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 journalArticlepeer-review

39 Citations (Scopus)


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 languageEnglish
Pages (from-to)E890-E898
JournalBritish Journal of General Practice
Issue number701
Publication statusPublished - 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


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


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