lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Excess Mortality and Its Association with SARS-CoV-2 Status During the First Pandemic Peak: Cross-Sectional Analyses of the English Primary Care Surveillance Network

25 Pages Posted: 13 Aug 2020

See all articles by Mark Joy

Mark Joy

University of Oxford - Nuffield Department of Primary Care Health Sciences

Richard Hobbs

University of Oxford - Nuffield Department of Primary Care Health Sciences; University of Birmingham

Julian Sherlock

University of Oxford - Nuffield Department of Primary Care Health Sciences

Dylan McGagh

Nuffield Department of Primary Care Health Sciences, University of Oxford

Oluwafunmi Akinyemi

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gayatri Amirthalingam

Public Health England - Immunisation and Countermeasures Division

Rachel Byford

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gavin Dabrera

Public Health England - National Infection Service

Jienchi Dorward

University of Oxford - Nuffield Department of Primary Care Health Sciences

Joanna Ellis

Government of the United Kingdom - Public Health England

Filipa Ferreira

University of Oxford - Nuffield Department of Primary Care Health Sciences

Nicholas Jones

University of Oxford - Nuffield Department of Primary Care Health Sciences

Jamie Lopez Bernal

Public Health England Colindale

Else Krajenbrink

Royal College of General Practitioners

Jason Oke

Nuffield Department of Primary Care Health Sciences, University of Oxford

Cecilia Okusi

University of Oxford - Nuffield Department of Primary Care Health Sciences

Brian D. Nicholson

University of Oxford - Nuffield Department of Primary Care Health Sciences

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department

James Sheppard

Nuffield Department of Primary Care Health Sciences, University of Oxford

Mary Sinnathamby

Government of the United Kingdom - Public Health England

Maria Zambon

Public Health England - Virus Reference Department

Gary Howsam

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

John Williams

University of Oxford - Nuffield Department of Primary Care Health Sciences

Simon de Lusignan

University of Oxford; University of Surrey - Department of Clinical & Experimental Medicine; Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

More...

Abstract

Background: The SARS-CoV-2 pandemic has passed its first peak in many European countries. We describe the mortality peak in England and the association of known SARS-CoV-2 status and other demographic and risk factors with mortality.

Methods: Pseudonymised, coded clinical data were uploaded from volunteer primary care providers who were members of a nationally representative sentinel network ((N=4,413,734) including SARS-CoV-2 status data (n=56,628, 1.3%). We compared all-cause mortality with the national rate for 2019, using a relative survival model, reporting relative hazard ratios (RHR) and 95% confidence intervals (CI). We conducted cross-sectional analyses of those with known SARS-CoV-2 status. We used multiple imputation to adjust for missing data and included an inverse probability analysis. We also complete cases analysis; presenting results as odds ratios (OR) with 95%CI.

Results: Mortality peaked in week 16 of 2020. People residing in households of 9 or more had a five-fold increase in relative mortality (RHR:5.1,95%CI:4.87-5.31, p<0.0001). The OR of mortality for definite case was 8.9 (95%CI:6.7-11.8, p<0.0001) and for a probable case 9.7 (95%CI:7.1-13.2, p<0.0001), using a negative test as reference. Male gender, population density, black ethnicity (compared to white), and people with long term conditions including learning disability had higher odds of mortality. The adjusted mortality in people with a definite SARS-CoV-2 diagnosis was 18.1% (95CI:17.6-18.7).

Discussion: There has been excess mortality in the first SARS-CoV-2 peak in England, planning for subsequent peaks needs to better manage risk in males, black ethnicity, older people, and people with learning disabilities and multi-occupancy dwellings.

Funding Statement: CO and JD are funded by Wellcome Trust, which allowed their time to be repurposed for SARS-CoV-2 research. The Oxford RCGP RSC is principally funded by Public Health England. JPS receives funding from the Wellcome Trust/Royal Society via a Sir Henry Dale Fellowship (ref: 211182/Z/18/Z) and an NIHR Oxford Biomedical Research Centre (BRC) Senior Fellowship. BDN is funded by the NIHR.

Declaration of Interests: The authors have no competing interests. SdeL is the Director of the Oxford RCGP RSC.

Ethics Approval Statement: The Oxford RCGP RSC surveillance system and its work with respect to SARS-CoV-2 are approved by Public Health England’s Caldicott Guardian Committee under Regulation 3 of the Health Service Control Patient Information Regulations 2002. The study was approved by RCGP.

Keywords: Medical record systems; computerized; General Practice; Sentinel Surveillance; Mortality

Suggested Citation

Joy, Mark and Hobbs, F.D. Richard and Sherlock, Julian and McGagh, Dylan and Akinyemi, Oluwafunmi and Amirthalingam, Gayatri and Byford, Rachel and Dabrera, Gavin and Dorward, Jienchi and Ellis, Joanna and Ferreira, Filipa and Jones, Nicholas and Bernal, Jamie Lopez and Krajenbrink, Else and Oke, Jason and Okusi, Cecilia and Nicholson, Brian D. and Ramsay, Mary E. and Sheppard, James and Sinnathamby, Mary and Zambon, Maria and Howsam, Gary and Williams, John and de Lusignan, Simon, Excess Mortality and Its Association with SARS-CoV-2 Status During the First Pandemic Peak: Cross-Sectional Analyses of the English Primary Care Surveillance Network (6/17/2020). Available at SSRN: https://ssrn.com/abstract=3633154 or http://dx.doi.org/10.2139/ssrn.3633154

Mark Joy

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

F.D. Richard Hobbs

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

University of Birmingham ( email )

Julian Sherlock

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Dylan McGagh

Nuffield Department of Primary Care Health Sciences, University of Oxford ( email )

Oluwafunmi Akinyemi

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gayatri Amirthalingam

Public Health England - Immunisation and Countermeasures Division ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Rachel Byford

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gavin Dabrera

Public Health England - National Infection Service ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Jienchi Dorward

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Joanna Ellis

Government of the United Kingdom - Public Health England ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Filipa Ferreira

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Nicholas Jones

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Jamie Lopez Bernal

Public Health England Colindale ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Else Krajenbrink

Royal College of General Practitioners ( email )

Jason Oke

Nuffield Department of Primary Care Health Sciences, University of Oxford ( email )

Cecilia Okusi

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Brian D. Nicholson

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department ( email )

United Kingdom

James Sheppard

Nuffield Department of Primary Care Health Sciences, University of Oxford ( email )

Mary Sinnathamby

Government of the United Kingdom - Public Health England ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Maria Zambon

Public Health England - Virus Reference Department ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Gary Howsam

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) ( email )

30 Euston Square
London
United Kingdom

John Williams

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Simon De Lusignan (Contact Author)

University of Oxford ( email )

Eagle House,
Walton Well Road,
Oxford, OX2 6ED
United Kingdom

HOME PAGE: http://https://orchid.phc.ox.ac.uk

University of Surrey - Department of Clinical & Experimental Medicine ( email )

Guildford
United Kingdom

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) ( email )

30 Euston Square
London
United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
937
Downloads
20
PlumX Metrics