COVID19-related and all-cause mortality risk among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection: a population-based cohort study in Southern Catalonia, Spain, March–June 2020

Abstract

Background Direct and indirect COVID19-related mortality is uncertain. This study investigated all-cause and COVID19-related deaths among middle-aged and older adults during the first wave of COVID-19 pandemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions. Methods Population-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (those occurred among patients with laboratory-confirmed COVID19) and all-cause deaths occurred among cohort members between 01/03/2020–30/06/2020. Mortality risks were assessed by Cox regression analyses. Results Cohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related deaths). Of the 124 deceased patients with a laboratory-confirmed COVID19, 112 (90.3%) died by (due to) COVID-19, while 12 (9.7%) died with COVID-19 (but likely due to other concomitant causes). All-cause mortality rate among cohort members across study period was 42.5 deaths per 100,000 persons-week, being 22.8 among healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. Increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06–1.10), sex male (HR: 1.82; 95% CI: 1.24–2.70), nursing-home residence (HR: 12.56; 95% CI: 8.07–19.54) and number of pre-existing comorbidities (HR: 1.14; 95% CI: 1.01–1.29) were significant predictors for COVID19-related mortality, but none specific comorbidity emerged significantly associated with an increased risk in multivariable analysis evaluating it. Conclusion COVID19-related deaths represented more than 20 % of all-cause mortality occurred among middle-aged and older adults during the first wave of the pandemic in the region. A considerable proportion (around 10 %) of these COVID19-related deaths could be attributed to other concomitant causes. Theoretically COVID19-excluded subjects (PCR-negative) suffered ten-times greater all-cause mortality than healthy/unrelated-COVID19 subjects, which points to the existence of considerable number of false negative results in earlier PCR testing and could explain part of the global excess all-cause mortality observed during the pandemic.

Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery

“…57 To estimate CPR cancer underdiagnosis, excess deaths that occurred in the pandemic were taken into account. 2 , 58 , 59 Expected incident cancers (E) in the CPR during the pandemic were estimated by applying 2019 cancer incidence specific rates by sex and 5-year age groups to the updated 2020 and 2021 Catalan population pyramids for each tumor site. 60 CPR incident cancers during the pandemic were considered observed cancers (O).…”

Association of Statins for Primary Prevention of Cardiovascular Diseases With Hospitalization for COVID‐19: A Nationwide Matched Population‐Based Cohort Study

“… 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 In 11 studies, ratio measures were close to 1. 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 In 2 studies, an increased risk was observed. 58 , 59 Most of these studies were conducted in hospitalized patients and/or patients tested for COVID‐19.…”

Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients

“…After a preliminary review and the elimination of duplicates, 5328 papers were screened and chosen for further evaluation. A total of 58 studies (Adejumo et al 2021 ; Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bergman et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Chudasama et al 2021 ; Costa et al 2021 ; Duanmu et al 2020 ; Gold et al 2020 ; Görgülü et al 2020 ; Goyal et al 2020 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Cavanna et al 2020 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Nakamura et al 2021 ; Nikpouraghdam et al 2020 ; Panda et al 2022 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Regina et al 2020 ; Ricoca-Peixoto et al 2020 ; Giorgi-Rossi et al 2020 ; Rugge et al 2020 ; Erdal et al 2021 ; Sami et al 2020 ; Santorelli et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Tehrani et al 2021 ; Vergara et al 2021 ; Vila-Corcoles et al 20...…”

“…A total of 42 studies (Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Ricoca Peixoto et al 2020 ; Giorgi-Rossi et al 2020; Rugge et al 2020 ; Erdal et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Vergara et al 2021 ; Vila-Corcoles et al 2021 ; Zhang et al 2021 ; Zhou et al 2021 ) were included in the analysis to compare the mortality rates of cancer and non-cancer patients infected with SARS-CoV-2. There were a total of 557,053 participants, of whom 21,599 were cancer patients.…”