Islam Nazrul, García López Fernando J, Jdanov Dimitri A, Royo-Bordonada Miguel Ángel, Khunti Kamlesh, Lewington Sarah, Lacey Ben, White Martin, Morris Eva J A, Zunzunegui María Victoria
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
National Epidemiology Centre, Health Institute Carlos III, Madrid, Spain; Centre for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Spain.
Gac Sanit. 2024;38:102424. doi: 10.1016/j.gaceta.2024.102424. Epub 2024 Nov 4.
We aimed to estimate regional inequalities in excess deaths and premature mortality in Spain during 2020 and 2021, before high vaccination coverage against COVID-19.
With data from the National Institute of Statistics, within each region, sex, and age group, we estimated the excess deaths, the change in life expectancy at birth (e) and age 65 (e) and years of life lost as the difference between the observed and expected deaths using a time series analysis of 2015-2019 data and life expectancies based on Lee-Carter forecasting using 2010-2019 data.
From January 2020 to June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in Spain with a substantial regional variability (highest in Madrid: 22,000, lowest in Canary Islands: -210). The highest reductions in e in 2020 were observed in Madrid (men -3.58 years, women -2.25), Castile-La Mancha (-2.72, -2.38), and Castile and Leon (-2.13, -1.39). During the first half of 2021, the highest reduction in e was observed in Madrid for men (-2.09; -2.37 to -1.84) and Valencian Community for women (-1.63; -1.97 to -1.3). The highest excess years of life lost in 2020 was in Castile-La Mancha (men: 5370; women: 3600, per 100 000). We observed large differences between reported COVID-19 deaths and estimated excess deaths across the Spanish regions.
Regions performed highly unequally on excess deaths, life expectancy and years of life lost. The investigation of the root causes of these regional inequalities might inform future pandemic policy in Spain and elsewhere.
我们旨在估算2020年至2021年西班牙在新冠病毒疫苗高接种覆盖率之前的超额死亡和过早死亡率方面的地区不平等情况。
利用国家统计局的数据，在每个地区、性别和年龄组内，我们通过对2015 - 2019年数据进行时间序列分析以及基于2010 - 2019年数据使用李 - 卡特预测法得出的预期寿命，估算超额死亡、出生时预期寿命（e）和65岁时预期寿命（e）的变化以及寿命损失年数，即观察到的死亡人数与预期死亡人数之差。
2020年1月至2021年6月，西班牙估计有89,200例超额死亡（男性：48,000例；女性：41,200例），地区差异很大（马德里最高：22,000例，加那利群岛最低：-210例）。2020年出生时预期寿命（e）下降幅度最大的地区是马德里（男性 -3.58岁，女性 -2.25岁）、卡斯蒂利亚 - 拉曼恰（-2.72岁，-2.38岁）和卡斯蒂利亚 - 莱昂（-2.13岁，-1.39岁）。在2021年上半年，出生时预期寿命（e）下降幅度最大的地区，男性是马德里（-2.09岁；-2.37岁至 -1.84岁），女性是巴伦西亚自治区（-1.63岁；-1.97岁至 -1.3岁）。2020年寿命损失年数最多的是卡斯蒂利亚 - 拉曼恰（男性：每10万人中5370年；女性：3600年）。我们观察到西班牙各地区报告的新冠病毒死亡人数与估算的超额死亡人数之间存在很大差异。
各地区在超额死亡、预期寿命和寿命损失年数方面表现极不均衡。对这些地区不平等根源的调查可能为西班牙及其他地区未来的疫情政策提供参考。
