Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England

Abstract

BackgroundThe SARS-CoV-2 pandemic has passed its first peak in Europe.AimTo describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors.Design and settingCross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network.MethodPseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network ( n = 4 413 734). All-cause mortality was compared with national rates for 2019, using a relative survival model, reporting relative hazard ratios (RHR), and 95% confidence intervals (CI). A multivariable adjusted odds ratios (OR) analysis was conducted for those with known SARS-CoV-2 status ( n = 56 628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis.ResultsMortality peaked in week 16. People living in households of ≥9 had a fivefold increase in relative mortality (RHR = 5.1, 95% CI = 4.87 to 5.31, P<0.0001). The ORs of mortality were 8.9 (95% CI = 6.7 to 11.8, P<0.0001) and 9.7 (95% CI = 7.1 to 13.2, P<0.0001) for virologically and clinically diagnosed cases respectively, using people with negative tests as reference. The adjusted mortality for the virologically confirmed group was 18.1% (95% CI = 17.6 to 18.7). Male sex, population density, black ethnicity (compared to white), and people with long-term conditions, including learning disability (OR = 1.96, 95% CI = 1.22 to 3.18, P = 0.0056) had higher odds of mortality.ConclusionThe first SARS-CoV-2 peak in England has been associated with excess mortality. Planning for subsequent peaks needs to better manage risk in males, those of black ethnicity, older people, people with learning disabilities, and people who live in multi-occupancy dwellings.

Mortality in COVID-19 amongst women on Hormone Replacement Therapy or Combined Oral Contraception: A cohort study

“…Recent work in Oxford RCGP database suggests that outcomes are similar in those with clinically probable and laboratory-confirmed cases. [17] Serology testing, if available nationally in the future could also be helpful. Our cohort is likely to reflect women with more severe COVID-19 symptoms who went for testing or made contact with a general practice for review.…”

“…[10,11] Our previous work shows that clinical and probable cases are similar in terms of outcomes; for mortality, the odds ratios were 8.9 (95% CI = 6.7 to 11.8, P <0.0001) and 9.7 (95% CI = 7.1 to 13.2, P <0.0001) for RT-PCR confirmed and clinically diagnosed cases, respectively. [12]…”

COVID-19 infection and outcomes in a population-based cohort of 17,173 adults with intellectual disabilities compared with the general population

“…These report COVID-19 mortality rates 2-3 fold higher than the general population,(12, 13) no difference in case-fatality,(14) overall case-fatality with OR=2.75 or OR=3.61 in the <70 year olds,(15) and all-cause mortality in those with known COVID-19 with OR=1.97. (11) A more comprehensive study on adults with intellectual disabilities, including only those in residential settings (compared with whole-community general population) reported COVID-19 infection rates to be about 4 times higher, case-fatality to be almost double, and mortality rates to be 7.8 times higher. (16) In our study of a whole nation’s adult population with intellectual disabilities, we found they were twice as likely to become infected with COVID-19, with a case-fatality 25% higher than in the general population, and COVID-19 mortality was 2.3 times higher than in the general population.…”

“…(8, 9) They are also more likely to live in congregate settings or be in receipt of social care (10); recent studies have reported high rates of COVID-19 mortality within multi-occupancy residences. (11) However, questions remain as to whether, compared with other people, people with intellectual disabilities are more likely to contract COVID-19, and whether they have more severe infections, and higher COVID-19 mortality.…”

“…A large self-selected sample of English general practices covering >4 million patients reported higher COVID-19 case-fatality among people with intellectual disabilities over weeks 2-20 of 2020 (OR 1.97, 95% CI 1.22-3.18). (11) A large study of people with intellectual and developmental disabilities living in about half of New York state’s residential settings were indirectly compared with the state’s general population up until 28 th May 2020. The study reported COVID-19 infection rate to be about 4 times higher, case-fatality almost double, and mortality rate 7.8 times higher.…”