Place and Underlying Cause of Death During the COVID-19 Pandemic: Retrospective Cohort Study of 3.5 Million Deaths in England and Wales, 2014 to 2020

To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. 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...

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Published in:	Mayo Clinic proceedings Vol. 96; no. 4; p. 952
Main Authors:	Wu, Jianhua, Mafham, Marion, Mamas, Mamas A, Rashid, Muhammad, Kontopantelis, Evangelos, Deanfield, John E, de Belder, Mark A, Gale, Chris P
Format:	Journal Article
Language:	English
Published:	England 01.04.2021
Subjects:	Adult Aged, 80 and over Cause of Death - trends COVID-19 - diagnosis COVID-19 - mortality COVID-19 - therapy Diagnostic Errors - mortality Diagnostic Errors - statistics & numerical data England - epidemiology Female Heart Diseases - mortality Home Care Services - statistics & numerical data Hospice Care - statistics & numerical data Hospital Mortality - trends Humans Male Middle Aged Mortality Neoplasms - mortality Nursing Homes - statistics & numerical data SARS-CoV-2 Wales - epidemiology England Wales
ISSN:	1942-5546, 1942-5546
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Abstract	To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. 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. 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. 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.
AbstractList	To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. 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. 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. 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. To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality.OBJECTIVETo describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality.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.METHODSThis 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.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.RESULTSBetween 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.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.CONCLUSIONThe 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.
Author	Wu, Jianhua Kontopantelis, Evangelos de Belder, Mark A Gale, Chris P Rashid, Muhammad Mamas, Mamas A Deanfield, John E Mafham, Marion
Author_xml	– sequence: 1 givenname: Jianhua surname: Wu fullname: Wu, Jianhua organization: Leeds Institute for Data Analytics, University of Leeds, United Kingdom; Division of Clinical and Translational Research, School of Dentistry, University of Leeds, United Kingdom – sequence: 2 givenname: Marion surname: Mafham fullname: Mafham, Marion organization: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, United Kingdom – sequence: 3 givenname: Mamas A surname: Mamas fullname: Mamas, Mamas A organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom – sequence: 4 givenname: Muhammad surname: Rashid fullname: Rashid, Muhammad organization: Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom – sequence: 5 givenname: Evangelos surname: Kontopantelis fullname: Kontopantelis, Evangelos organization: Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom – sequence: 6 givenname: John E surname: Deanfield fullname: Deanfield, John E organization: Institute of Cardiovascular Sciences, University College London, United Kingdom – sequence: 7 givenname: Mark A surname: de Belder fullname: de Belder, Mark A organization: National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom – sequence: 8 givenname: Chris P surname: Gale fullname: Gale, Chris P email: c.p.gale@leeds.ac.uk organization: Leeds Institute for Data Analytics, University of Leeds, United Kingdom; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom; Leeds Teaching Hospitals NHS Trust, United Kingdom. Electronic address: c.p.gale@leeds.ac.uk
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Copyright	Copyright © 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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Snippet	To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. This national death... To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality.OBJECTIVETo describe...
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SubjectTerms	Adult Aged, 80 and over Cause of Death - trends COVID-19 - diagnosis COVID-19 - mortality COVID-19 - therapy Diagnostic Errors - mortality Diagnostic Errors - statistics & numerical data England - epidemiology Female Heart Diseases - mortality Home Care Services - statistics & numerical data Hospice Care - statistics & numerical data Hospital Mortality - trends Humans Male Middle Aged Mortality Neoplasms - mortality Nursing Homes - statistics & numerical data SARS-CoV-2 Wales - epidemiology
Title	Place and Underlying Cause of Death During the COVID-19 Pandemic: Retrospective Cohort Study of 3.5 Million Deaths in England and Wales, 2014 to 2020
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