The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data
Abstract Background Coronavirus disease (COVID-19) quickly spread around the world after its initial identification in Wuhan, China in 2019 and became a global public health crisis. COVID-19 related hospitalizations and deaths as important disease outcomes have been investigated by many studies whil...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-024-21031-5 |
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| author | Anqi A. Chen Elizabeth M. Renouf Charmaine B. Dean X. Joan Hu |
| author_facet | Anqi A. Chen Elizabeth M. Renouf Charmaine B. Dean X. Joan Hu |
| author_sort | Anqi A. Chen |
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| description | Abstract Background Coronavirus disease (COVID-19) quickly spread around the world after its initial identification in Wuhan, China in 2019 and became a global public health crisis. COVID-19 related hospitalizations and deaths as important disease outcomes have been investigated by many studies while less attention has been given to the relationship between these two outcomes at a public health unit level. In this study, we aim to establish the relationship of counts of deaths and hospitalizations caused by COVID-19 over time across 34 public health units in Ontario, Canada, taking demographic, geographic, socio-economic, and vaccination variables into account. Methods We analyzed daily data of the 34 health units in Ontario between March 1, 2020 and June 30, 2022. Associations between numbers of COVID-19 related deaths and hospitalizations were explored over three subperiods according to the availability of vaccines and the dominance of the Omicron variant in Ontario. A generalized additive model (GAM) was fit in each subperiod. Heterogeneity across public health units was formulated via a random intercept in each of the models. Results Mean daily COVID-19 deaths increased quickly as daily hospitalizations increased, particularly when daily hospitalizations were less than 20. In all the subperiods, mean daily deaths of a public health unit was significantly associated with its population size and the proportion of confirmed cases in subjects over 60 years old. The proportion of fully vaccinated (2 doses of primary series) people in the 60 + age group was a significant factor after the availability of the COVID-19 vaccines. The deprivation index, a measure of poverty, had a significantly positive effect on COVID-19 mortality after the dominance of the Omicron variant in Ontario. Quantification of these effects was provided, including effects related to public health units. Conclusions The differences in COVID-19 mortality across health units decreased over time, after adjustment for other covariates. In the last subperiod when most public health protections were released and the Omicron variant dominated, the least advantaged group might suffer higher COVID-19 mortality. Interventions such as paid sick days and cleaner indoor air should be made available to counter lifting of health protections. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-62f61bb3be4c468ea1e663d9e45dcb082025-01-19T12:41:36ZengBMCBMC Public Health1471-24582025-01-0125111510.1186/s12889-024-21031-5The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial dataAnqi A. Chen0Elizabeth M. Renouf1Charmaine B. Dean2X. Joan Hu3Department of Statistics and Actuarial Science, Simon Fraser UniversityDepartment of Civil Engineering, University of OttawaDepartment of Statistics and Actuarial Science, University of WaterlooDepartment of Statistics and Actuarial Science, Simon Fraser UniversityAbstract Background Coronavirus disease (COVID-19) quickly spread around the world after its initial identification in Wuhan, China in 2019 and became a global public health crisis. COVID-19 related hospitalizations and deaths as important disease outcomes have been investigated by many studies while less attention has been given to the relationship between these two outcomes at a public health unit level. In this study, we aim to establish the relationship of counts of deaths and hospitalizations caused by COVID-19 over time across 34 public health units in Ontario, Canada, taking demographic, geographic, socio-economic, and vaccination variables into account. Methods We analyzed daily data of the 34 health units in Ontario between March 1, 2020 and June 30, 2022. Associations between numbers of COVID-19 related deaths and hospitalizations were explored over three subperiods according to the availability of vaccines and the dominance of the Omicron variant in Ontario. A generalized additive model (GAM) was fit in each subperiod. Heterogeneity across public health units was formulated via a random intercept in each of the models. Results Mean daily COVID-19 deaths increased quickly as daily hospitalizations increased, particularly when daily hospitalizations were less than 20. In all the subperiods, mean daily deaths of a public health unit was significantly associated with its population size and the proportion of confirmed cases in subjects over 60 years old. The proportion of fully vaccinated (2 doses of primary series) people in the 60 + age group was a significant factor after the availability of the COVID-19 vaccines. The deprivation index, a measure of poverty, had a significantly positive effect on COVID-19 mortality after the dominance of the Omicron variant in Ontario. Quantification of these effects was provided, including effects related to public health units. Conclusions The differences in COVID-19 mortality across health units decreased over time, after adjustment for other covariates. In the last subperiod when most public health protections were released and the Omicron variant dominated, the least advantaged group might suffer higher COVID-19 mortality. Interventions such as paid sick days and cleaner indoor air should be made available to counter lifting of health protections.https://doi.org/10.1186/s12889-024-21031-5SARS-CoV-2 infectionGeneralized additive modelsCOVID-19 vaccinesPublic reporting of health care dataCOVID-19 hospitalizationsRandom effects |
| spellingShingle | Anqi A. Chen Elizabeth M. Renouf Charmaine B. Dean X. Joan Hu The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data BMC Public Health SARS-CoV-2 infection Generalized additive models COVID-19 vaccines Public reporting of health care data COVID-19 hospitalizations Random effects |
| title | The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data |
| title_full | The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data |
| title_fullStr | The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data |
| title_full_unstemmed | The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data |
| title_short | The effects of deprivation, age, and regional differences in COVID-19 mortality from 2020 to 2022: a retrospective analysis of public provincial data |
| title_sort | effects of deprivation age and regional differences in covid 19 mortality from 2020 to 2022 a retrospective analysis of public provincial data |
| topic | SARS-CoV-2 infection Generalized additive models COVID-19 vaccines Public reporting of health care data COVID-19 hospitalizations Random effects |
| url | https://doi.org/10.1186/s12889-024-21031-5 |
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