Excess mortality and underlying causes of death during the COVID-19 pandemic in rural Bangladesh: insights from the Matlab health and demographic surveillance system.
IF 2.5 2区 医学Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Sayed Saidul Alam, Nur E Jannat Amee, Srizan Chowdhury, Md Mehedi Hasan, Chodziwadziwa Whiteson Kabudula, Jean Juste Harrisson Bashingwa, Md Sharoardy Sagar, Munirul Alam Bhuiyan, M Zahirul Haq, Beth A Tippett Barr, Stephen Tollman, Syed Manzoor Ahmed Hanifi
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引用次数: 0
Abstract
Background: Bangladesh, home to 165 million people, reported its first COVID-19 case in March 2020. This prompted a range of public health measures to control the epidemic. However, limited access to COVID-19 testing and incomplete or inaccurate death registration likely obscured the pandemic's true impact. We use longitudinal data from the Matlab Health and Demographic Surveillance System (HDSS) in Bangladesh to assess excess mortality and underlying causes of death during the COVID-19 pandemic.
Methods: We analysed mortality among 299,775 individuals residing within the Matlab HDSS catchment area between January 1, 2018 and December 31, 2021. Crude mortality rates were compared between the Pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. Adjusted sub-distribution hazard ratios (SHR) were estimated using the Fine and Gray competing risk model. Causes of death were determined using the WHO 2016 Verbal Autopsy questionnaire with supplementary COVID-19 module. We assessed changes in the distribution of causes of death and calculated cause-specific mortality rates by period and sex.
Results: Crude mortality rate increased to from 7.4 deaths per 1000 person-years in 2018-2019 (pre-COVID-19 period) to 8.5 deaths per 1000 person-years during the COVID-19 period (2020-2021). Among individuals aged 60 years and above, the COVID-19-related mortality rate was 3.5 deaths per 1000 person-years during the COVID-19 period. Overall mortality rate increased from 44.1 (95% CI: 42.4-45.9) deaths to 50.9 (95% CI: 49.1-52.7) deaths per 1000 person-years, corresponding to an adjusted SHR of 1.19 (95% CI: 1.12-1.25). Compared with the Pre-COVID-19 period, mortality attributable to non-communicable diseases (NCDs) increased by 11% (mortality rate ratio (MRR): 1.11; 95% CI: 1.04-1.18), while mortality from respiratory diseases increased by 82% (MRR: 1.82; 95% CI: 1.24-2.73) during the COVID-19 period.
Conclusion: During the COVID-19 period, mortality increased in rural Bangladesh, with the sharpest increase observed among older adults with noncommunicable and respiratory diseases. Future pandemic preparedness efforts should prioritise these high-risk subgroups to reduce adverse health outcomes and mortality.
期刊介绍：
Population Health Metrics aims to advance the science of population health assessment, and welcomes papers relating to concepts, methods, ethics, applications, and summary measures of population health. The journal provides a unique platform for population health researchers to share their findings with the global community. We seek research that addresses the communication of population health measures and policy implications to stakeholders; this includes papers related to burden estimation and risk assessment, and research addressing population health across the full range of development. Population Health Metrics covers a broad range of topics encompassing health state measurement and valuation, summary measures of population health, descriptive epidemiology at the population level, burden of disease and injury analysis, disease and risk factor modeling for populations, and comparative assessment of risks to health at the population level. The journal is also interested in how to use and communicate indicators of population health to reduce disease burden, and the approaches for translating from indicators of population health to health-advancing actions. As a cross-cutting topic of importance, we are particularly interested in inequalities in population health and their measurement.
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