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      Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden

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          Abstract

          Objective:

          It has been found that COVID-19 increases deaths within common diseases in countries that have implemented strict lockdowns. In order to elucidate the proper national response to a pandemic, the mortality rates within COVID-19 and various diseases need to be studied in countries whose pandemic response differ. Sweden represents a country with lax pandemic restrictions, and we aimed to study the effects of COVID-19 on historical mortality rates within common diseases during 2020.

          Methods:

          Regression models and moving averages were used to predict expected premature mortality per the ICD-10 during 2020 using historical data sets. Predicted values were then compared to recorded premature mortality to identify changes in mortality trends.

          Results:

          Seasonal increased mortality was found within neurological diseases. Infectious diseases, tumours and cardiac disease mortality rates decreased compared to expected outcome.

          Conclusions:

          Changes in mortality trends were observed for several common diseases during the COVID-19 pandemic. Neurological and cardiac conditions, infections and tumours are examples of diseases that were heavily affected by the pandemic. The indirect effects of COVID-19 on certain patient populations should be considered when determining pandemic impact.

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          Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

          Elissa Driggin, Mahesh V Madhavan, Behnood Bikdeli … (2020)
          The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission. We hereby review the peer-reviewed and pre-print reports pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
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            2021 Alzheimer's disease facts and figures

            (2021)
            This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.
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              Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy

              Ovidio De Filippo, Fabrizio D’Ascenzo, Filippo Angelini … (2020)
              To the Editor: To address the coronavirus (Covid-19) pandemic, 1 strict social containment measures have been adopted worldwide, and health care systems have been reorganized to cope with the enormous increase in the numbers of acutely ill patients. 2,3 During this same period, some changes in the pattern of hospital admissions for other conditions have been noted. The aim of the present analysis is to investigate the rate of hospital admissions for acute coronary syndrome (ACS) during the early days of the Covid-19 outbreak. In this study, we performed a retrospective analysis of clinical and angiographic characteristics of consecutive patients who were admitted for ACS at 15 hospitals in northern Italy. All the hospitals were hubs of local networks for treatment involving primary percutaneous coronary intervention. The study period was defined as the time between the first confirmed case of Covid-19 in Italy (February 20, 2020) and March 31, 2020. We compared hospitalization rates between the study period and two control periods: a corresponding period during the previous year (February 20 to March 31, 2019) and an earlier period during the same year (January 1 to February 19, 2020). The primary outcome was the overall rate of hospital admissions for ACS. We calculated incidence rates for the primary outcome by dividing the number of cumulative admissions by the number of days for each time period. Incidence rate ratios comparing the study period with each of the control periods were calculated with the use of Poisson regression. (Details regarding the study methods are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) Of the 547 patients who were hospitalized for ACS during the study period, 420 (76.8%) were males; the mean (±SD) age was 68±12 years. Of these patients, 248 (45.3%) presented with ST-segment elevation myocardial infarction (STEMI). The mean admission rate for ACS during the study period was 13.3 admissions per day. This rate was significantly lower than either the rate during the earlier period in the same year (total number of admissions, 899; 18.0 admissions per day; incidence rate ratio, 0.74; 95% confidence interval [CI], 0.66 to 0.82; P<0.001) or the rate during the previous year (total number of admissions, 756; 18.9 admissions per day; incidence rate ratio, 0.70; 95% CI, 0.63 to 0.78; P<0.001). The incidence rate ratios for individual ACS subtypes are presented in Table 1. After the national lockdown was implemented on March 8, 2020, 4 a further reduction in ACS admissions was reported. (Details regarding the full secondary analyses are provided in the Supplementary Appendix.) This report shows a significant decrease in ACS-related hospitalization rates across several cardiovascular centers in northern Italy during the early days of the Covid-19 outbreak. Recent data suggest a significant increase in mortality during this period that was not fully explained by Covid-19 cases alone. 5 This observation and data from our study raise the question of whether some patients have died from ACS without seeking medical attention during the Covid-19 pandemic.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Scand J Public Health
                Journal ID (iso-abbrev): Scand J Public Health
                Journal ID (publisher-id): SJP
                Journal ID (hwp): spsjp
                Title: Scandinavian Journal of Public Health
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1403-4948
                ISSN (Electronic): 1651-1905
                Publication date (Electronic): 21 December 2021
                Publication date (Print): August 2022
                Volume: 50
                Issue: 6
                Pages: 748-755
                Affiliations
                [1 ]Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
                [2 ]Theme Inflammation and Aging, Karolinska University Hospital, Sweden
                [3 ]Primary Care, Hudiksvall-Nordanstig, Sweden
                Author notes
                [*]Michael Axenhus, Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solnavägen 30, BioClinicum J9:20, 171 64 Solna, Sweden. E-mail: michael.axenhus.2@ 123456ki.se
                Author information
                https://orcid.org/0000-0002-2476-4465
                Article
                Publisher ID: 10.1177_14034948211064656
                DOI: 10.1177/14034948211064656
                PMC ID: 9361422
                PubMed ID: 34933630
                SO-VID: 8da9582f-4e68-4dae-a07a-eab96f003ea3
                Copyright © © Author(s) 2021
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage)

                History
                Date received : 11 July 2021
                Date revision received : 9 November 2021
                Date accepted : 15 November 2021
                Categories
                Subject: Original Articles
                Custom metadata
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                ScienceOpen disciplines: Public health
                Keywords: alzheimer’s disease,covid-19,icd-10,parkinson’s disease,tumours,ypll
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: alzheimer’s disease, covid-19, icd-10, parkinson’s disease, tumours, ypll

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