Disparities in excess deaths from the COVID-19 pandemic among migrant workers in Kuwait
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Abstract
Background
The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood.
Objective
To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations.
Methods
We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis.
Results
In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic.
Conclusion
The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.
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SciScore for 10.1101/2021.03.25.21254360: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This study has a number of limitations. At the time of writing, data on gender, age or cause of death stratification were not available. Although we present two methods in estimating 2020 expected deaths, there are more advanced forecasting techniques in predicting expected mortality such as seasonal autoregressive integrated moving …
SciScore for 10.1101/2021.03.25.21254360: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This study has a number of limitations. At the time of writing, data on gender, age or cause of death stratification were not available. Although we present two methods in estimating 2020 expected deaths, there are more advanced forecasting techniques in predicting expected mortality such as seasonal autoregressive integrated moving average (ARIMA) and machine learning. However, we were limited in our temporal resolution of annual deaths. Daily, weekly or monthly observed deaths were not publicly available. Because of that, the readers must be cautioned that our overall estimation of excess deaths percentage may be exaggerated. Finally, the disparity in migrant workers excess deaths is restricted to Kuwait and cannot be generalized to other contexts. Yet, the picture is unlikely to be completely different in other Gulf countries that are hosts to millions of migrant workers.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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