H5N1

Life expectancy and risk of death in 6791 communities in England from 2002 to 2019

Via The Lancet Public Health: Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data. The summary:

Background  

High-resolution data for how mortality and longevity have changed in England, UK are scarce. We aimed to estimate trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6791 middle-layer super output areas (MSOAs) in England.  

Methods  

We performed a high-resolution spatiotemporal analysis of civil registration data from the UK Small Area Health Statistics Unit research database using de-identified data for all deaths in England from 2002 to 2019, with information on age, sex, and MSOA of residence, and population counts by age, sex, and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs, and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA.  

Findings  

In 2002–06 and 2006–10, all but a few (0–1%) MSOAs had a life expectancy increase for female and male sexes. In 2010–14, female life expectancy decreased in 351 (5·2%) of 6791 MSOAs. By 2014–19, the number of MSOAs with declining life expectancy was 1270 (18·7%) for women and 784 (11·5%) for men. 

The life expectancy increase from 2002 to 2019 was smaller in MSOAs where life expectancy had been lower in 2002 (mostly northern urban MSOAs), and larger in MSOAs where life expectancy had been higher in 2002 (mostly MSOAs in and around London). As a result of these trends, the gap between the first and 99th percentiles of MSOA life expectancy for women increased from 10·7 years (95% credible interval 10·4–10·9) in 2002 to reach 14·2 years (13·9–14·5) in 2019, and for men increased from 11·5 years (11·3–11·7) in 2002 to 13·6 years (13·4–13·9) in 2019.  

Interpretation  

In the decade before the COVID-19 pandemic, life expectancy declined in increasing numbers of communities in England. To ensure that this trend does not continue or worsen, there is a need for pro-equity economic and social policies, and greater investment in public health and health care throughout the entire country.

Mortality rates by college degree before and during COVID-19

Via NBER, a paper by Anne Case and Angus Deaton: Mortality Rates by College Degree Before and During COVID-19. Click or tap through to download the PDF. The abstract:

It is now established that mortality and excess mortality from COVID-19 differed across racial and ethnic groups in 2020. Less is known about educational differences in mortality during the pandemic. We examine mortality rates by BA status within sex, age, and race/ethnic groups comparing 2020 with 2019. Mortality rates have increasingly differed by BA status in the US in recent years and there are good reasons to expect the gap to have widened further during the pandemic. 

Using publicly available provisional data from the National Center for Health Statistics we find that mortality rates increased in 2020 over 2019 for those with and without a BA, irrespective of age, sex, or race/ethnicity. Although mortality rates increased by more for those without a BA, the ratio of mortality rates for those with and without a BA changed surprisingly little from 2019 to 2020. Among 60 groups (sex by race/ethnicity by age) that are available in the data, the ratio of mortality rates of those without a BA to those with a BA fell for more than half of the groups. 

Our results suggest that differences in the risk of infection were less important in structuring mortality by education than differences in the risk of death conditional on infection.

Covid is killing rural Americans at twice the rate of people in urban areas

Via NBC News, a report by Lauren Weber of Kaiser Health News: Covid Is killing rural Americans at twice the rate of people in urban areas. Excerpt:

Rural Americans are dying of Covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated.  

While the initial surge of Covid-19 deaths skipped over much of rural America, where roughly 15 percent of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.  

Since the pandemic began, about 1 in 434 rural Americans have died from Covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall Covid death rates since the winter peak, rural mortality rates are now more than double that of urban ones — and accelerating quickly.  

In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin is grappling with a 39 percent vaccination rate in his community. Eleven patients died of Covid in the first half of September at his hospital in Mount Pleasant, population 16,000. Typically, three or four nonhospice patients die there in a whole month.  

“We don’t see death like that,” Scoggin said. “You usually don’t see your friends and neighbors die.”

Part of the problem is that Covid incidence rates in September were roughly 54 percent higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-wrote the institute’s report. He said the analysis compared the rates between nonmetropolitan, or rural, areas and metropolitan, or urban, areas. In 39 states, he added, rural counties had higher rates of Covid than their urban counterparts.  

“There is a national disconnect between perception and reality when it comes to Covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public, or among governing officials.”  

Still, the high incidence of cases and low vaccination rates don’t fully capture why mortality rates are so much higher in rural areas than elsewhere. Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.  

It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black or Hispanic people at disproportionately high rates.  

Vaccinations are the most effective way to prevent Covid infections from turning deadly. Roughly 41 percent of rural America was vaccinated as of Sept. 23, compared with about 53 percent of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates.

How the US vaccine effort derailed and why we shouldn’t be surprised

Via The Guardian: How the US vaccine effort derailed and why we shouldn’t be surprise. Excerpt:

There are very specific, well-documented reasons that Americans are hesitant to take vaccines. They vary from the troubling way the medical system treats people of color, to vaccine misinformation campaigns overwhelmingly popular in conservative circles, to logistical challenges.  

But population health researchers, whose work considers how society as a whole is fairing, said low vaccine uptake may be looked at another way: as the predictable outcome of a campaign subject to entrenched social forces that have diminished American health and life expectancy since the 1980s.  

“When I look at this I do see a very familiar pattern,” said Dr Steven Woolf, a prominent population health researcher at Virginia Commonwealth University. “When Operation Warp Speed came out I thought I was just seeing a modern example of this old problem where the scientific community developed the vaccine at ‘warp speed,’ but the implementation system for getting it out into the community was inadequate”.  

Woolf calls this “breakthrough without follow-through”. In that light, the plodding vaccination campaign could be seen as one more aspect of the American “health disadvantage”.  

The phrase describes a paradox: the US houses among the most advanced medical and research centers in the world, but performs poorly in basic health metrics such as maternal mortality and infant mortality; accidental injury, death and disability; and chronic and infectious disease.

"So much of the whole issue of social determinants of health and the US ‘health disadvantage’ is rooted in a lack of trust and a lack of trustworthiness in many parts of our society,” said Laudan Y Aron, a senior fellow at the Urban Institute’s health policy center. 

A key piece of research in this area is a 2013 report by a panel chaired by Woolf, directed by Aron, and funded by the National Institutes of Health. Called US Health in International Perspective: Shorter Lives, Poorer Health, the report describes how Americans spend more than double per person on healthcare compared to 17 peer nations, but rank near the bottom in health outcomes.  

The phenomenon is described as “pervasive”, impacting all age groups up to 75, with life expectancy declining especially for women. In just a few examples, Americans have the highest infant mortality, children are less likely to live to age five, and the US has the worst rates of Aids among peer nations.  

The US also has the highest or among the highest rates of cardiovascular disease, obesity, chronic lung disease and disability. Together, these risk factors culminate in Americans having the worst or second worst probability of living to age 50.  

Americans know intuitively that their healthcare is expensive, frustrating and often unfair. Remarkably, even amid the pandemic, roughly 30 million Americans went without health insurance, exposing them to potentially ruinous medical debt.  

“It’s also really interesting how often the messaging is: talk to your doctor, talk to someone you trust,” said Aron. “Yet, we don’t really acknowledge how many people don’t have a doctor, or a doctor they have a trust-based relationship with them”.

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Via The Lancet, but also published in 200 other health journals around the world: Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.

The UN General Assembly in September, 2021, will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the UN Climate Change Conference of the Parties (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1·5°C, halt the destruction of nature, and protect health.  

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1·5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. Despite the world's necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.  

Reflecting the severity of the moment, this Comment appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.  

The risks to health of increases above 1·5°C are now well established. Indeed, no temperature rise is “safe”. In the past 20 years, heat-related mortality among people older than 65 years has increased by more than 50%. Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality. Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.  

Global heating is also contributing to the decline in global yield potential for major crops, falling by 1·8–5·6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition. Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.  

The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the COVID-19 pandemic, we are globally as strong as our weakest member.  

Rises above 1·5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.  

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world's land and oceans by 2030.  

These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short-term and longer-term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations. Concern is growing that temperature rises above 1·5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community. Relatedly, current strategies for reducing emissions to net zero by the middle of the 21st century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.

This insufficient action means that temperature increases are likely to be well in excess of 2°C, a catastrophic outcome for health and environmental stability. Crucially, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed. This is an overall environmental crisis.

Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.

Many governments met the threat of the COVID-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions.

These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the COVID-19 pandemic. But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.

In particular, countries that have disproportionately created the environmental crisis must do more to support low-income and middle-income countries to build cleaner, healthier, and more resilient societies. High-income countries must meet and go beyond their outstanding commitment to provide US$100 billion a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.

Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low-income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42 billion of assets from fossil fuels; others should join them.

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1·5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.

Health inequality and COVID-19

Via the American Economic Association: Health inequality and COVID-19.

Early in the COVID-19 pandemic, there was a sense that everyone was equally vulnerable. Anyone could catch the deadly virus. Nevertheless, it has disproportionately affected less advantaged groups.   

In a paper in the Journal of Economic Perspectives, authors Marcella Alsan, Amitabh Chandra, and Kosali Simon document the initial health effects of COVID-19 in the United States and discuss the challenges of assessing its mortality toll. 

One measurement they analyzed was a calculation of “excess deaths,” or the difference between deaths observed in a particular time period and the deaths expected based on prior trends. 

Panel B of Figure 4 from Alsan et al. (2021)

Panel B of Figure 4 from the authors’ paper compares the excess mortality rates in 2020 of minorities to non-Hispanic Whites grouped by age range.       

The chart reveals that Black and Hispanic groups suffered from higher rates of death than White and Asian Americans in every age group.  

Black Americans as a whole experienced excess mortality of 2.14 deaths per 1,000 population—a 25 percent increase relative to trend, while Hispanic Americans saw excess mortality of 1.44 deaths per 1,000 population—a nearly 40 percent rise relative to trend.  

By comparison, non-Hispanic Whites and Asians experienced increases in mortality of 1.29 and 0.58 deaths per 1,000 population, respectively, which are both increases of less than 15 percent relative to trend. 

The panel also shows that the Black–White and Hispanic–White ratios are higher at younger ages compared to older groups. 

According to the researchers, alternative concepts, such as “years of potential life lost,” may do a better job at capturing the true costs of the pandemic for disadvantaged groups.

Lessons about COVID-19 vaccine hesitancy among minority ethnic people in the UK

Via The Lancet Infectious Diseases: Lessons about COVID-19 vaccine hesitancy among minority ethnic people in the UK.

According to data collected by Public Health England, in the UK, minority ethnic groups were between two and four times more likely to die due to COVID-19 compared with those from a White ethnic background. These outcomes are independent of age, sex, or socioeconomic factors. 

Moreover, at the start of the national vaccine rollout, routinely collected clinical data in England showed that Black people older than 80 years were only half as likely as White people to have been vaccinated against COVID-19. A UK-wide survey of 12 035 participants investigating attitudes towards COVID-19 vaccination showed that Black and Black British respondents had the highest rate of vaccine hesitancy (71·8%), followed by Pakistani and Bangladeshi respondents (42·3%), compared with White British or Irish respondents (15·2%) who were not likely or very unlikely to take a vaccine. 

Since the start of the COVID-19 vaccine programme, we, as health researchers, have sought to engage with over 200 community organisations that provide religious or social support for minority ethnic groups to offer information about available vaccines, answer questions, and encourage dialogue. We met with groups on online meeting platforms during the third national lockdown to answer questions and discuss concerns. The reasons for vaccine hesitancy are complex, multifactorial, and vary according to age, sex, and ethnic group. However, two broad themes were apparent.

The first theme relates to historical marginalisation, and this gap appears to have widened during the pandemic. Distrust of government and public health bodies has arisen due to ongoing discrimination (cited earlier this year by the independent National Health Service Race Observatory Board), previous unethical research (eg, in US Tuskegee syphilis study), and fears that groups are being misled about vaccines. All have contributed to current hesitancy among minority groups in receiving a COVID-19 vaccine. We found organisations supporting asylum seekers and migrants raise concerns regarding deportation through registering for a vaccine. These communities, in addition to minority ethnic groups who live in the most socioeconomically deprived urban areas, also highlighted concerns about access barriers in receiving a vaccine. 

The second theme identified a range of similar concerns across minority ethnic groups relating to safety and potential long-term effects on health, in which these groups felt that there was no clear guidance and advice. The speed of COVID-19 vaccine development and under-representation of minority ethnic groups in clinical trials exacerbated underlying hesitancy. 

In particular, older individuals discussed concerns regarding developing a rare blood clot after receiving the Oxford–AstraZeneca vaccine. Younger women frequently stated concerns about infertility after receiving a COVID-19 vaccine. Misinformation, through social media channels accessed by different minority groups, have amplified these anxieties and reduced confidence in COVID-19 vaccines. 

Furthermore, messaging from central government (through television, social media, or written media) to address vaccine safety concerns had not reached various communities we had engaged with. This was due to several reasons, including communication only being delivered in English and by politicians or policymakers who did not appear relatable. Celebrity adverts promoting COVID-19 vaccination also provided only one-way communication and did not enable a dialogue to occur with individuals and groups whose concerns had not been addressed. 

WHO noted a substantial increase in misinformation during the pandemic, which has been challenging and onerous to monitor. It is, therefore, essential for information to be provided in different languages and is widely promoted through community champions. Local health-care providers and national policymakers should be encouraged to engage in a direct and two-way dialogue with communities to address specific concerns and ensure individuals have sufficient information to make evidence-based decisions regarding COVID-19 vaccines. 

Forging conversations with minority ethnic communities, with non-stigmatising language and focusing on listening to anxieties, would improve vaccine uptake and could also engender trust in governmental institutions. Practical solutions to make vaccination more convenient, including pop-up vaccine clinics in community centres, places of worship, and door-to-door administration, should also improve uptake. In the long term, quantitative and qualitative data will be required to monitor the uptake of vaccinations across all communities and understand the reasons for any decline. 

The pandemic has disproportionality affected minority ethnic communities, causing some of the highest rates of hospitalisation and death. Developing and rolling out COVID-19 vaccines has been one of the biggest public health achievements in the current century. The success of the COVID-19 vaccine programme relies on ensuring all members of society can access and have confidence in receiving a vaccine. However, the increase of the SARS-CoV-2 B.1.617.2 variant among non-vaccinated people means that ongoing surveillance in minority ethnic populations makes effective engagement an urgent issue. This will also mitigate further worsening of disparities caused by the pandemic in minority ethnic groups.

Job one: Vaccinate the world

The Tyee has published my article Job One: Vaccinate the World. Excerpt:

According to Our World in Data, as of early August, Canada ranked fourth in the world in regard to the percentage of its people vaccinated. Only the United Arab Emirates, Uruguay and Chile are ahead of us. Worldwide, about 15 per cent of the globe’s people are fully vaccinated and 17 per cent are partly vaccinated. 

But countries like Afghanistan, Sudan, Mozambique and Haiti have been unable to vaccinate more than a small fraction of their populations. COVID-19 variants still have some five billion people to infect globally — not to mention the vaccinated people they may be able to reinfect. 

So while Canada and other rich nations define “success” as getting their own people vaccinated, COVID-19 thrives in the poor countries, spinning off variants that will eventually outwit our vaccines. 

Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, has called out wealthy countries on this inequity. While he understands why sovereign nations want to take care of their own, Ghebreyesus says a shift in priorities is crucial in the fight against the coronavirus. 

“We cannot accept countries that have already used most of the global supply of vaccines using even more of it, while the world’s most vulnerable people remain unprotected,” he said. “We need an urgent reversal, from the majority of vaccines going to high-income countries, to the majority going to low-income countries.”

Why are women more prone to long Covid?

Via The Guardian: Why are women more prone to long Covid? Excerpt:

In June 2020, as the first reports of long Covid began to filter through the medical community, doctors attempting to grapple with this mysterious malaise began to notice an unusual trend. While acute cases of Covid-19 – particularly those hospitalised with the disease – tended to be mostly male and over 50, long Covid sufferers were, by contrast, both relatively young and overwhelmingly female. 

Early reports of long Covid at a Paris hospital between May and July 2020 suggested that the average age was around 40, and women afflicted by the longer-term effects of Covid-19 outnumbered men by four to one. 

Over the past 12 months, a similar gender skew has become apparent around the world. From long Covid patients monitored by hospitals in Bangladesh and Russia to the Covid Symptom Tracker app, from the UK-wide Phosp-Covid study assessing the longer-term impact of Covid-19, to the medical notes of specialist post-Covid care clinics across both the US and the UK, a picture has steadily emerged of young to middle-aged women being disproportionately vulnerable. 

Dr Sarah Jolley, who runs the UCHealth post-Covid care clinic in Aurora, Colorado, told the Observer that about 60% of her patients have been women. In Sweden, Karolinska Institute researcher Dr Petter Brodin, who leads the long Covid arm of the Covid Human Genetic Effort global consortium, suspects that the overall proportion of female long Covid patients may be even higher, potentially 70-80%. 

“This pattern has been seen in other post-infectious syndromes,” says Dr Melissa Heightman, who runs the UCLH post-Covid care clinic in north London. “Around 66% of our patients have been women. A lot of them were in full-time jobs, have young children, and now more than a quarter of them are completely unable to work because they’re so unwell. Economically, it’s a bit of a catastrophe.” 

As Heightman points out, this is not a new trend when it comes to infectious diseases, rather one which has historically been neglected. Women are known to be up to four times more likely to get ME/CFS (myalgic encephalomyelitis, or chronic fatigue syndrome), a condition believed to have infectious origins in the majority of cases, while studies have also shown that patients with chronic Lyme disease are significantly more likely to be female.

But despite this, there have been relatively few attempts to drill down into why this is the case. Instead, because these conditions predominantly affect women, they have more often been dismissed as being psychological in origin. Over the years, both ME/CFS and chronic Lyme disease have been ridiculed by sectors of the medical community as forms of hypochondria. 

“In general, there’s not as much research money and attention on conditions that primarily affect women,” says Julie Nusbaum, an assistant professor at NYU Long Island School of Medicine. “That’s just a general disparity in medical research. I think certain biases persist that when women present with a lot of body aches or pains, there’s more often an emotional or personality component to it than medical origin.” 

Worryingly, signs of these age-old biases have crept in over the past year with long Covid. There are anecdotal reports of female patients complaining that their persistent symptoms have been dismissed or attributed to anxiety. Dr Janet Scott, an infectious diseases specialist at the University of Glasgow, says that there remains a school of thought within the academic community that the long Covid gender skew may simply be an artefact of women being more likely to report symptoms than men. 

“I don’t buy it myself,” says Scott. “I think it plays into the narrative of, ‘Don’t worry about long Covid, it’s just a bunch of hysterical, middle-aged women.’” 

But Scott and other scientists around the world are trying to delve into the different factors which make women more prone to developing long Covid. Understanding them could be crucial to shedding a light on this mysterious condition in general, as well as other illnesses which can be triggered by an infection.

High and rising working-age mortality in the US: A report from the National Academies of Sciences, Engineering, and Medicine

Via JAMA Network: High and Rising Working-Age Mortality in the US: A Report From the National Academies of Sciences, Engineering, and Medicine. Excerpt:

Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years). Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. 

This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation. 

A new report from a National Academies of Sciences, Engineering, and Medicine committee studied mortality data from 1990 to 2017 by cause of death, age, sex, race/ethnicity, socioeconomic status, and geography. It found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. 

Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). 

Mortality among working-age adults increased from other causes (eg, liver cancer, neurological diseases, homicides, transportation injuries), but none individually made large contributions to the overall trend.