Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium

BACKGROUND: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were ‘all in it together’. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period

Housing in Brussels: diagnosis and challenges

This synopsis highlights the various facets of the housing problem in Brussels through different approaches (demographic, legal, political and sociological). It does not constitute an exhaustive state of knowledge regarding housing, but presents a panorama of current knowledge and challenges. It highlights the different dimensions of housing in the context of demographic growth and social fragmentation, reveals the controversies and debates on this subject and points out the main challenges for the future.Cette note de synthèse met en lumière, en variant les approches (démographiques, juridiques, politiques, sociologiques), les diverses facettes de la problématique du logement à Bruxelles. Elle ne constitue pas un état des savoirs exhaustif sur l’habitat, mais offre un panorama des connaissances et des enjeux actuels. Elle met en évidence les différentes dimensions du logement dans le contexte de la croissance démographique et de la fragmentation sociale, révèle les controverses et débats à son sujet et pointe les principaux enjeux pour le futur.Deze synthesenota verduidelijkt de verschillende aspecten van de huidige huisvestingsproblematiek in Brussel vanuit verschillende invalshoeken (demografisch, juridisch, politiek en sociologisch). De nota verstrekt geen exhaustieve stand van zaken van de kennis over de woonomgeving, maar biedt een overzicht van de huidige kennis en actuele uitdagingen. De nota licht de verschillende dimensies van de huisvestingsproblematiek toe in de context van de demografische groei en de sociale fragmentering, brengt de controverses en debatten over dat vraagstuk aan het licht en stipt de grootste uitdagingen voor de toekomst aan

Le logement à Bruxelles : diagnostic et enjeux

Cette note de synthèse met en lumière, en variant les approches (démographiques, juridiques, politiques, sociologiques), les diverses facettes de la problématique du logement à Bruxelles. Elle ne constitue pas un état des savoirs exhaustif sur l’habitat, mais offre un panorama des connaissances et des enjeux actuels. Elle met en évidence les différentes dimensions du logement dans le contexte de la croissance démographique et de la fragmentation sociale, révèle les controverses et débats à son sujet et pointe les principaux enjeux pour le futur.Deze synthesenota verduidelijkt de verschillende aspecten van de huidige huisvestingsproblematiek in Brussel vanuit verschillende invalshoeken (demografisch, juridisch, politiek en sociologisch). De nota verstrekt geen exhaustieve stand van zaken van de kennis over de woonomgeving, maar biedt een overzicht van de huidige kennis en actuele uitdagingen. De nota licht de verschillende dimensies van de huisvestingsproblematiek toe in de context van de demografische groei en de sociale fragmentering, brengt de controverses en debatten over dat vraagstuk aan het licht en stipt de grootste uitdagingen voor de toekomst aan.This synopsis highlights the various facets of the housing problem in Brussels through different approaches (demographic, legal, political and sociological). It does not constitute an exhaustive state of knowledge regarding housing, but presents a panorama of current knowledge and challenges. It highlights the different dimensions of housing in the context of demographic growth and social fragmentation, reveals the controversies and debates on this subject and points out the main challenges for the future

Huisvesting in Brussel: diagnose en uitdagingen

Deze synthesenota verduidelijkt de verschillende aspecten van de huidige huisvestingsproblematiek in Brussel vanuit verschillende invalshoeken (demografisch, juridisch, politiek en sociologisch). De nota verstrekt geen exhaustieve stand van zaken van de kennis over de woonomgeving, maar biedt een overzicht van de huidige kennis en actuele uitdagingen. De nota licht de verschillende dimensies van de huisvestingsproblematiek toe in de context van de demografische groei en de sociale fragmentering, brengt de controverses en debatten over dat vraagstuk aan het licht en stipt de grootste uitdagingen voor de toekomst aan.Cette note de synthèse met en lumière, en variant les approches (démographiques, juridiques, politiques, sociologiques), les diverses facettes de la problématique du logement à Bruxelles. Elle ne constitue pas un état des savoirs exhaustif sur l’habitat, mais offre un panorama des connaissances et des enjeux actuels. Elle met en évidence les différentes dimensions du logement dans le contexte de la croissance démographique et de la fragmentation sociale, révèle les controverses et débats à son sujet et pointe les principaux enjeux pour le futur.This synopsis highlights the various facets of the housing problem in Brussels through different approaches (demographic, legal, political and sociological). It does not constitute an exhaustive state of knowledge regarding housing, but presents a panorama of current knowledge and challenges. It highlights the different dimensions of housing in the context of demographic growth and social fragmentation, reveals the controversies and debates on this subject and points out the main challenges for the future

Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes

<p>Abstract</p> <p>Background</p> <p>Since most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study aims to examine past trends and future projections of place of death.</p> <p>Methods</p> <p>Analysis of death certificates (decedents aged ≥ 1 year) in Belgium (Flanders and Brussels Capital region) 1998-2007. Trends in place of death were adjusted for cause of death, sociodemographic characteristics, environmental factors, numbers of hospital beds, and residential and skilled nursing beds in care homes. Future trends were based on age- and sex-specific mortality prognoses.</p> <p>Results</p> <p>Hospital deaths decreased from 55.1% to 51.7% and care home deaths rose from 18.3% to 22.6%. The percentage of home deaths remained stable. The odds of dying in a care home versus hospital increased steadily and was 1.65 (95%CI:1.53-1.78) in 2007 compared to 1998. This increase could be attributed to the replacement of residential beds by skilled nursing beds. Continuation of these trends would result in the more than doubling of deaths in care homes and a decrease in deaths at home and in hospital by 2040.</p> <p>Conclusions</p> <p>Additional end-of-life care resources in care homes largely explain the decrease in hospital deaths. Care homes will become the main locus of end-of-life care in the future. Governments should provide sufficient skilled nursing resources in care homes to fulfil the end-of-life care preferences and needs of patients.</p