Changes in mortality patterns and place of death during the COVID-19 pandemic: A descriptive analysis of mortality data across four nations

Abstract

Background: Understanding patterns of mortality and place of death during the COVID-19 pandemic is important to help provide appropriate services and resources. Aims: To analyse patterns of mortality including place of death in the United Kingdom (UK) (England, Wales, Scotland and Northern Ireland) during the COVID-19 pandemic to date. Design: Descriptive analysis of UK mortality data between March 2020 and March 2021. Weekly number of deaths was described by place of death, using the following definitions: (1) expected deaths: average expected deaths estimated using historical data (2015–19); (2) COVID-19 deaths: where COVID-19 is mentioned on the death certificate; (3) additional non-COVID-19 deaths: above expected but not attributed to COVID-19; (4) baseline deaths: up to and including expected deaths but excluding COVID-19 deaths. Results: During the analysis period, 798,643 deaths were registered in the UK, of which 147,282 were COVID-19 deaths and 17,672 were additional non-COVID-19 deaths. While numbers of people who died in care homes and hospitals increased above expected only during the pandemic waves, the numbers of people who died at home remained above expected both during and between the pandemic waves, with an overall increase of 41%. Conclusions: Where people died changed during the COVID-19 pandemic, with an increase in deaths at home during and between pandemic waves. This has implications for planning and organisation of palliative care and community services. The extent to which these changes will persist longer term remains unclear. Further research could investigate whether this is reflected in other countries with high COVID-19 mortality.

COVID-19 deaths in care homes: primary care management study

“…Deaths in care homes increased by 134% during the first wave of the COVID-19 pandemic, the greatest relative increase for any recorded place of death 7. The rates of ‘typical’ COVID-19 symptoms within our cohort were consistent with other studies 8.…”

Effects of COVID-19 in Care Homes - A Mixed Methods Review

“…[Davies 2021, Shoaib 2021], the UK [Graham 2020, O’Donnell 2021] and Canada [Decarie 2021, Sundaram 2021]; and one each in Scotland [Burton 2021], Ireland [Cusack 2020], France…”

COVID-19 amongst western democracies: A welfare state analysis

“…For instance, in the US, it is estimated that within the first three months of the pandemic, about 44.7% of COVID-19 cases and 40.0% of COVID-19 deaths were unaccounted for, until May 24, when the federal guidelines started to require facilities to report such cases to the National Healthcare Safety Network (Shen et al 2021 ). In the UK, it is estimated that the number of people who died in care homes was above the expected mortality level by 134% at the end of the First Wave in the pandemic (O’Donnell et al 2021 ). However, the underreporting of COVID-19 rates in care homes decreased by the Second and Third Waves.…”

“…However, the underreporting of COVID-19 rates in care homes decreased by the Second and Third Waves. For instance, the number of people in England, Wales, Scotland and Northern Ireland that died in care homes only increased above expected levels by 10% in the Second Wave and later dropped to 3% by the Third Wave (O’Donnell et al 2021 ). It is difficult to include a universal, valid measure that counts nursing home deaths due to national variations in reporting and across different points in time, yet as the care homes underreporting was only higher during the First Wave of the pandemic compared to the Second and Third waves, such underreporting only constitutes a minor limitation of the data.…”