ESPE Yearbook of Paediatric Endocrinology

In Brief: The authors highlight recent data published by the UK Office for Health Improvement and Disparities (OHID) on estimated excess mortality in England, overall and by age, ethnicity, region and cause. Age-standardised mortality was higher than expected during June 2022 to 30th June 2023. Particular causes of death showed excess mortality: cardiovascular diseases (12% relative excess), heart failure (20%), ischaemic heart diseases (15%), liver diseases (19%), acute respiratory infections (14%), and diabetes (13%).

During the acute phase of the COVID-19 pandemic, the greatest numbers of excess deaths occurred among the elderly. By contrast, since the pandemic there is strong evidence for persisting excess deaths most apparent among middle-aged and younger adults, and particularly due to cardiometabolic diseases. The highest relative excess deaths post-pandemic occurred among middle-aged adults (50–64 years): cardiovascular diseases (33% relative excess), ischaemic heart diseases (44%), cerebrovascular diseases (40%); heart failure (39%), acute respiratory infections (43%), diabetes (35%), liver diseases (19%).

The COVID-19 pandemic prompted enhanced monitoring and many reports have documented substantial adverse changes in physical and mental health, physical activity, and diet, largely attributed to the lifestyle restrictions during periods of population ‘lockdown’. We know that rates of overweight and obesity increased rapidly in all age groups, and this is thought to be the main reason for the 2- to 3-fold higher incidence of central precocious puberty, commented on in Yearbook 2023 (https://www.espeyearbook.org/ey/0020/ey0020.5-7) and since systematically reviewed (1).

The current data serve as a warning that enhanced levels of monitoring need to continue. There are few data on the post-pandemic numbers of overweight and obesity (2) - and none on central precocious puberty (has this returned to pre-pandemic rates?). Furthermore, studies are needed to understand whether persisting excess deaths may be due to persisting unhealthy changes in lifestyle behaviours, persisting physical and mental disease, or even some form of metabolic programming.

References: 1. Nguyen NN, et al. Difference in Precocious Puberty Between Pre-COVID-19 and COVID-19 Periods: A Meta-Analysis. American Journal of Epidemiology, 2024 Aug 21:kwae295, Online ahead of print. https://doi.org/10.1093/aje/kwae2952. Maessen SE, et al. High but decreasing prevalence of overweight in preschool children: encouragement for further action. BMJ. 2023 Oct 9:383:e075736. doi: 10.1136/bmj-2023-075736.