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Open Access 01-12-2024 | COVID-19 | Research

Uncovering the toll of the first three COVID-19 waves: excess mortality and social patterns in Belgium

Authors: Laura Van den Borre, Sylvie Gadeyne, Brecht Devleesschauwer, Katrien Vanthomme

Published in: Archives of Public Health | Issue 1/2024

Abstract

Background

This study aims to assess which population groups experienced the heaviest mortality burden during the first three COVID-19 waves in Belgium; and investigate potential changes in social differences in all-cause mortality during the epidemic and compared to the pre-COVID period.

Methods

Exhaustive all-cause mortality information (2015–2021) from the Belgian population register was linked to demographic and socioeconomic census and register data. Annual cohorts consisting of 6.5 million to 6.8 million persons were created selecting persons aged 35 and older. Excess mortality was investigated comparing the 137,354 deaths observed during the first three COVID-19 waves with mortality in the reference period 2015–2019. Methods of analysis include direct standardization and Poisson regression analyses.

Results

Elderly men experienced the highest absolute mortality burden during all three COVID-waves, followed by elderly women, middle-aged men, and middle-aged women. Care home residents consistently experienced higher mortality rates during the first and second wave compared to peers living in other living arrangements. In wave 3, care home residents showed significant absolute mortality deficits compared to the reference period. When adjusting for all demographic and socioeconomic factors, the traditional pattern of educational and income mortality inequalities was found among the elderly population during the COVID-waves. In contrast, the educational mortality gap among middle-aged persons deepened during COVID-waves 2 and 3 with excess mortality between 19 and 30% observed among mainly lower-educated persons. Income mortality inequalities among middle-aged women and men remained stable or even diminished for some specific groups in some waves.

Conclusion

The widening educational mortality gap among middle-aged persons in successive waves suggest an important role of knowledge and associated educational resources during the COVID-19 epidemic. Belgium’s broad implementation of public health control and prevention measures may have successfully averted a further widening of social mortality inequality between income groups and among the elderly population.

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Bambra C, Lynch J, Smith KE. The Unequal Pandemic [Internet]. 1st ed. Bristol University Press; 2021 [cited 2021 Jul 9]. http://www.jstor.org/stable/j.ctv1qp9gnf

Saarinen S, Moustgaard H, Remes H, Sallinen R, Martikainen P. Income differences in COVID-19 incidence and severity in Finland among people with foreign and native background: A population-based cohort study of individuals nested within households. Mody A, editor. PLoS Med [Internet]. 2022 Aug 10 [cited 2022 Dec 9];19(8):e1004038. https://doi.org/10.1371/journal.pmed.1004038

Gadeyne S, Rodriguez-Loureiro L, Surkyn J, Van Hemelrijck W, Nusselder W, Lusyne P, et al. Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium.Int J Equity Health. 2021;20:258. https://doi.org/10.1186/s12939-021-01594-0

Vanthomme K, Gadeyne S, Lusyne P, Vandenheede H. A population-based study on mortality among Belgian immigrants during the first COVID-19 wave in Belgium. Can demographic and socioeconomic indicators explain differential mortality? SSM Popul Health. 2021;14:100797. https://doi.org/10.1016/j.ssmph.2021.100797

Vanthomme K, Gadeyne S, Devleesschauwer B, Van den Borre L. Excess mortality among native Belgians and migrant groups in Belgium during the first three COVID-19 waves: the evolving dynamics of social inequalities. J Public Health. 2023. https://doi.org/10.1007/s10389-023-02180-0

Imlach F, McKinlay E, Kennedy J, Pledger M, Middleton L, Cumming J et al. Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future. Int J Health Policy Manag [Internet]. 2021 Apr 13 [cited 2022 Dec 9];1. http://www.ijhpm.com/article_4031.html

Peacock HM, Tambuyzer T, Verdoodt F, Calay F, Poirel HA, De Schutter H et al. Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis. ESMO Open [Internet]. 2021 Jun [cited 2021 Jul 22];100197. https://linkinghub.elsevier.com/retrieve/pii/S2059702921001587

Ruzzenenti G, Maloberti A, Giani V, Biolcati M, Leidi F, Monticelli M et al. Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective. High Blood Press Cardiovasc Prev [Internet]. 2021 Jun 26 [cited 2021 Jul 14]; https://link.springer.com/https://doi.org/10.1007/s40292-021-00464-8

Angelici L, Sorge C, Di Martino M, Cappai G, Stafoggia M, Agabiti N et al. Incidence of SARS-CoV-2 Infection and Related Mortality by Education Level during Three Phases of the 2020 Pandemic: A Population-Based Cohort Study in Rome. JCM [Internet]. 2022 Feb 7 [cited 2022 May 12];11(3):877. https://www.mdpi.com/2077-0383/11/3/877.

10.

Beese F, Waldhauer J, Wollgast L, Pförtner TK, Wahrendorf M, Haller S et al. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review. Int J Public Health [Internet]. 2022 Aug 29 [cited 2023 Jul 19];67:1605128. https://www.ssph-journal.org/articles/https://doi.org/10.3389/ijph.2022.1605128/full

11.

Strongman H, Carreira H, De Stavola BL, Bhaskaran K, Leon DA. Factors associated with excess all-cause mortality in the first wave of the COVID-19 pandemic in the UK: A time series analysis using the Clinical Practice Research Datalink. Basu S, editor. PLoS Med [Internet]. 2022 Jan 6 [cited 2022 Dec 9];19(1):e1003870. https://doi.org/10.1371/journal.pmed.1003870

12.

Dorrucci M, Minelli G, Boros S, Manno V, Prati S, Battaglini M et al. Excess Mortality in Italy During the COVID-19 Pandemic: Assessing the Differences Between the First and the Second Wave, Year 2020. Front Public Health [Internet]. 2021 Jul 16 [cited 2021 Nov 18];9:669209. https://www.frontiersin.org/articles/https://doi.org/10.3389/fpubh.2021.669209/full

13.

Fazekas-Pongor V, Szarvas Z, Nagy ND, Péterfi A, Ungvári Z, Horváth VJ et al. Different patterns of excess all-cause mortality by age and sex in Hungary during the 2nd and 3rd waves of the COVID-19 pandemic. GeroScience [Internet]. 2022 Jul 22 [cited 2022 Sep 5]; https://link.springer.com/https://doi.org/10.1007/s11357-022-00622-3

14.

Clouston SAP, Rubin MS, Phelan JC, Link BG. A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality. Demography [Internet]. 2016 Oct 1 [cited 2021 Oct 19];53(5):1631–56. https://read.dukeupress.edu/demography/article/53/5/1631/167645/A-Social-History-of-Disease-Contextualizing-the

15.

Clouston SAP, Natale G, Link BG. Socioeconomic inequalities in the spread of coronavirus-19 in the United States: A examination of the emergence of social inequalities. Social Science & Medicine [Internet]. 2021 Jan [cited 2021 Jun 1];268:113554. https://linkinghub.elsevier.com/retrieve/pii/S0277953620307735

16.

Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Extra Issue:80–94.CrossRef

17.

Marí-Dell’Olmo M, Gotsens M, Pasarín MI, Rodríguez-Sanz M, Artazcoz L, Garcia de Olalla P et al. Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns. IJERPH [Internet]. 2021 Jan 30 [cited 2021 Jul 13];18(3):1256. https://www.mdpi.com/1660-4601/18/3/1256

18.

Meurisse M, Lajot A, Devleesschauwer B, Van Cauteren D, Van Oyen H, Van den Borre L, et al. The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020–2021. Arch Public Health. 2022;80:1–10. https://doi.org/10.1186/s13690-022-00856-9

19.

Statistics Belgium. Statistieken over het onderwijsniveau: Vergelijking van twee bronnen en poging om de verschillen te verklaren [Internet]. 2024 [cited 2024 Aug 14]. https://statbel.fgov.be/sites/default/files/files/documents/Census2021/Fiche%20EDU%20CENSUS%20versus%20LFS_Short%20version_NL.pdf

20.

Altman DG, Bland JM. Statistics Notes: Interaction revisited: the difference between two estimates. BMJ [Internet]. 2003 Jan 25 [cited 2022 Aug 16];326(7382):219–219. https://www.bmj.com/lookup/doi/https://doi.org/10.1136/bmj.326.7382.219

21.

Hutchinson MK, Holtman MC. Analysis of count data using poisson regression. Research in Nursing & Health [Internet]. 2005 Oct [cited 2024 Aug 14];28(5):408–18. https://onlinelibrary.wiley.com/doi/https://doi.org/10.1002/nur.20093

22.

Kunst A, Mackenbach JP. Measuring socioeconomic inequalities in health [Internet]. Copenhagen: World Health Organization Regional Office for Europe; 1995 [cited 2018 Mar 7]. 115 p. https://trove.nla.gov.au/version/28584039

23.

Peeters I, Vermeulen M, Bustos Sierra N, Renard F, Van der Heyden J, Scohy A et al. Surveillance of COVID-19 mortality in Belgium. Epidemiology and methodology during 1st and 2nd wave (March 2020–14 February 2021) [Internet]. Brussels, Belgium: Sciensano; 2021 [cited 2023 Aug 4] p. 40. Report No.: D/2021/14.440/57. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_THEMATIC%20REPORT_SURVEILLANCE%20OF%20COVID-19%20MORTALITY%20IN%20BELGIUM_2.pdf

24.

Ose SO, Kaspersen SL, Leinonen T, Verstappen S, De Rijk A, Spasova S et al. Follow-up regimes for sick-listed employees: A comparison of nine north-western European countries. Health Policy [Internet]. 2022 Jul [cited 2024 Aug 14];126(7):619–31. https://linkinghub.elsevier.com/retrieve/pii/S016885102200104X

25.

Pijls BG, Jolani S, Atherley A, Derckx RT, Dijkstra JIR, Franssen GHL et al. Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies. BMJ Open [Internet]. 2021 Jan [cited 2021 Jul 14];11(1):e044640. https://bmjopen.bmj.com/lookup/doi/https://doi.org/10.1136/bmjopen-2020-044640

26.

Hardy OJ, Dubourg D, Bourguignon M, Dellicour S, Eggerickx T, Gilbert M et al. A world apart: Levels and determinants of excess mortality due to COVID-19 in care homes: The case of the Belgian region of Wallonia during the spring 2020 wave. DemRes [Internet]. 2021 Nov 4 [cited 2021 Nov 9];45:1011–40. https://www.demographic-research.org/volumes/vol45/33/

27.

Sciensano. COVID-19 Surveillance. Frequently asked questions. Brussels, Belgium [Internet]. 2022 [cited 2022 Dec 15];42. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_FAQ_ENG_final.pdf

28.

Lagasse R, Deboosere P. Epidemiologische evaluatie van de impact van Covid-19 in België op datum van 15 juli 2020 [Internet]. Brussels, Belgium; 2020 p. 129. http://interfacedemography.be/covid-19/wp-content/uploads/2020/09/Rapport-14-08-2020-NL-v2.pdf

29.

Vandael E, Latour K, Islamaj E, Panis LI, Callies M, Haarhuis F et al. COVID-19 cases, hospitalizations and deaths in Belgian nursing homes: results of a surveillance conducted between April and December 2020. Arch Public Health [Internet]. 2022 Dec [cited 2022 May 12];80(1):45. https://archpublichealth.biomedcentral.com/articles/https://doi.org/10.1186/s13690-022-00794-6

30.

Amnesty International België. Woonzorgcentra in de dode hoek. Mensenrechten van ouderen tijdens de COVID-19 pandemie in België [Internet]. Brussels, Belgium: Amnesty International België; 2020 [cited 2023 Sep 6]. https://www.amnesty-international.be/sites/default/files/bijlagen/amnesty_international.woonzorgcentra_in_de_dode_hoek.pdf

31.

Deschacht M, Malfait S, Eeckloo K. Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way. Int J Older People Nursing [Internet]. 2021 May [cited 2023 Sep 6];16(3):e12366. https://onlinelibrary.wiley.com/doi/https://doi.org/10.1111/opn.12366

32.

Catteau L, van Loenhout J, Stouten V, Billuart M, Hubin P, Haarhuis F et al. Thematisch Verslag: Vaccinatiegraad en Epidemiologische Impact van de Covid-19-Vaccinatiecampagne in België. Gegevens tot en met 31 oktober 2021 [Internet]. Brussels, Belgium: Sciensano; 2021 [cited 2023 Sep 6] p. 53. Report No.: D/2021/14.440/80. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID_19_THEMATIC_REPORT_VaccineCoverageAndImpactReport_NL.pdf

33.

Cavillot L, van Loenhout JAF, Devleesschauwer B, Wyndham-Thomas C, Van Oyen H, Ghattas J, et al. Sociodemographic and socioeconomic disparities in COVID-19 vaccine uptake in Belgium: a nationwide record linkage study. J Epidemiol Community Health. 2024;78:176. https://doi.org/10.1136/jech-2023-220751

34.

Risk Assesment Group. Impact. van de vaccinatiestrategie op de geldende maatregelen rond testen en quarantaine in initiële fase-1ste update [Internet]. Brussels, Belgium: Risk Assesment Group; 2021 [cited 2023 Sep 6]. Report No.: RAG vergadering 23/02/2021 – gevalideerd door RMG 25/02/2021. https://covid-19.sciensano.be/sites/default/files/Covid19/20210226_Advice_RAG_ImpactofVaccinationonTandQ_update%20Feb_NL.pdf

35.

Hoebel J, Grabka MM, Schröder C, Haller S, Neuhauser H, Wachtler B et al. Socioeconomic position and SARS-CoV-2 infections: seroepidemiological findings from a German nationwide dynamic cohort. J Epidemiol Community Health [Internet]. 2022 Apr [cited 2023 Sep 6];76(4):350–3. https://jech.bmj.com/lookup/doi/https://doi.org/10.1136/jech-2021-217653

36.

Nafilyan V, Pawelek P, Ayoubkhani D, Rhodes S, Pembrey L, Matz M, et al. Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults. Occup Environ Med. 2022;79:433–41.CrossRefPubMed

37.

Witteveen D. Sociodemographic inequality in exposure to COVID-19-induced economic hardship in the United Kingdom. Research in Social Stratification and Mobility [Internet]. 2020 Oct [cited 2021 Jul 6];69:100551. https://linkinghub.elsevier.com/retrieve/pii/S0276562420300871

38.

Wizan M, Neelen W, Marchal S. Balancing speed and effectiveness: smoothing income volatility through COVID-19 social policy responses in Belgium. Antwerp, Belgium: Centrum voor Sociaal Beleid Herman Deleeck; 2023. Report No.: 23/04.

39.

Phelan JC, Link BG, Tehranifar P. Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. J Health Soc Behav [Internet]. 2010 Mar [cited 2023 Feb 10];51(1_suppl):S28–40. http://journals.sagepub.com/doi/https://doi.org/10.1177/0022146510383498

40.

Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide? J R Soc Med [Internet]. 2020 Sep [cited 2022 Feb 4];113(9):329–34. http://journals.sagepub.com/doi/https://doi.org/10.1177/0141076820956802

Title: Uncovering the toll of the first three COVID-19 waves: excess mortality and social patterns in Belgium
Authors: Laura Van den Borre
Sylvie Gadeyne
Brecht Devleesschauwer
Katrien Vanthomme
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: COVID-19
Published in: Archives of Public Health / Issue 1/2024
Electronic ISSN: 2049-3258
DOI: https://doi.org/10.1186/s13690-024-01444-9

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Uncovering the toll of the first three COVID-19 waves: excess mortality and social patterns in Belgium

Abstract

Background

Methods

Results

Conclusion

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Abstract

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