Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals.
Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals.
复制标题
调整Covid-19期间死亡率位移的预期死亡人数：一种基于模型的反事实方法在个人水平上。
DOI：
10.1186/s12874-023-01984-8
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发表时间：
2023-10-18
影响因子：
4
通讯作者：
Burton, Paul
中科院分区：
文献类型：
--
作者：
Holleyman, Richard James;Barnard, Sharmani;Bauer-Staeb, Clarissa;Hughes, Andrew;Dunn, Samantha;Fox, Sebastian;Newton, John N.;Fitzpatrick, Justine;Waller, Zachary;Deehan, David John;Charlett, Andre;Gregson, Celia L.;Wilson, Rebecca;Fryers, Paul;Goldblatt, Peter;Burton, Paul
在COVID-19大流行期间，对超额死亡率的近实时监测一直是一个重要工具。随着大流行病的减弱，监测死亡率仍然至关重要，以发现与大流行病的长期影响（如感染、遏制措施和卫生及其他系统提供的服务减少）以及随后的应对措施（如遏制措施的缩减、疫苗接种以及卫生及其他系统对积压工作的应对）有关的死亡率波动。随着许多国家放宽社交距离制度和减少检测，衡量COVID-19感染的影响变得至关重要。然而，整个人口的死亡率长期超过预期，这使人们对使用未经调整的历史死亡率估计数来计算预期死亡人数的有效性产生了怀疑，这些死亡人数构成了计算超额死亡人数的基线，因为许多人的死亡时间早于他们本来的死亡时间：也就是说，他们的死亡率在大流行期间提前发生，而不是在历史比率预测时发生。这在文献中也经常被称为“收获”。我们提出了一种新的基于Cox回归的方法，使用时间依赖性协变量来估计英格兰髋部骨折患者人群中感染COVID-19的个体随时间推移死亡风险增加的概况（N = 98，365）。我们使用这些风险来模拟存在COVID-19阳性测试的生存时间分布，然后基于没有阳性测试的风险率计算生存时间，并使用这些分布的中位数之间的差异来估计死亡被取代的天数。该方法应用于个人层面，而非人口层面，以更好地了解COVID-19检测呈阳性对社会人口和健康特征赋予不同脆弱性的群体的死亡率的影响。最后，我们应用死亡率位移估计调整估计的超额死亡率使用“球和瓮”模型。在样本人群中，我们提出了一个端到端的应用我们的方法来估计死亡率位移的程度。更大比例的老年、男性和体弱者遭受了重大流离失所，而年轻女性和体弱程度较低的个体的流离失所程度更高：这些群体在没有COVID-19的情况下本应有相当长的预期寿命。我们的研究结果表明，仅根据历史趋势计算英格兰第一波大流行后的预期死亡人数会导致高估，因此超额死亡率会被低估。我们的研究结果，使用这个样本数据集是有条件的，经历了髋部骨折，这是不一般的一般人群。在事故/手术后的几周内阻碍活动的骨折大大缩短了预期寿命，并且本身就是严重脆弱的标志。因此，重要的是将这些新方法应用于一般人群，其中我们预计死亡率转移的强烈模式-无论是在其长度和患病率-按年龄，性别，虚弱和合并症的类型。这种反事实方法也可用于调查更广泛的破坏性人口健康事件。这对英国和全球的公共卫生监测和公共卫生数据的解释具有重要意义。 在线版本包含补充材料，可通过10.1186/s12874-023-01984-8获得。
Near-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed “harvesting” in the literature. We present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a “ball and urn” model. Among the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy. Our results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement – both in its length and prevalence – by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally. The online version contains supplementary material available at 10.1186/s12874-023-01984-8.
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DOI：
10.1016/j.health.2021.100006
发表时间：
2021-09-28
期刊：
Healthcare Analytics
影响因子：
--
作者：
Rehman H;Chandra N;Jammalamadaka SR
通讯作者：
Jammalamadaka SR
影响因子：
2.7
作者：
COX, DR
通讯作者：
COX, DR
影响因子：
2.3
作者：
Barnard, Sharmani;Chiavenna, Chiara;De Angelis, Daniela
通讯作者：
De Angelis, Daniela
影响因子：
3.7
作者：
KAPLAN, EL;MEIER, P
通讯作者：
MEIER, P
DOI：
10.1016/j.lanepe.2021.100109
发表时间：
2021-07
期刊：
The Lancet regional health. Europe
影响因子：
--
作者：
Bhaskaran K;Bacon S;Evans SJ;Bates CJ;Rentsch CT;MacKenna B;Tomlinson L;Walker AJ;Schultze A;Morton CE;Grint D;Mehrkar A;Eggo RM;Inglesby P;Douglas IJ;McDonald HI;Cockburn J;Williamson EJ;Evans D;Curtis HJ;Hulme WJ;Parry J;Hester F;Harper S;Spiegelhalter D;Smeeth L;Goldacre B
通讯作者：
Goldacre B