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. 2020 Nov;81(5):785-792.
doi: 10.1016/j.jinf.2020.08.037. Epub 2020 Aug 25.

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

Simon de Lusignan  1 , Mark Joy  2 , Jason Oke  3 , Dylan McGagh  4 , Brian Nicholson  5 , James Sheppard  6 , Oluwafunmi Akinyemi  7 , Gayatri Amirthalingam  8 , Kevin Brown  9 , Rachel Byford  10 , Gavin Dabrera  11 , Else Krajenbrink  12 , Harshana Liyanage  13 , Jamie LopezBernal  14 , Cecilia Okusi  15 , Mary Ramsay  16 , Julian Sherlock  17 , Mary Sinnathamby  18 , Ruby S M Tsang  19 , Victoria Tzortziou Brown  20 , John Williams  21 , Maria Zambon  22 , Filipa Ferreira  23 , Gary Howsam  24 , F D Richard Hobbs  25
Affiliations

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

Simon de Lusignan et al. J Infect. 2020 Nov.

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 197.8/10,000 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.

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

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Conflict of interest statement

Declaration of Competing Interest SdeL is the director of RCGP RSC. He has unrelated projects funded by GSK, Seqirus and has been a member of Global Advisory Boards for Seqirus and Sanofi.

Figures

Fig. 1
Fig. 1
Mortality in people aged ≥ 45 years old per 100,000 between ISO Weeks 2 – 20 of 2018, 2019 and 2020 from sentinel network (RCGP RSC) and Office of National Statistics (ONS).
Fig. 2
Fig. 2
Kaplan Meier Estimates of overall survival in the RCGP RSC cohort age 45 years and above and relative survival.
See this image and copyright information in PMC

Comment in

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