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

Mark Joy; F. D. Richard Hobbs; Jamie Lopez Bernal; Julian Sherlock; Gayatri Amirthalingam; Dylan McGagh; Oluwafunmi Akinyemi; Rachel Byford; Gavin Dabrera; Jienchi Dorward; Joanna Ellis; Filipa Ferreira; Nicholas Jones; Jason Oke; Cecilia Okusi; Brian D. Nicholson; Mary Ramsay; James P. Sheppard; Mary Sinnathamby; Maria Zambon; Gary Howsam; John Williams; Simon de Lusignan

doi:10.3399/BJGP20X713393

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

Mark Joy, F. D. Richard Hobbs, Jamie Lopez Bernal, Julian Sherlock, Gayatri Amirthalingam, Dylan McGagh, Oluwafunmi Akinyemi, Rachel Byford, Gavin Dabrera, Jienchi Dorward, Joanna Ellis, Filipa Ferreira, Nicholas Jones, Jason Oke, Cecilia Okusi, Brian D. Nicholson, Mary Ramsay, James P. Sheppard, Mary Sinnathamby, Maria ZambonGary Howsam, John Williams, Simon de Lusignan^*

^*Corresponding author for this work

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

43 Citations (Scopus)

Abstract

Background The SARS-CoV-2 pandemic has passed its first peak in Europe. Aim To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Design and setting Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Method Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4413734). 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 SARSCoV-2 status (n = 56628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Results Mortality 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. Conclusion The 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.

Original language	English
Pages (from-to)	E890-E898
Journal	British Journal of General Practice
Volume	70
Issue number	701
DOIs	https://doi.org/10.3399/BJGP20X713393
Publication status	Published - Dec 2020

Bibliographical note

Funding Information:
Cecilia Okusi and Jienchi Dorward 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. James P Sheppard 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. Brian D Nicholson 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.

Funding Information:
Simon de Lusignan has received, through his University, funding from Astra-Zeneca, GSK, Lilly, MSD, Novo Nordisk, Takeda, and is a member of advisory boards for Sanofi and Seqirus. All are in areas unrelated to this manuscript. All other authors have declared no competing interests.

Publisher Copyright:
© The Authors

Keywords

Computerized
Medical record systems
Mortality
Pandemics
Sentinel surveillance
Severe acute respiratory syndrome coronavirus 2

Access to Document

10.3399/BJGP20X713393

Cite this

Joy, M., Richard Hobbs, F. D., Bernal, J. L., Sherlock, J., Amirthalingam, G., McGagh, D., Akinyemi, O., Byford, R., Dabrera, G., Dorward, J., Ellis, J., Ferreira, F., Jones, N., Oke, J., Okusi, C., Nicholson, B. D., Ramsay, M., Sheppard, J. P., Sinnathamby, M., ... de Lusignan, S. (2020). 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. British Journal of General Practice, 70(701), E890-E898. https://doi.org/10.3399/BJGP20X713393

@article{04ee575127b343539eea96c565f9c840,

title = "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 = "Background The SARS-CoV-2 pandemic has passed its first peak in Europe. Aim To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Design and setting Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Method Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4413734). 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 SARSCoV-2 status (n = 56628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Results Mortality 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. Conclusion The 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.",

keywords = "Computerized, Medical record systems, Mortality, Pandemics, Sentinel surveillance, Severe acute respiratory syndrome coronavirus 2",

author = "Mark Joy and {Richard Hobbs}, {F. D.} and Bernal, {Jamie Lopez} and Julian Sherlock and Gayatri Amirthalingam and Dylan McGagh and Oluwafunmi Akinyemi and Rachel Byford and Gavin Dabrera and Jienchi Dorward and Joanna Ellis and Filipa Ferreira and Nicholas Jones and Jason Oke and Cecilia Okusi and Nicholson, {Brian D.} and Mary Ramsay and Sheppard, {James P.} and Mary Sinnathamby and Maria Zambon and Gary Howsam and John Williams and {de Lusignan}, Simon",

note = "Funding Information: Cecilia Okusi and Jienchi Dorward 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. James P Sheppard 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. Brian D Nicholson 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. Funding Information: Simon de Lusignan has received, through his University, funding from Astra-Zeneca, GSK, Lilly, MSD, Novo Nordisk, Takeda, and is a member of advisory boards for Sanofi and Seqirus. All are in areas unrelated to this manuscript. All other authors have declared no competing interests. Publisher Copyright: {\textcopyright} The Authors",

year = "2020",

month = dec,

doi = "10.3399/BJGP20X713393",

language = "English",

volume = "70",

pages = "E890--E898",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "701",

}

Joy, M, Richard Hobbs, FD, Bernal, JL, Sherlock, J, Amirthalingam, G, McGagh, D, Akinyemi, O, Byford, R, Dabrera, G, Dorward, J, Ellis, J, Ferreira, F, Jones, N, Oke, J, Okusi, C, Nicholson, BD, Ramsay, M, Sheppard, JP, Sinnathamby, M , Zambon, M, Howsam, G, Williams, J & de Lusignan, S 2020, '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', British Journal of General Practice, vol. 70, no. 701, pp. E890-E898. https://doi.org/10.3399/BJGP20X713393

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. / Joy, Mark; Richard Hobbs, F. D.; Bernal, Jamie Lopez et al.
In: British Journal of General Practice, Vol. 70, No. 701, 12.2020, p. E890-E898.

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

TY - JOUR

T1 - Excess mortality in the first COVID pandemic peak

T2 - 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

AU - Joy, Mark

AU - Richard Hobbs, F. D.

AU - Bernal, Jamie Lopez

AU - Sherlock, Julian

AU - Amirthalingam, Gayatri

AU - McGagh, Dylan

AU - Akinyemi, Oluwafunmi

AU - Byford, Rachel

AU - Dabrera, Gavin

AU - Dorward, Jienchi

AU - Ellis, Joanna

AU - Ferreira, Filipa

AU - Jones, Nicholas

AU - Oke, Jason

AU - Okusi, Cecilia

AU - Nicholson, Brian D.

AU - Ramsay, Mary

AU - Sheppard, James P.

AU - Sinnathamby, Mary

AU - Zambon, Maria

AU - Howsam, Gary

AU - Williams, John

AU - de Lusignan, Simon

N1 - Funding Information: Cecilia Okusi and Jienchi Dorward 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. James P Sheppard 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. Brian D Nicholson 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. Funding Information: Simon de Lusignan has received, through his University, funding from Astra-Zeneca, GSK, Lilly, MSD, Novo Nordisk, Takeda, and is a member of advisory boards for Sanofi and Seqirus. All are in areas unrelated to this manuscript. All other authors have declared no competing interests. Publisher Copyright: © The Authors

PY - 2020/12

Y1 - 2020/12

N2 - Background The SARS-CoV-2 pandemic has passed its first peak in Europe. Aim To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Design and setting Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Method Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4413734). 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 SARSCoV-2 status (n = 56628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Results Mortality 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. Conclusion The 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.

AB - Background The SARS-CoV-2 pandemic has passed its first peak in Europe. Aim To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Design and setting Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Method Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4413734). 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 SARSCoV-2 status (n = 56628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Results Mortality 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. Conclusion The 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.

KW - Computerized

KW - Medical record systems

KW - Mortality

KW - Pandemics

KW - Sentinel surveillance

KW - Severe acute respiratory syndrome coronavirus 2

UR - http://www.scopus.com/inward/record.url?scp=85096946983&partnerID=8YFLogxK

U2 - 10.3399/BJGP20X713393

DO - 10.3399/BJGP20X713393

M3 - Article

C2 - 33077508

AN - SCOPUS:85096946983

SN - 0960-1643

VL - 70

SP - E890-E898

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 701

ER -

Joy M, Richard Hobbs FD, Bernal JL, Sherlock J, Amirthalingam G, McGagh D et al. 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. British Journal of General Practice. 2020 Dec;70(701):E890-E898. doi: 10.3399/BJGP20X713393

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

Bibliographical note

Keywords

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