Evaluation of the Global Health Security Index as a predictor of Covid-19 excess mortality standardised for under-reporting and age structure

Bibliographic Data

ID21879446
AuthorsJorge Ricardo Ledesma (0000-0001-7022-3275, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA), Christopher R Isaac (Nuclear Threat Initiative), Scott F Dowell (0000-0002-3878-5056, Gates Foundation), David L Blazes (Gates Foundation), Gabrielle V Essix (Nuclear Threat Initiative), Katherine Budeski (University of Oxford), Jessica Bell (0000-0002-3433-0265, Nuclear Threat Initiative), Jennifer B Nuzzo (0000-0002-7137-6625, Brown University)
Year2023
Volume8
Issue7
Pagese012203
Publication date2023-06-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-012203
PMID37414431
OpenAlexW4383466380
LanguageEN
Citations received12
References cited89

BACKGROUND: Previous studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality. METHODS: We indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist. RESULTS: The GHS Index was negatively associated with excess COVID-19 CMRs (table 2; β= -0.21, 95% CI= -0.35 to -0.08). Greater capacities related to prevention (β= -0.11, 95% CI= -0.22 to -0.00), detection (β= -0.09, 95% CI= -0.19 to -0.00), response (β = -0.19, 95% CI= -0.36 to -0.01), international commitments (β= -0.17, 95% CI= -0.33 to -0.01) and risk environments (β= -0.30, 95% CI= -0.46 to -0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist). CONCLUSION: The first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available

Covariate · Disease · Econometrics · Economics · Environmental health · Excess mortality · Mortality rate · Pandemic · Preparedness · Public health · Sociology · COVID-19 epidemiological studies · Demography · Insurance, Mortality, Demography, Risk Management · Medicine · Viral Infections and Outbreaks Research

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