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                  <mods:namePart>Zunzunegui, Maria Victoria</mods:namePart>
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               <mods:identifier type="citation">Nazrul Islam; García López, Fernando J, Jdanov, Dimitri A; Royo-Bordonada, Miguel Ángel; Khunti, Kamlesh; Lacey, Ben; White, Martin; Morris, Eva JA; Zunzunegui, Maria Victoria. Excess deaths, life expectancy and premature mortality in Spanish regions, 2020-2021.</mods:identifier>
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               <mods:abstract>[EN] Objective:  We aimed to estimate regional inequalities in excess deaths and premature mortality in Spain during 2020 and 2021, before high vaccination coverage against COVID-19. Methods: With data from the National Institute of Statistics, within each region, sex, and age group, we estimated the excess deaths, the change in life expectancy at birth (e0) and age 65 (e65) and years of life lost as the difference between the observed and expected deaths using a time series analysis of 2015-2019 data and life expectancies based on Lee-Carter forecasting using 2010-2019 data. Results: From January 2020 to June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in Spain with a substantial regional variability (highest in Madrid: 22,000, lowest in Canary Islands: -210). The highest reductions in e_0 in 2020 were observed in Madrid (men: -3.58 years, women: -2.25), Castile La Mancha (-2.72, -2.38), and Castile and León (-2.13, -1.39). During the first half of 2021, the highest reduction in e_0 was observed in Madrid for men (-2.09; -2.37 to -1.84) and Valencian Community for women (-1.63; -1.97 to -1.3). The highest excess years of life lost in 2020 was in Castile-La Mancha (men: 5370; women: 3600, per 100 000). We observed large differences between reported COVID-19 deaths and estimated excess deaths across the Spanish regions. Conclusions: Regions performed highly unequally on excess deaths, life expectancy and years of life lost. The investigation of the root causes of these regional inequalities might inform future pandemic policy in Spain and elsewhere. [ES] Objetivo: Estimar las desigualdades regionales en exceso de muertes y mortalidad prematura en España entre enero de 2020 y junio de 2021, antes de la vacunación poblacional masiva contra la COVID-19. Métodos: Con datos del Instituto Nacional de Estadística, se estimaron el exceso de muertes con respecto a las muertes esperadas por regiones, sexos y grupos de edad, el cambio en la esperanza de vida al nacer (e_0) y a los 65 años (e65) y los años de vida perdidos, mediante series temporales (2015-2019) y el pronóstico de Lee-Carter (2010-2019). Resultados: En el periodo del estudio, el exceso de muertes fue de 89.200 (hombres, 48.000; mujeres, 41.200), con una gran variabilidad regional (desde Madrid, 22.000, hasta las Islas Canarias, -210). Las mayores reducciones de e_0 en 2020 fueron en Madrid (hombres, -3,58 años; mujeres, -2,25), Castilla La Mancha (-2,72; -2,38) y Castilla y León (-2,13; -1,39) y en el primer semestre de 2021, en Madrid (hombres, -2,09; -2,37 a -1,84) y en la Comunidad Valenciana (mujeres, -1,63; -1,97 a -1,3). El mayor exceso de años de vida perdidos en 2020 se produjo en Castilla-La Mancha (hombres, 5.370; mujeres, 3.600, por 100.000). Hubo grandes diferencias entre las muertes por COVID-19 notificadas y el exceso de muertes. Conclusiones: Hubo enormes desigualdades regionales en el exceso de muertes, la esperanza de vida y los años de vida perdidos. La determinación de las causas fundamentales de estas desigualdades podría servir para mejorar las políticas de salud pública en pandemias futuras.</mods:abstract>
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                  <mods:topic>Excess deaths</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Life expectancy</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Years of life lost</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Premature mortality</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>COVID-19</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Geographic inequalities</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Spain</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Desigualdades regionales</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Exceso de muertes</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Mortalidad prematura</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Mortalidad</mods:topic>
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               <mods:subject>
                  <mods:topic>España</mods:topic>
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               <mods:subject>
                  <mods:topic>Vacunas</mods:topic>
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               <mods:subject>
                  <mods:topic>Esperanza de vida</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Salud pública</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Pandemia</mods:topic>
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