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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
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
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