Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay ...between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention.
To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories.
We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas.
Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.
Wealthier populations do better than poorer ones on most measures of health status, including nutrition, morbidity and mortality, and healthcare utilization.
This study examines the association ...between household wealth status and HIV serostatus to identify what characteristics and behaviours are associated with HIV infection, and the role of confounding factors such as place of residence and other risk factors.
Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods.
In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision.
In sub-Saharan Africa, HIV prevalence does not exhibit the same pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.
The transformation of life courses in industrialized countries since the mid-twentieth century can be analyzed through the lens of life course complexity, a function of the number of transitions or ...states experienced by individuals over a given time span. Life course complexity is often measured with composite indices in a static sequence analysis framework (i.e. over a single age interval), but this method has seldom been evaluated. This paper fills this gap. We review nine indicators of life course complexity and explore the advantages of a dynamic approach to sequence analysis (i.e. examining many nested or consecutive age intervals). An application to data on the partnership histories of American and French women is used to show the properties of each measure. We conclude that simple indicators, used alone or in combination, provide a more easily interpretable description of changes and differentials in life course complexity than commonly used composite indices. In addition, we show that, for all indicators, a dynamic approach allows a more nuanced illustration of age-related transformations of life course complexity than the static approach does.
How household-level data from censuses and surveys are analyzed to study household structure is an issue that has received little attention. The present study proposes a new methodological approach ...to address this gap. Specifically, we introduce the idea of the household configuration as a mathematical representation of observations from the household roster that uses the tools of sequence analysis to study relationships between household members. This “household configuration approach” is statistically efficient, captures the heterogeneity of family forms in a population, and is computationally simple. An application to Canadian census data for Indigenous and non-Indigenous peoples shows that our approach can yield interesting insights into household structure, otherwise not readily obtained.
At the population level, there is limited empirical evidence on the characteristics of individuals who were hospitalized because of Covid-19, the role of hospitalization in mortality risk, and how ...both evolved over time. Through the analysis of surveillance data for 7 million people in Austria, Germany, and Italy, we investigate: (1) the demographic characteristics and outcomes of individuals hospitalized because of Covid-19; and (2) the role of demographic risk factors and healthcare utilization (as measured by hospitalization) for the individual probability of dying because of Covid-19, in both cases comparing the period February to June 2020 with July 2020 to February 2021. We find that the demographic profile of individuals who were hospitalized or died because of Covid-19 is the same in both periods, except for a younger age profile for hospitalizations in the second period. Mortality differentials across countries result from the interaction of demographic risk factors and hospitalization at the individual level.
In this research note, we review available concepts and statistics for Indigenous families and households. We show how there is currently a knowledge gap concerning the composition of Indigenous ...households and their evolution over time, which is essential to improve our understanding of their social organization and its relationship to well-being, and thus to develop appropriate policies.
In countries with generalized HIV/AIDS epidemics, married couples have a shared risk of acquiring HIV/AIDS. Yet very little research has adopted a couple-level perspective to investigate perceived ...risk of HIV infection. In this paper, we used population-based data from 768 married monogamous couples in the 2004 Malawi Diffusion and Ideational Change Project (MDICP) to compare respondents’ perceptions about their spouses’ HIV status to their spouses’ actual HIV status. Using chi-squared and Kappa coefficient statistics, we evaluated how accurately respondents assess their spouse’s HIV status, and compared the assessment of their spouse’s HIV status with their assessment of their own serostatus. We found that individuals tend to overestimate their spouse’s as well as their own risk of having HIV. Husbands were generally more accurate in assessing their own risk of HIV infection than that of their wives, but wives were more accurate in assessing the HIV status of their spouses. In our multivariate logistic regression results, we found that marital infidelity is the most important correlate of overestimating individual and spousal HIV risk.
Background
The case fatality rate (CFR) is one of the most important measures for monitoring disease progression and evaluating appropriate policy health measures over the course of the COVID-19 ...pandemic. To remove biases arising from the age structure of COVID-19 cases in international comparisons of the CFR, existing studies have relied mainly on direct standardisation.
Objective
We propose and validate a synthetic indicator of COVID-19 fatality (SCFR) that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases without relying on the arbitrary choice of a standard population.
Results
Contrary to what comparisons of the crude CFR suggest, differences in COVID-19 fatality across countries according to the proposed SCFR are not very stark. Importantly, once we adjust for the age structure of COVID-19 cases, the higher case fatality among men emerges as the main driver of international differences in COVID-19 CFR.
Conclusions
The SCFR is a simple indicator that is useful for monitoring the fatality of SARS-CoV-2 mutations and the efficacy of health policy measures for COVID-19, including vaccination.
Contributions
(1) A simple synthetic indicator of COVID-19 fatality that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases; (2) Evidence that sex differences in COVID-19 fatality drive international differences in the overall CFR.
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