台灣嬰兒潮世代對COVID-19大流行之超額死亡影響

Abstract

背景 亞洲地區嬰兒潮出生世代(出生於1946-1964 年之間)人口老化狀況在COVID-19大流行期間面臨超額全死因死亡的重大挑戰。但很少研究針對此一現象進行探討，尤其針對嬰兒潮對於不同SARS-CoV-2變異株易感性及超額死亡進行分析。 研究目標：本研究主要以台灣嬰兒潮世代受COVID-19大流行期間，探討不同SARS-CoV-2變異株時期對於超額死亡之影響。 研究方法：本研究以台灣2002年總人口23,186,278人為基礎，區分為嬰兒潮世代58-76歲5,307,761人及77歲以上死亡17,878,517人非嬰兒潮世代進行分析。以中斷時間序列設計方式，以COVID-19大流行前及後的時間為區隔，以大流行前死亡來進行預測流行後之死亡數，並與目前實際觀察死亡數進行作比較(預期死亡數－實際死亡數)。進一步利用卜瓦松時間序列回歸(Poisson time-series regression)探討嬰兒潮世代與COVID-19大流行發生對於死亡率是否有其交互作用。 結果：由於嬰兒潮世代的背景死亡率呈上升趨勢，但非嬰兒潮世代持續不變狀況下，與非嬰兒潮世代相比，在2020年嬰兒潮世代負超額死亡(D614G)少於2%，2021年超額死亡人數超過3%(Alpha and Delta)。在2022年Omicron關注變異株大規模流行，嬰兒潮世代及非嬰兒潮世代的超額死亡分別增加9%及10%。更有趣的是嬰兒潮世代58-76歲與非嬰兒潮世代77歲或以上的超額死亡率相同為9%。與非嬰兒潮世代相比，嬰兒潮世代有較高的超額死亡數為非因COVID-19死亡(33% vs 29%)。 結論：在COVID-19大流行期間，與年齡較大的非嬰兒潮世代相比，嬰兒潮世代的COVID-19死亡人數相近，但有較多的非因COVID-19死亡人數。獲得醫療照顧服務的機會較低及醫療能力不足可能是導致嬰兒潮世代有大量超額死亡率的原因。

Background: Ageing populations of baby boomers (born between 1946 and 1964) in Asia face significant challenges of excess total cause deaths during the COVID-19 pandemic. However, few studies have addressed this phenomenon, particularly the susceptibility of baby boomers to different SARS-CoV-2 variants and excess deaths. Objectives: This study focuses on the impact of different SARS-CoV-2 variants on excess mortality during the COVID-19 pandemic in Taiwan. Methods: Based on the total population of 23,186,278 in Taiwan in 2002, this study was divided into 5,307,761 baby boomers aged 58-76 and 17,878,517 non-baby boomers over 77 years old. The number of post-pandemic deaths was predicted by using pre-pandemic and post-pandemic time separations using pre-pandemic and post-pandemic mortality using an interrupted time series design, and compared with the actual observed deaths (expected deaths - actual deaths). Poisson time-series regression was used to explore whether there was an interaction between baby boomers and the COVID-19 pandemic on mortality. Results: Compared with non-Baby Boomers, the negative excess mortality (D614G) of Baby Boomers was less than 2% in 2020 and more than 3% in 2021 (Alpha and Delta) due to the upward trend in background mortality among Baby Boomers and the persistence of non-Baby Boomers. In 2022, the Omicron variant of concern was prevalent, with excess deaths among baby boomers and non-baby boomers increasing by 9% and 10%, respectively. More interestingly, Baby Boomers aged 58-76 have the same excess mortality rate as non-Baby Boomers aged 77 or older, at 9%. Baby boomers had a higher number of excess deaths not attributable to COVID-19 compared with non-Baby Boomers (33 versus 29 percent). Conclusions: During the COVID-19 pandemic, Baby Boomers had a similar number of COVID-19 deaths compared to older non-Baby Boomers, but there were more non-COVID-19 deaths. Poor access to health care and inadequate medical capacity may be responsible for the high excess mortality among baby boomers.