TY - JOUR
T1 - Place and Underlying Cause of Death During the COVID-19 Pandemic
T2 - Retrospective Cohort Study of 3.5 Million Deaths in England and Wales, 2014 to 2020
AU - Wu, Jianhua
AU - Mafham, Marion
AU - Mamas, Mamas A
AU - Rashid, Muhammad
AU - Kontopantelis, Evangelos
AU - Deanfield, John E
AU - de Belder, Mark A
AU - Gale, Chris P
N1 - Funding Information:
Grant Support: J.W. and C.P.G are funded by the University of Leeds . M.A.M. is funded by the University of Kentucky . The funding organizations for this study had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research
PY - 2021/4/1
Y1 - 2021/4/1
N2 - OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality.METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death.RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected.CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.
AB - OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality.METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death.RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected.CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.
KW - Adult
KW - Aged, 80 and over
KW - COVID-19/diagnosis
KW - Cause of Death/trends
KW - Diagnostic Errors/mortality
KW - England/epidemiology
KW - Female
KW - Heart Diseases/mortality
KW - Home Care Services/statistics & numerical data
KW - Hospice Care/statistics & numerical data
KW - Hospital Mortality/trends
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality
KW - Neoplasms/mortality
KW - Nursing Homes/statistics & numerical data
KW - SARS-CoV-2
KW - Wales/epidemiology
U2 - 10.1016/j.mayocp.2021.02.007
DO - 10.1016/j.mayocp.2021.02.007
M3 - Article
C2 - 33714592
SN - 0025-6196
VL - 96
SP - 952
EP - 963
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 4
ER -
