Mortality in Switzerland 2020-2021

In this report, we update previously published results on all-cause mortality in Switzerland in 2020 and extend them to the first half of 2021. Whereas mortality in Switzerland increased by 9.2% in 2020 compared with 2019 as a result of the first two waves of COVID-19, it decreased by about 10.8 % in the first half of 2021 compared with 2020, bringing the level of mortality in 2021 below that of 2019. In terms of life expectancy, we have gained about 3.1 months so far in 2021 in Switzerland compared to 2019, 6.0 months for women and 0.3 months for men. By mid-2021, women have therefore more than recovered the secular downward trend in mortality, i.e. an increase in life expectancy of about 2 months each year, while men are still slightly behind. A look at the weekly mortality data reveals that mortality levels in 2021 were consistently lower than those observed in previous years, with the exception of the first 4-6 weeks of 2021, corresponding to the end of the second wave of COVID-19. Notably, 2021 is the second consecutive year without a visible impact of influenza on mortality in Switzerland, and there was no third wave of mortality related to COVID-19. Therefore, 2021 is so far the best year ever regarding mortality in Switzerland. Résumé Dans ce rapport, nous mettons à jour les résultats précédemment publiés sur la mortalité toutes causes confondues en Suisse en 2020 et les étendons au premier semestre 2021. Alors que la mortalité en Suisse a augmenté de 9,2 % en 2020 par rapport à 2019 suite aux deux premières vagues de COVID-19, elle a diminué d'environ 10,8 % au premier semestre 2021 par rapport à 2020, ramenant le niveau de mortalité en 2021 en dessous de celui de 2019. En termes d'espérance de vie, nous avons gagné en Suisse environ 3,1 mois jusqu'à présent en 2021 par rapport à 2019, 6,0 mois pour les femmes et 0,3 mois pour les hommes. À la mi-2021, les femmes ont donc plus que récupéré la tendance séculaire à la baisse de la mortalité, soit une augmentation de l'espérance de vie d'environ 2 mois chaque année, alors que les hommes sont encore légèrement en retard. Une analyse des données hebdomadaires de mortalité révèle que les niveaux de mortalité en 2021 étaient systématiquement inférieurs à ceux observés les années précédentes, à l'exception des 4 à 6 premières semaines de 2021, correspondant à la fin de la deuxième vague de COVID-19. En particulier, 2021 est la deuxième année consécutive sans impact visible de la grippe sur la mortalité en Suisse, et nous n’avons pas observé de troisième vague de mortalité liée au COVID-19. Par conséquent, 2021 est jusqu'à présent la meilleure année jamais enregistrée en matière de mortalité en Suisse

Authors' response to ‘Limitless longevity': The contribution of rectangularization to the secular increase in life expectancy: an empirical study

We thank our colleagues Modig et al.1 for their inter-est in our paper ‘The contribution of rectangulariza-tion to the secular increase of life expectancy: an empirical study’,2 and for raising substantial issues related to mortality among the oldest old persons. The authors are correct in pointing out that the maximum age at death depends partly on the size of the population at risk of dying, in that a larger number of people reaching old age will increase the probability of there being one single person with a very high age at death. It was for this very reason of buffering the effect of population size on extreme values that our paper used the 90th quantile as an indicator of longevity, rather than using the max-imum age at death. One should note that from a the

Comparing the loss of life expectancy at birth during the 2020 and 1918 pandemics in six European countries

The COVID-19 pandemic that reached Europe in 2020 has often been compared to the Spanish flu pandemic of 1918. In this article, we compare the two pandemics in terms of their respective impacts on the loss of life expectancy at birth in six European countries (France, Italy, the Netherlands, Spain, Sweden, Switzerland) by estimating life expectancy in 2020 using Eurostat data. We found that the loss of life expectancy at birth was up to 20 times larger between 1917 and 1918 than between 2019 and 2020. A decomposition of these losses clearly shows that in all six countries, the main contributors were older age groups in 2020 and younger age groups in 1918. These observations are consistent with evidence indicating that most COVID-19 fatalities were among the elderly, while a majority of Spanish flu fatalities were among the young

The contribution of rectangularization to the secular increase of life expectancy: an empirical study

Background In low-mortality countries, life expectancy is increasing steadily. This increase can be disentangled into two separate components: the delayed incidence of death (i.e. the rectangularization of the survival curve) and the shift of maximal age at death to the right (i.e. the extension of longevity). Methods We studied the secular increase of life expectancy at age 50 in nine European countries between 1922 and 2006. The respective contributions of rectangularization and longevity to increasing life expectancy are quantified with a specific tool. Results For men, an acceleration of rectangularization was observed in the 1980s in all nine countries, whereas a deceleration occurred among women in six countries in the 1960s. These diverging trends are likely to reflect the gender-specific trends in smoking. As for longevity, the extension was steady from 1922 in both genders in almost all countries. The gain of years due to longevity extension exceeded the gain due to rectangularization. This predominance over rectangularization was still observed during the most recent decades. Conclusions Disentangling life expectancy into components offers new insights into the underlying mechanisms and possible determinants. Rectangularization mainly reflects the secular changes of the known determinants of early mortality, including smoking. Explaining the increase of maximal age at death is a more complex challenge. It might be related to slow and lifelong changes in the socio-economic environment and lifestyles as well as population composition. The still increasing longevity does not suggest that we are approaching any upper limit of human longevit

Gender and socioeconomic disparities in BMI trajectories in the Seychelles: a cohort analysis based on serial population-based surveys

ABSTRACT: BACKGROUND: The relationship between body mass index (BMI) and socioeconomic status (SES) tends to change over time and across populations. In this study, we examined, separately in men and women, whether the association between BMI and SES changed over successive birth cohorts in the Seychelles (Indian Ocean, African region). METHODS: We used data from all participants in three surveys conducted in 1989, 1994 and 2004 in independent random samples of the population aged 25-64 years in the Seychelles (N= 3'403). We used linear regression to model mean BMI according to age, cohort, SES and smoking status, allowing for a quadratic term for age to account for a curvilinear relation between BMI and age and interactions between SES and age and between SES and cohorts to test whether the relation between SES and BMI changed across subsequent cohorts. All analyses were performed separately in men and women. RESULTS: BMI increased with age in all birth cohorts. BMI was lower in men of low SES than high SES but was higher in women of low SES than high SES. In all SES categories, BMI increased over successive cohorts (1.24 kg/m2 in men and 1.51 kg/m2 for a 10-year increase in birth cohorts, p <0.001). The difference in BMI between men or women of high vs. low SES did not change significantly across successive cohorts (the interaction between SES and year of birth of cohort was statistically not significant). Smoking was associated with lower BMI in men and women (respectively -1.55 kg/m2 and 2.46 kg/m2, p <0.001). CONCLUSIONS: Although large differences exist between men and women, social patterning of BMI did not change significantly over successive cohorts in this population of a middle-income country in the African region

Increased EEG power and slowed dominant frequency in patients with neurogenic pain

To study the mechanisms of chronic neurogenic pain, we compared the power spectra of the resting EEG of patients (n = 15, 38-75 years, median 64 years, 6 women) and healthy controls (n = 15, 41-71 years, median 60 years, 8 women). On an average, the patient group exhibited higher spectral power over the frequency range of 2-25 Hz, and the dominant peak was shifted towards lower frequencies. Maximal differences appeared in the 7-9 Hz band in all electrodes. Frontal electrodes contributed most to this difference in the 13-15 Hz band. Bicoherence analysis suggests an enhanced coupling between theta (4-9 Hz) and beta (12-25 Hz) frequencies in patients. The subgroup of six patients free from centrally acting medication showed higher spectral power in the 2-18 Hz frequency range. On an individual basis, the combination of peak height and peak frequency discriminated between patient and control groups: discriminant analysis classified 87% of all subjects correctly. After a therapeutic lesion in the thalamus (central lateral thalamotomy, CLT) we carried out follow-up for a subgroup of seven patients. Median pain relief was 70 and 95% after 3 and 12 months, respectively. The average EEG power of all seven patients gradually decreased in the theta band and approached normal values only after 12 months. The excess theta EEG power in patients and its decrease after thalamic surgery suggests that both EEG and neurogenic pain are determined by tightly coupled thalamocortical loops. The small therapeutic CLT lesion is thought to initiate a progressive normalization in the affected thalamocortical system, which is reflected in both decrease of EEG power and pain relie

Predicting the burden of cancer in Switzerland up to 2025

Predicting the short-term evolution of the number of cancers is essential for planning investments and allocating health resources. The objective of this study was to predict the numbers of cancer cases and of the 12 most frequent cancer sites, and their age-standardized incidence rates, for the years 2019–2025 in Switzerland. Projections of the number of malignant cancer cases were obtained by combining data from two sources: forecasts of national age-standardized cancer incidence rates and population projections from the Swiss Federal Statistical Office. Age-standardized cancer incidence rates, approximating the individual cancer risk, were predicted by a low-order Autoregressive Integrated Moving Average (ARIMA) model. The contributions of changes in cancer risk (epidemiological component) and population aging and growth (demographic components) to the projected number of new cancer cases were each quantified. Between 2018 and 2025, age-standardized cancer incidence rates are predicted to stabilize for men and women at around 426 and 328/100,000, respectively (<1% change). These projected trends are expected for most cancer sites. The annual number of cancers is expected to increase from 45,676 to 52,552 (+15%), more so for men (+18%) than for women (+11%). These increases are almost entirely due to projected changes in population age structure (+12% for men and +6% for women) and population growth (+6% for both sexes). The rise in numbers of expected cancers for each site is forecast to range from 4.15% (thyroid in men) to 26% (bladder in men). While ranking of the three most frequent cancers will remain unchanged for men (1st prostate, 2nd lung, 3rd colon-rectum), colorectal cancer will overtake by 2025 lung cancer as the second most common female cancer in Switzerland, behind breast cancer. Effective and sustained prevention measures, as well as infrastructural interventions, are required to counter the increase in cancer cases and prevent any potential shortage of professionals in cancer care delivery

Outcomes and reoperations after total correction of complete atrio-ventricular septal defect

Background: Surgical correction of complete atrio-ventricular septal defect (AVSD) achieves satisfactory results with low morbidity and mortality, but may require reoperation. Our recent operative results at mid-term were followed-up. Methods: From June 2000 to December 2007, 81 patients (Down syndrome; n=60), median age 4.0 months (range 0.7-118.6) and weight 4.7kg (range 2.2-33), underwent complete AVSD correction. Patch closure for the ventricular septal defect (VSD; n=69) and atrial septal defect (ASD; n=42) was performed with left atrio-ventricular valve (LAVV) cleft closure (n=76) and right atrio-ventricular valve (RAVV) repair (n=57). Mortality, morbidity, and indications for reoperation were retrospectively studied; the end point ‘time to reoperation' was analyzed using Kaplan-Meier curves. Follow-up was complete except in two patients and spanned a median of 28 months (range 0.4-6.1 years). Results: In-hospital mortality was 3.7% (n=3) and one late death occurred. Reoperation was required in 7/79 patients (8.9%) for LAVV insufficiency (n=4), for a residual ASD (n=1), for right atrio-ventricular valve insufficiency (n=1), and for subaortic stenosis (n=1). At last follow-up, no or only mild LAVV and RAVV insufficiency was present in 81.3% and 92.1% of patients, respectively, and 2/3 of patients were medication-free. Risk factors for reoperation were younger age (≪3 months; p=0.001) and lower weight (≪4kg; p=0.003), and a trend towards less and later reoperations in Down syndrome (p≪0.2). Conclusions: Surgical correction of AVSD can be achieved with low mortality and need for reoperation, regardless of Down syndrome or not. Immediate postoperative moderate or more residual atrio-ventricular valve insufficiency will eventually require a reoperation, and could be anticipated in patients younger than 3 months and weighing ≪4k