Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network

Abstract

Objectives: Few studies report contributors to the excess mortality in England during the first wave of coronavirus disease 2019 (COVID-19) infection. We report the absolute excess risk (AER) of mortality and excess mortality rate (EMR) from a nationally representative COVID-19 sentinel surveillance network including known COVID-19 risk factors in people aged 45 years and above. Methods: Pseudonymised, coded clinical data were uploaded from contributing primary care providers (N = 1,970,314, ≥45years). We calculated the AER in mortality by comparing mortality for weeks 2 to 20 this year with mortality data from the Office for National Statistics (ONS) from 2018 for the same weeks. We conducted univariate and multivariate analysis including preselected variables. We report AER and EMR, with 95% confidence intervals (95% CI). Results: The AER of mortality was 197.8/10,0 0 0 person years (95%CI:194.30-201.40). The EMR for male gender, compared with female, was 1.4 (95%CI:1.35-1.44, p < 0.00); for our oldest age band (≥75 years) 10.09 (95%CI:9.46-10.75, p < 0.00) compared to 45-64 year olds; Black ethnicity's EMR was 1.17 (95%CI: 1.03-1.33, p < 0.02), reference white; and for dwellings with ≥9 occupants 8.01 (95%CI: 9.46-10.75, p < 0.00). Presence of all included comorbidities significantly increased EMR. Ranked from lowest to highest these were: hypertension, chronic kidney disease, chronic respiratory and heart disease, and cancer or immunocompromised. Conclusions: The absolute excess mortality was approximately 2 deaths per 100 person years in the first wave of COVID-19. More personalised shielding advice for any second wave should include ethnicity, comorbidity and household size as predictors of risk.

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

“…Given the limited data on COVID-19 and related risk factors, 3 – 5 , 17 this finding is entirely novel and not easily explained. It may be a chance statistical finding due to multiple hypothesis testing and future studies should look to confirm the relationship observed in these data.…”

“… 13 Establishing whether this is also the case for hypertensive patients living in the community is important because the focus on routine chronic disease management has reduced during the pandemic. 14 Based on previous studies, 3 – 5 , 13 , 15 – 17 we hypothesized that uncontrolled blood pressure would be associated with worse COVID-19 outcomes for hypertensive patients with suspected COVID-19. We used the electronic health records from primary care to test this hypothesis and examined the association between blood pressure control and SARS-CoV-2 infection, COVID-19–related hospitalization, and death.…”

Impact of COVID-19 preventive measures on other infectious and non-infectious respiratory diseases in Pakistan

“…The collateral damage due to co-infection of COVID-19 with other respiratory pathogens and collateral benefits due to the implementation of COVID-19 preventative measures has been recently reported in the studies [ 3 , 4 ].…”

Disproportionate impact of SARS-CoV-2 on ethnic minority and frontline healthcare workers: A cross-sectional seroprevalence survey at a North London hospital

“…We read with interest the study by de Lusignan et al, who found that, among 1,970,314 UK primary care patients aged ≥ 45 years, being male, increasing age, chronic disease, Black ethnicity and deprivation were associated with excess mortality during the first wave of the COVID-19 pandemic 1 . These findings highlight the unequal burden of COVID-19 across society and reflect our patient and staff experience at North Middlesex University Hospital (NMUH) 2 .…”