Socioeconomic inequalities in health
COVID-19 disease was not the only significant cause of the increase in deaths in the first year of the pandemic. The state of emergency brought about, among other things, limitations in health care as well as patient’s fears related to the neglect of their own health problems. This is evidenced by the observed increase in the risk of death from cardiovascular disease by place of death; i.e. primarily at home or in a social care setting. The topic is the subject of a recent study by the National Institute of SYRI, published in the prestigious journal Nature, Scientific Report.
Among other things, the study provides data on systemic risks during health crises. "In the event of future stressful situations of this type, it will be necessary to strengthen the availability of acute health care, but also to emphasize patient awareness so that they do not delay acute health care," points out Dagmar Dzúrová, who leads SYRI's research group on socioeconomic inequalities in health.
The increase in mortality directly due to COVID-19 is a direct impact of the pandemic and these have been documented in recent years, but we know much less about the indirect impacts. It can be assumed that changes in health care delivery, people's behaviour, or inaccuracies in the coding of causes of death may have played a major role in the onset of the pandemic. SYRI researchers therefore focused on cardiovascular disease, observed variations in the delivery of outpatient and inpatient cardiac care, and variations in mortality rates, including changes during the year that contradict the traditional and long-observed seasonality of these processes.
Cardiovascular mortality rates in the Czech Republic had been declining gradually in the years before the pandemic, with possible fluctuations also occurring in relation to the incidence of influenza. "However, this positive trend changed with the start of the pandemic. In April 2020, there was a 10% increase in deaths from heart disease at home compared to the average and almost 9% in social care settings. This corresponds with the decline in cardiac outpatient or hospital care provided in March and April of the same year. At the same time, a state of emergency was in force in the Czech Republic," Dzúrová said.
There was an even more significant increase in deaths from cardiovascular diseases at the end of the first year of the pandemic, especially in October 2020 (an increase of 12% compared to the average in medical facilities, 15% at home, and 29% in social care facilities) and November 2020 (an increase of 45% compared to the average in social care facilities, while the increase at home or in medical facilities was around 2-3%). The year 2021 was already quieter in terms of fluctuations in cardiovascular mortality; thus, COVID-19 played a major role in the significant deterioration in mortality rates. Compared to the first pandemic year, the fluctuations in the volume of cardiology care provided in 2021 were not even that significant. The last extraordinary increase in the number of cardiovascular deaths occurring in hospital was recorded in December 2022 at 12%, which corresponds to the severe influenza epidemic that hit much of Europe at that time.
"During the first two years of the pandemic, COVID-19 was the leading cause of death contributing to the decline in life expectancy. However, in the first year of the pandemic, 2020, this finding is only partially valid, as the increased mortality from cardiovascular diseases also contributed to less than one-fifth of the overall mortality decline, which may be related to the reduced use of specialist health care in times of emergency. However, these changes may be caused both on the supply side (i.e. limited availability of care) and on the demand side (i.e. interest) or, on the contrary, refusal or fear to seek health care," said Klára Hulíková-Tesárková, co-author of the article. According to the authors, it is therefore crucial to ensure the availability of acute health care in the event of future crises affecting people's behaviour or use of health care, but also to promote public awareness of the essential role and indispensability of acute health care in protecting public health.
Further information: https://www.nature.com/articles/s41598-023-47949-1