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; Mark Joy; Jason Oke; Dylan McGagh; Brian Nicholson; James Sheppard; Oluwafunmi Akinyemi; Gayatri Amirthalingam; Kevin Brown; Rachel Byford; Gavin Dabrera; Else Krajenbrink; Harshana Liyanage; Jamie Lopez Bernal; Cecilia Okusi; Mary Ramsay; Julian Sherlock; Mary Sinnathamby; Ruby S.M. Tsang; Victoria Tzortziou Brown; John Williams; Maria Zambon; Filipa Ferreira; Gary Howsam; F. D.Richard Hobbs

doi:10.1016/j.jinf.2020.08.037

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^*, Mark Joy, Jason Oke, Dylan McGagh, Brian Nicholson, James Sheppard, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Kevin Brown, Rachel Byford, Gavin Dabrera, Else Krajenbrink, Harshana Liyanage, Jamie Lopez Bernal, Cecilia Okusi, Mary Ramsay, Julian Sherlock, Mary Sinnathamby, Ruby S.M. Tsang, Victoria Tzortziou BrownJohn Williams, Maria Zambon, Filipa Ferreira, Gary Howsam, F. D.Richard Hobbs

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

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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.

Original language	English
Pages (from-to)	785-792
Number of pages	8
Journal	Journal of Infection
Volume	81
Issue number	5
DOIs	https://doi.org/10.1016/j.jinf.2020.08.037
Publication status	Published - 1 Nov 2020

Bibliographical note

Funding Information: The authors would like to thank the participating practices and patients for providing the data for this cohort. We acknowledge collaboration with the general practitioner computer system suppliers – EMIS health, The Phoenix Partnership and InPractice Systems-Apollo Medical Systems, Public Health England, Wellcome Trust and our other funders and collaborators. Funders have no role in the writing of the manuscript or the decision to submit it for publication. FDRH acknowledges part-funding from the National Institute for Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC, UHT), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC).

The Oxford RCGP RSC is principally funded by Public Health England. CO receives funding from Wellcome Trust, which allowed her time to be repurposed for SARS-CoV-2 research. 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. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. There was no specific funding for this research.

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.

Open Access: This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)

Publisher Copyright: © 2020 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association.

Citation: Simon de Lusignan, Mark Joy, Jason Oke, Dylan McGagh, Brian Nicholson, James Sheppard, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Kevin Brown, Rachel Byford, Gavin Dabrera, Else Krajenbrink, Harshana Liyanage, Jamie LopezBernal, Cecilia Okusi, Mary Ramsay, Julian Sherlock, Mary Sinnathamby, Ruby S.M. Tsang, Victoria Tzortziou Brown, John Williams, Maria Zambon, Filipa Ferreira, Gary Howsam, F.D. Richard Hobbs, Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network,
Journal of Infection, Volume 81, Issue 5, 2020, Pages 785-792, ISSN 0163-4453,
https://doi.org/10.1016/j.jinf.2020.08.037.

DOI: https://doi.org/10.1016/j.jinf.2020.08.037.

Keywords

General Practice
Medical record systems, computerized
Mortality
Sentinel Surveillance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

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DeLusignan2020DisparitiesInTheExcessRiskOfMortalityInTheFirstWaveOfCOVID-19JInfectFinal published version, 735 KBLicence: CC BY-NC-ND

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de Lusignan, S., Joy, M., Oke, J., McGagh, D., Nicholson, B., Sheppard, J., Akinyemi, O., Amirthalingam, G., Brown, K., Byford, R., Dabrera, G., Krajenbrink, E., Liyanage, H., Lopez Bernal, J., Okusi, C., Ramsay, M., Sherlock, J., Sinnathamby, M., Tsang, R. S. M., ... Hobbs, F. D. R. (2020). Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network. Journal of Infection, 81(5), 785-792. https://doi.org/10.1016/j.jinf.2020.08.037

@article{6ab49d94d14b4732888ed8c4f2af5a6d,

title = "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 197.8/10,000 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",

author = "{de Lusignan}, Simon and Mark Joy and Jason Oke and Dylan McGagh and Brian Nicholson and James Sheppard and Oluwafunmi Akinyemi and Gayatri Amirthalingam and Kevin Brown and Rachel Byford and Gavin Dabrera and Else Krajenbrink and Harshana Liyanage and {Lopez Bernal}, Jamie and Cecilia Okusi and Mary Ramsay and Julian Sherlock and Mary Sinnathamby and Tsang, {Ruby S.M.} and {Tzortziou Brown}, Victoria and John Williams and Maria Zambon and Filipa Ferreira and Gary Howsam and Hobbs, {F. D.Richard}",

note = "Funding Information: The authors would like to thank the participating practices and patients for providing the data for this cohort. We acknowledge collaboration with the general practitioner computer system suppliers – EMIS health, The Phoenix Partnership and InPractice Systems-Apollo Medical Systems, Public Health England, Wellcome Trust and our other funders and collaborators. Funders have no role in the writing of the manuscript or the decision to submit it for publication. FDRH acknowledges part-funding from the National Institute for Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC, UHT), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC). The Oxford RCGP RSC is principally funded by Public Health England. CO receives funding from Wellcome Trust, which allowed her time to be repurposed for SARS-CoV-2 research. 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. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. There was no specific funding for this research. 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. Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Publisher Copyright: {\textcopyright} 2020 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association. Citation: Simon de Lusignan, Mark Joy, Jason Oke, Dylan McGagh, Brian Nicholson, James Sheppard, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Kevin Brown, Rachel Byford, Gavin Dabrera, Else Krajenbrink, Harshana Liyanage, Jamie LopezBernal, Cecilia Okusi, Mary Ramsay, Julian Sherlock, Mary Sinnathamby, Ruby S.M. Tsang, Victoria Tzortziou Brown, John Williams, Maria Zambon, Filipa Ferreira, Gary Howsam, F.D. Richard Hobbs, Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network, Journal of Infection, Volume 81, Issue 5, 2020, Pages 785-792, ISSN 0163-4453, https://doi.org/10.1016/j.jinf.2020.08.037. DOI: https://doi.org/10.1016/j.jinf.2020.08.037.",

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doi = "10.1016/j.jinf.2020.08.037",

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volume = "81",

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de Lusignan, S, Joy, M, Oke, J, McGagh, D, Nicholson, B, Sheppard, J, Akinyemi, O, Amirthalingam, G , Brown, K, Byford, R, Dabrera, G, Krajenbrink, E, Liyanage, H, Lopez Bernal, J, Okusi, C, Ramsay, M, Sherlock, J, Sinnathamby, M, Tsang, RSM, Tzortziou Brown, V, Williams, J, Zambon, M, Ferreira, F, Howsam, G & Hobbs, FDR 2020, 'Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network', Journal of Infection, vol. 81, no. 5, pp. 785-792. https://doi.org/10.1016/j.jinf.2020.08.037

TY - JOUR

T1 - Disparities in the excess risk of mortality in the first wave of COVID-19

T2 - Cross sectional study of the English sentinel network

AU - de Lusignan, Simon

AU - Joy, Mark

AU - Oke, Jason

AU - McGagh, Dylan

AU - Nicholson, Brian

AU - Sheppard, James

AU - Akinyemi, Oluwafunmi

AU - Amirthalingam, Gayatri

AU - Brown, Kevin

AU - Byford, Rachel

AU - Dabrera, Gavin

AU - Krajenbrink, Else

AU - Liyanage, Harshana

AU - Lopez Bernal, Jamie

AU - Okusi, Cecilia

AU - Ramsay, Mary

AU - Sherlock, Julian

AU - Sinnathamby, Mary

AU - Tsang, Ruby S.M.

AU - Tzortziou Brown, Victoria

AU - Williams, John

AU - Zambon, Maria

AU - Ferreira, Filipa

AU - Howsam, Gary

AU - Hobbs, F. D.Richard

N1 - Funding Information: The authors would like to thank the participating practices and patients for providing the data for this cohort. We acknowledge collaboration with the general practitioner computer system suppliers – EMIS health, The Phoenix Partnership and InPractice Systems-Apollo Medical Systems, Public Health England, Wellcome Trust and our other funders and collaborators. Funders have no role in the writing of the manuscript or the decision to submit it for publication. FDRH acknowledges part-funding from the National Institute for Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC, UHT), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC). The Oxford RCGP RSC is principally funded by Public Health England. CO receives funding from Wellcome Trust, which allowed her time to be repurposed for SARS-CoV-2 research. 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. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. There was no specific funding for this research. 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. Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Publisher Copyright: © 2020 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association. Citation: Simon de Lusignan, Mark Joy, Jason Oke, Dylan McGagh, Brian Nicholson, James Sheppard, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Kevin Brown, Rachel Byford, Gavin Dabrera, Else Krajenbrink, Harshana Liyanage, Jamie LopezBernal, Cecilia Okusi, Mary Ramsay, Julian Sherlock, Mary Sinnathamby, Ruby S.M. Tsang, Victoria Tzortziou Brown, John Williams, Maria Zambon, Filipa Ferreira, Gary Howsam, F.D. Richard Hobbs, Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network, Journal of Infection, Volume 81, Issue 5, 2020, Pages 785-792, ISSN 0163-4453, https://doi.org/10.1016/j.jinf.2020.08.037. DOI: https://doi.org/10.1016/j.jinf.2020.08.037.

PY - 2020/11/1

Y1 - 2020/11/1

N2 - 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.

AB - 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.

KW - General Practice

KW - Medical record systems, computerized

KW - Mortality

KW - Sentinel Surveillance

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M3 - Article

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

Abstract

Bibliographical note

Keywords

UN SDGs

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