Wyper Grant M A, Assunção Ricardo, Cuschieri Sarah, Devleeschauwer Brecht, Fletcher Eilidh, Haagsma Juanita A, Hilderink Henk B M, Idavain Jane, Lesnik Tina, Von der Lippe Elena, Majdan Marek, Milicevic Milena S, Pallari Elena, Peñalvo José L, Pires Sara M, Plaß Dietrich, Santos João V, Stockton Diane L, Thomsen Sofie Theresa, Grant Ian
Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK.
Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal.
Arch Public Health. 2020 May 29;78:47. doi: 10.1186/s13690-020-00433-y. eCollection 2020.
Evidence has emerged showing that elderly people and those with pre-existing chronic health conditions may be at higher risk of developing severe health consequences from COVID-19. In Europe, this is of particular relevance with ageing populations living with non-communicable diseases, multi-morbidity and frailty. Published estimates of Years Lived with Disability (YLD) from the Global Burden of Disease (GBD) study help to characterise the extent of these effects. Our aim was to identify the countries across Europe that have populations at highest risk from COVID-19 by using estimates of population age structure and YLD for health conditions linked to severe illness from COVID-19.
Population and YLD estimates from GBD 2017 were extracted for 45 countries in Europe. YLD was restricted to a list of specific health conditions associated with being at risk of developing severe consequences from COVID-19 based on guidance from the United Kingdom Government. This guidance also identified individuals aged 70 years and above as being at higher risk of developing severe health consequences. Study outcomes were defined as: (i) proportion of population aged 70 years and above; and (ii) rate of YLD for COVID-19 vulnerable health conditions across all ages. Bivariate groupings were established for each outcome and combined to establish overall population-level vulnerability.
Countries with the highest proportions of elderly residents were Italy, Greece, Germany, Portugal and Finland. When assessments of population-level YLD rates for COVID-19 vulnerable health conditions were made, the highest rates were observed for Bulgaria, Czechia, Croatia, Hungary and Bosnia and Herzegovina. A bivariate analysis indicated that the countries at high-risk across both measures of vulnerability were: Bulgaria; Portugal; Latvia; Lithuania; Greece; Germany; Estonia; and Sweden.
Routine estimates of population structures and non-fatal burden of disease measures can be usefully combined to create composite indicators of vulnerability for rapid assessments, in this case to severe health consequences from COVID-19. Countries with available results for sub-national regions within their country, or national burden of disease studies that also use sub-national levels for burden quantifications, should consider using non-fatal burden of disease estimates to estimate geographical vulnerability to COVID-19.
有证据表明，老年人以及患有慢性健康问题的人群感染新冠病毒后出现严重健康后果的风险可能更高。在欧洲，随着人口老龄化，非传染性疾病、多种疾病并存和身体虚弱的情况普遍存在，这一问题尤为突出。全球疾病负担（GBD）研究公布的残疾调整生命年（YLD）估计数有助于描述这些影响的程度。我们的目的是通过利用人口年龄结构估计数和与新冠病毒严重疾病相关健康状况的YLD，确定欧洲哪些国家的人口面临新冠病毒的最高风险。
提取了GBD 2017中45个欧洲国家的人口和YLD估计数。根据英国政府的指导意见，YLD仅限于与感染新冠病毒后出现严重后果风险相关的特定健康状况清单。该指导意见还确定70岁及以上的个体出现严重健康后果的风险更高。研究结果定义为：（i）70岁及以上人口的比例；（ii）所有年龄段新冠病毒易感性健康状况的YLD率。为每个结果建立了双变量分组，并将其合并以确定总体人群层面的脆弱性。
老年居民比例最高的国家是意大利、希腊、德国、葡萄牙和芬兰。在对新冠病毒易感性健康状况的人群层面YLD率进行评估时，保加利亚、捷克、克罗地亚、匈牙利和波斯尼亚和黑塞哥维那的YLD率最高。双变量分析表明，在两种脆弱性衡量标准下均处于高风险的国家是：保加利亚；葡萄牙；拉脱维亚；立陶宛；希腊；德国；爱沙尼亚；以及瑞典。
人口结构的常规估计数和非致命疾病负担测量结果可以有效地结合起来，创建脆弱性综合指标以进行快速评估，在这种情况下是针对新冠病毒导致的严重健康后果。国内有次国家级区域可用结果的国家，或在疾病负担研究中也使用次国家级层面进行负担量化的国家，应考虑使用非致命疾病负担估计数来评估对新冠病毒的地理脆弱性。
