques de certification et de codage des causes initiales de décès ne sont pas toutes les mêmes, ce qui peut nuire à la pertinence et la fiabilité des statistiques de mortalité par cause. La cohérence de ces données au sein d’un même pays peut être considérée comme un critère de qualité. Cet article évalue la cohérence à l’échelle infranationale des statistiques sur les causes de décès en Russie, en Allemagne, aux États-Unis et en France. On estime la part respective des principaux groupes de causes dans les structures de mortalité régionales, et on les compare aux moyennes interrégionales. Ces écarts à la moyenne sont présentés sur des matrices de cartes thermiques qui permettent d’identifier les combinaisons cause-région les plus éloignées des moyennes, les causes présentant une forte variabilité infranationale, ainsi que les régions dont la structure de mortalité est particulière. C’est en France que les données sur les causes de décès sont les plus cohérentes d’une région à l’autre, et en Russie que la part des valeurs aberrantes est la plus élevée. On constate également des différences selon la difficulté à diagnostiquer les causes de décès : la variabilité interrégionale diminue avec le degré de spécificité des symptômes permettant le diagnostic. Plus le diagnostic est difficile, plus les écarts interrégionaux sont importants.

National authorities publish COVID-19 death counts, which are extensively re-circulated and compared; but data are generally poorly sourced and documented. Academics and stakeholders need tools to assess data quality and to track data-related discrepancies for comparability over time or across countries. “The Demography of COVID-19 Deaths” database aims at bridging this gap. It provides COVID-19 death counts along with associated documentation, which includes the exact data sources and points out issues of quality and coverage of the data. The database — launched in April 2020 and continuously updated — contains daily cumulative death counts attributable to COVID-19 broken down by sex and age, place and date of occurrence of the death. Data and metadata undergo quality control checks prior to online release. As of mid-December 2021, it covers 21 countries in Europe and beyond. It is open access at a bilingual (English and French) website with content intended for expert users and non-specialists ( https://dc-covid.site.ined.fr/en/ ; figshare: 10.6084/m9.figshare.c.5807027 ). Data and metadata are available for each country separately and pooled over all countries.

Objectives The paper seeks to examine the contribution of internal socioeconomic disparities in mortality to the United States international disadvantage in life expectancy at birth. Methods Using individual death records from the US national vital statistics system for years 1982 to 2019 and data for other countries from the Human Mortality Database, we compare age-specific death rates and life expectancy between counties classified into ten socioeconomic categories and 20 high-income countries. We also calculate the number of years of life lost in each socioeconomic decile in relation to the comparison set. Results There is a clear and increasing socioeconomic gradient of mortality in the United States but the growing divergence in internal mortality trends does not explain the rising gap between the country and its peers. In 2019, even American women in the most socioeconomically advantaged decile lived shorter lives while only the 10% men in the most affluent decile fared better than their peers. The long-standing US disadvantage in young adult mortality has been growing and the country previous advantage in mortality at ages 75 years and above has virtually disappeared for all but for Americans in the most affluent counties. Discussion The similar age-pattern of differences in mortality rates between socioeconomic deciles and the comparison group suggests that the underlying factors might be the same. The roles of external causes (including drug overdoses) for middle-age adults and a slowing down in progress to control cardiovascular diseases at older ages at the national level are consistent with this pattern.

Le 1 er janvier 2022, la France comptait 67,8 millions d’habitants soit 187 000 de plus qu’au 1 er janvier 2021. Les nombres de naissances, d’IVG et de mariages en 2021 ont augmenté par comparaison à 2020, sans retrouver les niveaux observés avant la crise sanitaire (2019). Il en est même pour les décès dont le nombre a diminué, mais reste encore supérieur à celui observé en 2019. En 2021, la France fait partie des 9 pays européens parmi les 27 dont le solde naturel est positif. Son solde migratoire l’est également et, en 2021, est supérieur au solde naturel. Au total, la population de la France continue d’augmenter, mais à un rythme plus faible qu’avant la pandémie. En 2020, les flux d’entrées de personnes venant de pays tiers avec un titre de séjour ont très fortement diminué du fait de la crise sanitaire. Ce sont les titres pour raison professionnelle qui ont le plus baissé. Les demandes se concentrent en Île-de-France. En 2021, l’indice conjoncturel de fécondité augmente très légèrement (1,83 enfant par femme), principalement du fait de la hausse des taux entre 30 et 39 ans. Le profil par âge varie selon les régions. Le recours à l’avortement est plutôt stable entre 2020 et 2021, mais la part des IVG réalisées par la méthode médicamenteuse augmente d’année en année (77 % en 2021), surtout celles pratiquées en cabinet de ville. Cependant, on observe d’importantes différences territoriales, du fait d’une offre de soins inégale au niveau local. En 2021, le rattrapage des mariages qui n’ont pu être célébrés en 2020 n’a été que partiel. Pour la première fois en 2020, le nombre de pacs dépasse celui des mariages. Les mariages sont plus fréquents sur le flanc est du pays et les pacs sur la façade atlantique et dans le Sud-Ouest. Le nombre de décès reste important en 2021 malgré une amélioration par rapport à 2020. L’espérance de vie en 2021 reste inférieure de 4,6 mois pour les hommes par rapport à 2019, et de 1,4 mois pour les femmes. La surmortalité est estimée à 6,3 % en 2021 après avoir été de 7,5 % en 2020. Les régions les plus touchées ne sont pas nécessairement celles où la mortalité était initialement forte.

COVID-19 mortality increases dramatically with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts can have conflicting implications because BIPOC populations are younger than white populations. In analyses of California and Minnesota--demographically divergent states--we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups. Vaccination schemas directly implicate equitability of access, both domestically and globally.

The COVID-19 pandemic has revealed substantial coverage and quality gaps in existing international and national statistical monitoring systems. It is striking that obtaining timely, accurate, and comparable across countries data in order to adequately respond to unexpected epidemiological threats is very challenging. The most robust and reliable approach to quantify the mortality burden due to short-term risk factors is based on estimating weekly excess deaths. This approach is more reliable than monitoring deaths with COVID-19 diagnosis or calculating incidence or fatality rates affected by numerous problems such as testing coverage and comparability of diagnostic approaches. In response to the emerging data challenges, a new data resource on weekly mortality has been established. The Short-term Mortality Fluctuations (STMF, available at www.mortality.org ) data series is the first international database providing open-access harmonized, uniform, and fully documented data on weekly all-cause mortality. The STMF online vizualisation tool provides an opportunity to perform a quick assessment of the excess weekly mortality in one or several countries by means of an interactive graphical interface.