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.
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.
| Original language | English |
|---|---|
| Article number | 217 |
| Pages (from-to) | 1-14 |
| Number of pages | 14 |
| Journal | Archives of Public Health |
| Volume | 82 |
| DOIs | |
| Publication status | Published - 18 Nov 2024 |
Bibliographical note
Funding Information:We would like to thank Belgian Science Policy (BELSPO) for funding this research (grant number B2/202/P3/HELICON). In addition, we would like to thank Statistics Belgium for the data linkage and delivery as well as for the practical support.
Funding Information:
Belgian Science Policy (BELSPO) funded this research under grant number B2/202/P3/HELICON.
Publisher Copyright:
© The Author(s) 2024.
Keywords
- covid-19
- all-cause mortality
- excess mortality
- social inequalities
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Dive into the research topics of 'Uncovering the toll of the first three COVID-19 waves: excess mortality and social patterns in Belgium'. Together they form a unique fingerprint.Projects
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SRP76: SRP-Onderzoekszwaartepunt: Demographic and Societal Challenges of the 21st Century
Bircan, T. (Administrative Promotor), Vanroelen, C. (Administrative Promotor), Vanroelen, C. (CoI (Co-Promotor)), Vandenheede, H. (Co-Promotor), Verhaeghe, P.-P. (Co-Promotor), Gadeyne, S. (Co-Promotor), Bircan, T. (Co-Promotor), Baró Porras, F. (Co-Promotor), Spruyt, B. (CoI (Co-Promotor)), Vandebroeck, D. (CoI (Co-Promotor)), Schreurs, B. (CoI (Co-Promotor)), Van Belle, E. (CoI (Co-Promotor)), De Moortel, D. (CoI (Co-Promotor)), Schirmer, W. (CoI (Co-Promotor)), Buffel, V. (CoI (Co-Promotor)) & Celinska-Janowicz, D. (Administrative Promotor)
1/11/22 → 31/10/27
Project: Fundamental
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