COVID-19 疫情期間都會區與其週邊非都會區超額死亡模式剖析

Abstract

背景： 2019 年 12 月於中國武漢爆發多起類似嚴重急性呼吸道綜合症的非典型肺炎，經鑑定為一種新型冠狀病毒，故稱新型冠狀病毒或 COVID-19 病毒，該病症即為新型冠狀肺炎。由於國際間交通快速便捷，該病毒迅速傳播至世界各地，我國於 2020 年 1 月 15 日將其公告新增為第五類法定傳染病，凡符合通報定義的疑似個案，必須在 24 小時內通報[1]。世界衛生組織 (World Health Organization; WHO) 亦於 2020 年 1 月 30 日公布此非典型肺炎為公共衛生緊急事件 (Public Health Emergency of International Concern; PHEIC)。 材料與方法： 根據內政部公布全國及各縣市死亡人數及疾病管制署縣市別及年齡別人口數、COVID-19 死亡個案數，以 2019 年死亡率為基準，透過線性外推法計算臺灣某大都會區A市及其週邊某非都會區B市 2020 〜 2023 年主要死因超額死亡率及性別死亡風險比、A 市各年齡層主要死因性別死亡風險比及 B 市各年齡層 COVID-19 死亡率、累積 COVID-19 死亡率。 結果： 受各項非藥物介入 (Non-pharmaceutical interventions; NPI) 措施及 COVID-19 疫情影響，2020 年A市及 B 市全死因死亡率較 2019 年下降，2021 及 2022 年上升，2023年疫情趨緩才下降，尤其2022年死亡人數年增率較前一年增加1.5倍、B市增加2.5倍，其中A市死亡人數年增率及每 10 萬人口死亡率增幅均創歷年新高， COVID-19 死亡增幅約 3.8 倍最大。A市心臟疾病、糖尿病、高血壓性疾病、血管性及未明示之失智症連續 4 年超額死亡，肺炎則連續 4 年負超額死亡，高血壓性疾病超額死亡率遠高於B市；B市糖尿病、慢性下呼吸道疾病、血管性及未明示之失智症連續 4 年超額死亡，且糖尿病、血管性及未明示之失智症相對超額死亡率高於A市。A市與B市慢性下呼吸道疾病男性比上女性性別死亡風險最高。 結論： 本研究探討大都會區及非都會區在COVID-19流行期間超額死亡以及死因別超額死亡貢獻，其中COVID-19 是臺灣 2022 年主要死因之一，然而得益於 NPI 措施，A 市肺炎呈負超額死亡，A 市心臟疾病、糖尿病、高血壓性疾病於 2020 〜 2023 年均呈超額死亡；COVID-19 及慢性疾病的死亡風險，男性較女性高，25 歲以後，隨年齡增長風險亦隨之增加。B 市全死因死亡率、 COVID-19累積死亡率均高於 A 市。A市與B市平均餘命在2022年首度下降。整體顯示大都會區與非都會區造成超額死亡型態類似，但影響程度不同，受疫情期間NPI程度所影響之醫療照護量能緊縮程度而不同，藉此經驗可作為未來對於NPI執行參考實證依據以降低超額死亡之衝擊。

Background: In December 2019, multiple cases of atypical pneumonia resembling severe acute respiratory syndrome emerged in Wuhan, China. This illness was identified as being caused by a novel coronavirus, later named SARS-CoV-2. Due to rapid global transportation, the virus quickly spread worldwide. On January 15, 2020, Taiwan classified SARS-CoV-2 as a Category V notifiable infectious disease, requiring suspected cases that met the reporting criteria to be reported within 24 hours. On January 30, 2020, the World Health Organization (WHO) declared this atypical pneumonia a Public Health Emergency of International Concern (PHEIC). Materials and Methods This study utilized nationwide and regional mortality data from the Ministry of the Interior and population data by age and region from the Taiwan Centers for Disease Control. Based on the 2019 mortality rate as a baseline, we applied linear extrapolation to estimate the excess mortality rate of major causes of death and the gender-specific mortality risk ratio from 2020 to 2023. Additionally, we analyzed the gender-specific mortality risk ratio for major causes of death across different age groups, as well as the age-specific and cumulative COVID-19 mortality rates. Results: Due to the impact of SARS-CoV-2 and the implementation of non-pharmaceutical interventions (NPIs), the all-cause mortality rate in both City A and City B decreased in 2020 compared to 2019, rose in 2021 and 2022, and declined again in 2023 as the pandemic subsided. Notably, in 2022, the annual increase in deaths was 1.5 times higher than in the previous year for City A and 2.5 times higher for City B. City A recorded its highest-ever annual increase in both total deaths and mortality rate per 100,000 people, with COVID-19 deaths increasing by approximately 3.8 times. In City A, heart disease, diabetes, hypertensive diseases, and vascular and unspecified dementia showed excess mortality for four consecutive years, while pneumonia exhibited negative excess mortality. The excess mortality rate for hypertensive diseases in City A was significantly higher than in City B. In contrast, City B experienced excess mortality for diabetes, chronic lower respiratory diseases, and vascular and unspecified dementia over four consecutive years, with diabetes and dementia having relatively higher excess mortality rates than in City A. In both cities, the gender-specific mortality risk for chronic lower respiratory diseases was highest for males compared to females. Conclusions: This study examined excess mortality and the contribution of specific causes of death in metropolitan and non-metropolitan areas during the SARS-CoV-2 pandemic. COVID-19 was one of Taiwan’s leading causes of death in 2022. However, due to the implementation of NPIs, pneumonia in City A exhibited negative excess mortality, while heart disease, diabetes, and hypertensive diseases in City A showed excess mortality from 2020 to 2023. The mortality risk of COVID-19 and chronic diseases was higher in males than in females, with risk increasing with age beyond 25 years. Both all-cause mortality and cumulative COVID-19 mortality rates were higher in City B than in City A. Additionally, the life expectancy of both cities declined for the first time in 2022. Overall, while metropolitan and non-metropolitan areas displayed similar excess mortality patterns, the degree of impact varied, likely influenced by differences in healthcare capacity constraints during the pandemic. These findings provide empirical evidence for future implementation of NPIs.