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COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study

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dc.contributor.author Cajachagua-Torres, Kim N.
dc.contributor.author Quezada-Pinedo, Hugo G.
dc.contributor.author Huayanay Espinoza, Carlos Andrés
dc.contributor.author Obeso-Manrique, Jordan A.
dc.contributor.author Pena-Rodriguez, Victor A.
dc.contributor.author Vidal, Elisa
dc.contributor.author Huicho Oriundo, Luis
dc.date.accessioned 2023-01-06T13:40:11Z
dc.date.available 2023-01-06T13:40:11Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/12990
dc.description.abstract Background: Peru has experienced unprecedented mortality and economic toll due to the COVID-19 (Coronavirus disease 2019) pandemic in 2020. We aimed to assess the association between socioeconomic factors and excess death rate, and to explore the relative contribution of these factors to the differences in excess death rate during January–December 2020. Methods: Different national secondary data sources were used to describe excess death rates and different determinants, from distal to proximal. A confounding-adjusted multilevel mixed-effects linear regression was used to assess the association between these variables and excess death rates. Their relative contributions to the differences in excess death rate between the periods with the highest and lowest excess death rates were analyzed through regression-based Oaxaca-Blinder decomposition methods. Findings: The excess death rate showed an increasing trend in all regions, with different slopes. The confounding-adjusted multilevel analysis showed that higher healthcare access was associated with lower excess death rates (difference (95%CI) -0.004 (-0.005, -0.002)), whereas COVID-19 incidence was associated with higher excess death rates (difference (95%CI) 0.052 (0.042, 0.063)). The decomposition analysis showed COVID-19 incidence (41.9%), per capita income (19.4%) and unemployment rate (14.6%) as the main risk factors, while the main protective factors included per capita health expenditure (44.7%), healthcare access (33.2%) and health insurance (12.1%). Interpretation: Our study suggests that the excess death rate during the COVID-19 pandemic in Peru may have been influenced by other factors besides COVID-19 incidence, from distal to proximal drivers, including socioeconomic determinants, factors outside and within the health sector, and susceptibility factors. Further studies at individual level are needed to corroborate our findings. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Heliyon
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject COVID-19 en_US
dc.subject Pandemic en_US
dc.subject Excess death en_US
dc.subject Mortality en_US
dc.subject Inequity en_US
dc.subject Peru en_US
dc.title COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.heliyon.2022.e11948
dc.relation.issn 2405-8440


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