National Statistics Research Articles

Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of telephone triage in identifying need for emergency care among those with suspected COVID-19 infection and identify factors which affect triage accuracy.DesignObservational cohort study.SettingCommunity telephone triage provided...

Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017–2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens – especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.

Changing risk factors for developing SARS-CoV-2 infection from Delta to Omicron.

One of the few studies to estimate infection risk with SARS-CoV-2 in the general population was the UK Office of National Statistics Infection Survey. This survey provided data that allowed us to describe and interpret apparent risk factors for testing positive for SARS-CoV-2 in a period when variants and COVID-19 controls experienced large changes. The ONS published estimates of likelihood of individuals testing positive in two week monitoring periods between 21st November 2021 and 7th May 2022, relating this positivity to social and behavioural factors. We applied meta-regression to these estimates of likelihood of testing positive to determine whether the monitored potential risk factors remained constant during the pandemic. Some risk factors had consistent relationship with risk of infection (always protective or always linked to higher risk, throughout monitoring period). Other risk factors had variable relationship with risk of infection, with changes seeming to especially correlate with the emergence of Omicron BA.2 dominance. These variable factors were mask-wearing habits, history of foreign travel, household size, working status (retired or not) and contact with children or persons age over 70. Relevance of some risk factors to likelihood of testing positive for SARS-CoV-2 may relate to reinfection risk, variant infectiousness and status of social distancing regulations.

Crop yields fail to rise in smallholder farming systems in sub-Saharan Africa

Drawing on a harmonized longitudinal dataset covering more than 55,000 smallholder farms in six African countries, we analyze changes in crop productivity from 2008 to 2019. Because smallholder farmers represent a significant fraction of the world's poorest people, agricultural productivity in this context matters for poverty reduction and for the broader achievement of the UN Sustainable Development Goals. Our analysis measures productivity trends for nationally representative samples of smallholder crop farmers, using detailed data on agricultural inputs and outputs which we integrate with detailed data on local weather and environmental conditions. In spite of government commitments and international efforts to strengthen African agriculture, we find no evidence that smallholder crop productivity improved over this 12-y period. Our preferred statistical specification of total factor productivity (TFP) suggests an overall decline in productivity of -3.5% per year. Various other models we test also find declining productivity in the overall sample, and none of them finds productivity growth. However, the different countries in our sample experienced varying trends, with some instances of growth in some regions. The results suggest that major challenges remain for agricultural development in sub-Saharan Africa. They complement previous analyses that relied primarily on aggregate national statistics to measure agricultural productivity, rather than detailed microdata.

The rate of return to early childhood education in Japan: estimates from the nationwide expansion

ABSTRACT We present new estimates of the internal rate of return to early childhood education. Utilizing the nationwide expansion of preschool education in Japan between 1960 and 1980, we initially assess the impact of preschool attendance on high school graduation and college enrollment for men. Subsequently, we compute the social rate of return to preschool attendance for men by drawing upon national wage statistics to project expected wage trajectories and referencing government documents to account for the social cost of preschools. Our findings indicate a social rate of return ranging from 5.7% to 8.1%, consistent with previous estimates in the literature.

Prediction of Annual Rural Unemployment Rate in West Bengal using Grey Model

The rural unemployment rate is a critical economic indicator used to assess strength of rural economy in India. Annual estimates of rural UR are released in both usual status (ps+ss) as well as current weekly status (CWS) at the state and national level in India by National Statistics Office (NSO) through Periodic Labour Force Survey (PLFS). At present, the annual rural UR estimates are available for the state of West Bengal from the year 2017-18 to 2021-22. However, there is a notable delay in the publication of UR estimates as compared to the reference period. Therefore, accurate forecasting of the UR is crucial for timely and targeted interventions, and effective policy planning. Conventional forecasting models fail to provide accurate predictions of UR in these type of small time series due to the violation of requirement of number of data points. In contrast, the Grey model requires limited data to establish a differential forecasting model. In this study, application of grey model has been considered to forecast annual rural UR in West Bengal for different age groups as well as gender, and it was found that grey model provides satisfactory forecast.

Decoupling economic growth from carbon emissions: How have Chinese provinces performed in green growth over time?

Extensive research has shown that it is essential to take environmental responsibilities into careful consideration in economic development. Green growth has thereby become one of the most important topics in environmental economics across the globe no matter people are from academia, public, or private sectors. Even though there are many researchers who have investigated the relationship between economic growth and environmental pollution, the vast majority of research has only focused on the absolute amount of economic growth and carbon emissions. In this study, utilizing national statistics about gross domestic product and carbon emissions by region over decades, I not only provide a concrete and comprehensive picture of the green growth of Chinese provinces over time, but also present multiple indicators to capture the growth of carbon emissions and gross domestic product, as well as the growth rate of green growth. The results show that, in spite of a high GDP growth rate, the green growth rate was negative because the carbon emissions growth rate was much higher than the rate of GDP growth. This work has shed some light regarding how Chinese provinces can balance between high economic growth and low carbon emissions in order to have a more sustainable and environment-friendly development path.

Financial and economic costs of healthcare-associated infections in Africa

Healthcare associated infections (HAI) remain a global health challenge and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and sometimes death. The costs of HAI are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation, and hygiene (WASH), environmental cleaning and healthcare waste management. In Sub-Saharan Africa these services are lacking in at least 50% of healthcare facilities. This study estimated the costs associated with HAIs at national level in fourteen countries in Sub-Saharan Africa. Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined GDP and US$15.7 per capita. Healthcare costs were US$500 per HAI and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, resulted in benefit-cost ratios of 1.6 (financial health care savings only) and 8.6 (including all economic benefits). HAIs have a major health and economic burden on African societies, and a significant share can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources, and training to address HAIs.

Conditions for Training Future Teachers on a Tolerant Basis: A Sociological Analysis in Case of Kazakhstan

This article discusses the main conditions and features of the formation of pedagogical tolerance among future teachers. The phenomena of tolerance and social distance are studied, problematic aspects in the field of pedagogical tolerance formation are considered, ways of their solution are proposed. The data of the Committee for the Protection of Children's Rights of the Ministry of Education and Science of the Republic of Kazakhstan, the international rating Kids Rights Index, the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan were used. The theoretical concepts and methodology of the Emory Bogardus scale of social distance are considered. The article also discusses theoretical approaches to the formation of tolerant values among students – future teachers and their practical implementation in the educational process of the university. Pedagogical tolerance is understood as a value, the formation of which is facilitated by conditions whose effectiveness has been confirmed experimentally. Received: 9 February 2023 / Accepted: 29 April 2024 / Published: 5 May 2024

Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study

BackgroundAn immediate, temporal risk of heart failure and arrhythmias after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation has been demonstrated, particularly in the first month post-exacerbation. However, the clinical profile of patients who develop heart failure (HF) or atrial fibrillation/flutter (AF) following exacerbation is unclear. Therefore we examined factors associated with people being hospitalized for HF or AF, respectively, following a COPD exacerbation.MethodsWe conducted two nested case-control studies, using primary care electronic healthcare records from the Clinical Practice Research Datalink Aurum linked to Hospital Episode Statistics, Office for National Statistics for mortality, and socioeconomic data (2014-2020). Cases had hospitalization for HF or AF within 30 days of a COPD exacerbation, with controls matched by GP practice (HF 2:1;AF 3:1). We used conditional logistic regression to explore demographic and clinical factors associated with HF and AF hospitalization.ResultsOdds of HF hospitalization (1,569 cases, 3,138 controls) increased with age, type II diabetes, obesity, HF and arrhythmia history, exacerbation severity (hospitalization), most cardiovascular medications, GOLD airflow obstruction, MRC dyspnea score, and chronic kidney disease. Strongest associations were for severe exacerbations (adjusted odds ratio (aOR)=6.25, 95%CI 5.10-7.66), prior HF (aOR=2.57, 95%CI 1.73-3.83), age≥80 years (aOR=2.41, 95%CI 1.88-3.09), and prior diuretics prescription (aOR=2.81, 95%CI 2.29-3.45).Odds of AF hospitalization (841 cases, 2,523 controls) increased with age, male sex, severe exacerbation, arrhythmia and pulmonary hypertension history and most cardiovascular medications. Strongest associations were for severe exacerbations (aOR=5.78, 95%CI 4.45-7.50), age≥80 years (aOR=3.15, 95%CI 2.26-4.40), arrhythmia (aOR=3.55, 95%CI 2.53-4.98), pulmonary hypertension (aOR=3.05, 95%CI 1.21-7.68), and prescription of anticoagulants (aOR=3.81, 95%CI 2.57-5.64), positive inotropes (aOR=2.29, 95%CI 1.41-3.74) and anti-arrhythmic drugs (aOR=2.14, 95%CI 1.10-4.15).ConclusionsCardiopulmonary factors were associated with hospitalization for HF in the 30 days following a COPD exacerbation, while only cardiovascular-related factors and exacerbation severity were associated with AF hospitalization. Understanding factors will help target people for prevention.

Investigating inflation, living costs and mental health service utilization in post-COVID-19 England

This study investigates the association between price inflation and mental health conditions in the general population during the post-coronavirus disease 2019 (COVID-19) era in England, beginning from April 2022. Here, utilizing data from the Office for National Statistics and the National Health Service, we examined the association between price inflation, reflected by an official index ‘Consumer Prices Index including owner occupiers’ housing costs’ and the number of people in contact with mental health services across different age groups. Our findings revealed that, compared with the pre-COVID-19 period (August 2016 to February 2020), significant associations emerged between specific living costs (including costs for ‘food and non-alcoholic beverages’, ‘housing, water and fuels’ and ‘miscellaneous goods and services’) and mental health service utilization during the post-COVID-19 era. This association was particularly noted for adults aged 19–64 years and the elderly population aged 65 years and over. The results highlight the importance of addressing the potential causes of mental health issues in the context of rising living costs and can inform targeted social and economic policies, such as financial subsidies for food and non-alcoholic beverages and the need to scale up mental health services.

General population normative values for the EORTC QLQ-C30 by age, sex, and health condition for the French general population

BackgroundGeneral population normative values for the widely used health-related quality of life (HRQoL) measure EORTC QLQ-C30 support the interpretation of trial results and HRQoL of patients in clinical practice. Here, we provide sex-, age- and health condition-specific normative values for the EORTC QLQ-C30 in the French general population.MethodsFrench general population data was collected in an international EORTC project. Online panels with quota samples were used to recruit sex and age groups. Number and type of comorbidities were assessed. Descriptive statistics were used to calculate general population values for each QLQ-C30 scale, separately for sex, age, and presence of one- and more chronic health conditions. A multivariate linear regression model has been developed to allow estimating the effect of sex, age, and the presence for one- and more chronic health conditions on EORTC QLQ-C30 scores. Data was weighted according to United Nation statistics adjusting for the proportion of sex and age groups.ResultsIn total, 1001 French respondents were included in our analyses. The weighted mean age was 47.9 years, 514 (51.3%) participants were women, and 497 (52.2%) participants reported at least one health condition. Men reported statistically significant better scores for Emotional Functioning (+9.6 points, p = 0.006) and Fatigue (−7.8 point; p = 0.04); women reported better profiles for Role Functioning (+8.7 points; p = 0.008) and Financial Difficulty (−7.8 points, p = 0.011). According to the regression model, the sex effect was statistically significant in eight scales; the effect of increasing age had a statistically significant effect on seven of the 15 EORTC QLQ-C30 scales. The sex- and age effect varied in its direction across the various scales. The presence of health conditions showed a strong negative effect on all scales.ConclusionThis is the first publication of detailed French normative values for the EORTC QLQ-C30. It aims to support the interpretation of HRQoL profiles in French cancer populations. The strong impact of health conditions on QLQ-C30 scores highlights the importance of considering the impact of comorbidities in cancer patients when interpreting HRQoL data.

Legislative policy to criminalizing human trafficking in anti-trafficking law in Saudi Arabia

This research discusses one of the most important crimes against humanity, where national and international statistics and reports revealed that the bad living conditions or bad troubled situations have forced thousands of women, children and men in their countries to be susceptible to the trafficking and exploitation. The study has been divided into two main sections. The first section presents concept of the trafficking in persons in international charters and conventions, reasons, seriousness and elements of the crime in general. The second section studies the Saudi lawmaker's addressing the crime in terms of definition, forms, prescribed penalty and reasons for augmentation of penalty. The study has concluded to a set of results and recommendations, the most important of which is that the Saudi lawmaker adopted position of the international conventions in defining crime and determining its forms. Moreover, the Kingdom has also made great strides in combating this type of crime at both international and local levels. The study recommended the need to impose harsh penalties on employers, who practice patterns of forced slavery to their workers, as well as the need to intensify efforts in order to take adequate measures to prevent smuggling the illegal labor.

Food insecurity in high-risk rural communities before and during the COVID-19 pandemic

ObjectiveTo perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic. MethodsIn 2020, we mailed a comprehensive cross-sectional survey to all households in Sullivan County, a rural county with the second-worst health outcomes among all counties in New York State. Surveys of households included validated food insecurity screening questions. Questions were asked in reference to 2019, prior to the pandemic, and for 2020, in the first year of the pandemic. Respondents also responded to demographic questions. Raking adjustments were performed using age, sex, race/ethnicity, and health insurance strata to mitigate non-response bias. To identify significant hotspots of food insecurity within the county, we also performed geospatial analysis. FindingsFrom the 28,284 households surveyed, 20% of households responded. Of 4725 survey respondents, 26% of households reported experiencing food insecurity in 2019, and in 2020, this proportion increased to 35%. In 2020, 58% of Black and Hispanic households reported experiencing food insecurity. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. The geospatial analyses revealed that hotspots of food insecurity were primarily located in or near more urban areas of the rural county. ConclusionsOur countywide health survey in a high-risk rural county identified significant increases of food insecurity in the first year of the COVID-19 pandemic, despite national statistics reporting a stable rate. Responses to future crises should include targeted interventions to bolster food security among vulnerable rural populations.

Risk equations for prosthetic joint infections (PJIs) in UK: a retrospective study using the Clinical Practice Research Datalink (CPRD) AURUM and GOLD databases

BackgroundProsthetic joint infections (PJIs) are a serious negative outcome of arthroplasty with incidence of about 1%. Risk of PJI could depend on local treatment policies and guidelines; no UK-specific risk...

Incidence, prevalence and mortality of idiopathic pulmonary fibrosis in England from 2008 to 2018: a cohort study

BackgroundOwing to discrepancies in methodologies and how idiopathic pulmonary fibrosis (IPF) is diagnosed it is challenging to establish a consistent understanding of the disease burden In the UK, over 10...

Features and public financing of digitalization and E-Government: The case of Kazakhstan

In Kazakhstan, for more than 20 years, the state policy on the formation of a single information space, aimed at reducing budgetary resources for the formation and maintenance of information resources of government agencies, as well as the creation of a unified communication environment. The relevance of the article is due to the following factors: the acceleration of digital modernization processes in Kazakhstan under the influence of global informatization and the consideration of the prospects of improving the efficiency of the Kazakh government through the introduction of information technology is not always recognized by society as an institutional advantage. As special methodological tools, the study used experimental, empirical and heuristic methods to analyze factors and identify problems in budget financing in the field of digitalization and E-Government in Kazakhstan. The main source of data is the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan. The main conclusions: there is a need for further economic and political modernization of Kazakh society through the widespread use of information technology, and in our view, the practical approach to the use of public financing to create a real e-government and the prospects for its development in Kazakhstan is interesting.

Cancer incidence, treatment, and survival in the prison population compared with the general population in England: a population-based, matched cohort study

The growing and ageing prison population in England makes accurate cancer data of increasing importance for prison health policies. This study aimed to compare cancer incidence, treatment, and survival between patients diagnosed in prison and the general population. In this population-based, matched cohort study, we used cancer registration data from the National Cancer Registration and Analysis Service in England to identify primary invasive cancers and cervical cancers in situ diagnosed in adults (aged ≥18 years) in the prison and general populations between Jan 1, 1998, and Dec 31, 2017. Ministry of Justice and Office for National Statistics population data for England were used to calculate age-standardised incidence rates (ASIR) per year and age-standardised incidence rate ratios (ASIRR) for the 20-year period. Patients diagnosed with primary invasive cancers (ie, excluding cervical cancers in situ) in prison between Jan 1, 2012, and Dec 31, 2017 were matched to individuals from the general population and linked to hospital and treatment datasets. Matching was done in a 1:5 ratio according to 5-year age group, gender, diagnosis year, cancer site, and disease stage. Our primary objectives were to compare the incidence of cancer (1998-2017); the receipt of treatment with curative intent (2012-17 matched cohort), using logistic regression adjusted for matching variables (excluding cancer site) and route to diagnosis; and overall survival following cancer diagnosis (2012-17 matched cohort), using a Cox proportional hazards model adjusted for matching variables (excluding cancer site) and route to diagnosis, with stratification for the receipt of any treatment with curative intent. We identified 2015 incident cancers among 1964 adults (1556 [77·2%] men and 459 [22·8%] women) in English prisons in the 20-year period up to Dec 31, 2017. The ASIR for cancer for men in prison was initially lower than for men in the general population (in 1998, ASIR 119·33 per 100 000 person-years [95% CI 48·59-219·16] vs 746·97 per 100 000 person-years [742·31-751·66]), but increased to a similar level towards the end of the study period (in 2017, 856·85 per 100 000 person-years [675·12-1060·44] vs 788·59 per 100 000 person-years [784·62-792·57]). For women, the invasive cancer incidence rate was low and so ASIR was not reported for this group. Over the 20-year period, the incidence of invasive cancer for men in prison increased (incidence rate ratio per year, 1·05 [95% CI 1·04-1·06], during 1999-2017 compared with 1998). ASIRRs showed that over the 20-year period, overall cancer incidence was lower in men in prison than in men in the general population (ASIRR 0·76 [95% CI 0·73-0·80]). The difference was not statistically significant for women (ASIRR 0·83 [0·68-1·00]). Between Jan 1, 2012, and Dec 31, 2017, patients diagnosed in prison were less likely to undergo curative treatment than matched patients in the general population (274 [32·3%] of 847 patients vs 1728 [41·5%] of 4165; adjusted odds ratio (OR) 0·72 [95% CI 0·60-0·85]). Being diagnosed in prison was associated with a significantly increased risk of death on adjustment for matching variables (347 deaths during 2021·9 person-years in the prison cohort vs 1626 deaths during 10 944·2 person-years in the general population; adjusted HR 1·16 [95% CI 1·03-1·30]); this association was partly explained by stratification by curative treatment and further adjustment for diagnosis route (adjusted HR 1·05 [0·93-1·18]). Cancer incidence increased in people in prisons in England between 1998 and 2017, with patients in prison less likely to receive curative treatments and having lower overall survival than the general population. The association with survival was partly explained by accounting for differences in receipt of curative treatment and adjustment for diagnosis route. Improved routine cancer surveillance is needed to inform prison cancer policies and decrease inequalities for this under-researched population. UK National Institute for Health and Care Research, King's College London, and Strategic Priorities Fund 2019/20 of Research England via the University of Surrey.

Life cycle assessment of food consumption in different cities: Analysis of socioeconomic level and environmental hotspots

This study presents a comprehensive life cycle assessment of the environmental impacts of dietary patterns in different cities, focusing on the correlation between food consumption and environmental impact. The functional unit was the food required to meet one person's yearly needs (1 Inh/year). To determine the quantity and type of food consumed, as well as the income level of the residents, 523 surveys were conducted in households in four cities in Chile (Iquique, Santiago, Temuco, and Coyhaique). Survey data were complemented with secondary information from national statistics and the Ecoinvent database. The environmental impact assessment was carried out using SimaPro, selecting the categories of global warming, terrestrial acidification, terrestrial ecotoxicity, freshwater ecotoxicity, freshwater eutrophication, land use, and fossil resource scarcity. The results show that higher-income households generate greater environmental impacts attributed to higher per capita food consumption. In the global warming category, the environmental impact can range from 1.08 kg CO2 eq/inh/year for the first quintile to 2.15 kg CO2 eq/inh/year for the fifth quintile in Santiago. In this category, the impacts in the highest quintiles can be up to 2.2 times greater than those in the lowest quintiles. Similarly, in acidification, this difference can reach 2.3 times. In the freshwater eutrophication category, the highest-income quintiles can double the environmental impacts compared to the lowest (I and II), mainly due to higher consumption of red meat and dairy products. The food production stage was the environmental hotspot across all evaluated impact categories, accounting for 45%–60% of the impacts in global warming, terrestrial ecotoxicity, and fossil resource scarcity; 74%–78% in terrestrial acidification, freshwater eutrophication, and land use; and 68%–71% in freshwater ecotoxicity. Meat was pinpointed as the primary environmental hotspot in global warming (44%), terrestrial acidification (56%), freshwater eutrophication (50%), land use (35%), and fossil resource scarcity (30%). Conversely, cereals are the primary environmental hotspot in terrestrial ecotoxicity (30%) and vegetables in freshwater ecotoxicity (18%). The geographical location of cities also influenced the environmental impacts of food consumption, primarily due to the types of available foods in regions near each city. Food availability conditions, diets, and quantities consumed, thus influencing environmental impacts. Finally, household incomes, the geographical location of cities, and the food production systems in each city determine the environmental impacts of food consumption. Different configurations of these variables create unique environmental impact profiles for each city. Despite this, typical environmental hotspots in food consumption were identified across all cities, enabling the implementation of strategies to minimize environmental impacts on a national scale. Thus, circular economy strategies linked to food production systems, as well as food loss and waste, could significantly reduce environmental impacts, presenting an intriguing opportunity for future research in this field.

Excess Child Mortality Associated With Colombia’s Armed Conflict, 1998-2019

Armed conflicts are directly and indirectly associated with morbidity and mortality due to destruction of health infrastructure and diversion of resources, forced displacement, environmental damage, and erosion of social and economic security. Colombia's conflict began in the 1940s and has been uniquely long-lasting and geographically dynamic. To estimate the proportion of infant and child mortality associated with armed conflict exposure from 1998 to 2019 in Colombia. This ecological cohort study includes data from all 1122 municipalities in Colombia from 1998 to 2019. Statistical analysis was conducted from February 2022 to June 2023. Armed conflict exposure was measured dichotomously by the occurrence of conflict-related events in each municipality-year, enumerated and reported by the Colombian National Center for Historic Memory. Deaths among children younger than 5 years and deaths among infants younger than 1 year, offset by the number of births in that municipality-year, enumerated by Colombia's national vital statistics. The analytical sample included 24 157 municipality-years and 223 101 conflict events covering the period from 1998 to 2019. Overall, the presence of armed conflict in a municipality was associated with a 52% increased risk of death for children younger than 5 years of age (relative risk, 1.52 [95% CI, 1.34-1.72]), with similar results for 1- and 5-year lagged analyses. Armed conflict was associated with a 61% increased risk in infant (aged <1 year) death (relative risk, 1.61 [95% CI, 1.43-1.82]). On the absolute scale, this translates to a risk difference of 3.7 excess child deaths per 1000 births (95% CI, 2.7-4.7 per 1000 births) and 3.0 excess infant deaths per 1000 births (95% CI, 2.3-3.6 per 1000 births) per year, beyond what would be expected in the absence of armed conflict. Across the 22-year study period, the population attributable risk was 31.7% (95% CI, 23.5%-39.1%) for child deaths and 35.3% (95% CI, 27.8%-42.0%) for infant deaths. This ecological cohort study of Colombia's spatiotemporally dynamic armed conflict suggests that municipal exposure to armed conflict was associated with excess child and infant deaths. With a record number of children living near active conflict zones in 2020, policy makers and health professionals should understand the magnitude of and manner in which armed conflicts directly and indirectly undermine child health.