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Factors associated with deaths due to COVID-19 versus other causes: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform.
Bhaskaran, Krishnan; Bacon, Sebastian; Evans, Stephen Jw; Bates, Chris J; Rentsch, Christopher T; MacKenna, Brian; Tomlinson, Laurie; Walker, Alex J; Schultze, Anna; Morton, Caroline E; Grint, Daniel; Mehrkar, Amir; Eggo, Rosalind M; Inglesby, Peter; Douglas, Ian J; McDonald, Helen I; Cockburn, Jonathan; Williamson, Elizabeth J; Evans, David; Curtis, Helen J; Hulme, William J; Parry, John; Hester, Frank; Harper, Sam; Spiegelhalter, David; Smeeth, Liam; Goldacre, Ben.
  • Bhaskaran K; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Bacon S; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Evans SJ; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Bates CJ; The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.
  • Rentsch CT; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • MacKenna B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Tomlinson L; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Walker AJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Schultze A; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Morton CE; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Grint D; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Mehrkar A; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Eggo RM; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Inglesby P; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Douglas IJ; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • McDonald HI; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Cockburn J; The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.
  • Williamson EJ; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Evans D; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Curtis HJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Hulme WJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Parry J; The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.
  • Hester F; The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.
  • Harper S; The Phoenix Partnership, TPP House, Horsforth, Leeds, UK.
  • Spiegelhalter D; Winton Centre for Risk and Evidence Communication, Statistical Laboratory Centre for Mathematical Sciences, Cambridge, UK.
  • Smeeth L; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
  • Goldacre B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Lancet Reg Health Eur ; 6: 100109, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1225324
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Semantic information from SemMedBD (by NLM)
1. COVID-19 CAUSES Cessation of life
Subject
COVID-19
Predicate
CAUSES
Object
Cessation of life
2. COVID-19 AFFECTS Persons
Subject
COVID-19
Predicate
AFFECTS
Object
Persons
3. COVID-19 CAUSES Cessation of life
Subject
COVID-19
Predicate
CAUSES
Object
Cessation of life
4. COVID-19 AFFECTS Persons
Subject
COVID-19
Predicate
AFFECTS
Object
Persons
ABSTRACT

BACKGROUND:

Mortality from COVID-19 shows a strong relationship with age and pre-existing medical conditions, as does mortality from other causes. We aimed to investigate how specific factors are differentially associated with COVID-19 mortality as compared to mortality from causes other than COVID-19.

METHODS:

Working on behalf of NHS England, we carried out a cohort study within the OpenSAFELY platform. Primary care data from England were linked to national death registrations. We included all adults (aged ≥18 years) in the database on 1st February 2020 and with >1 year of continuous prior registration; the cut-off date for deaths was 9th November 2020. Associations between individual-level characteristics and COVID-19 and non-COVID deaths, classified according to the presence of a COVID-19 code as the underlying cause of death on the death certificate, were estimated by fitting age- and sex-adjusted logistic models for these two outcomes.

FINDINGS:

17,456,515 individuals were included. 17,063 died from COVID-19 and 134,316 from other causes. Most factors associated with COVID-19 death were similarly associated with non-COVID death, but the magnitudes of association differed. Older age was more strongly associated with COVID-19 death than non-COVID death (e.g. ORs 40.7 [95% CI 37.7-43.8] and 29.6 [28.9-30.3] respectively for ≥80 vs 50-59 years), as was male sex, deprivation, obesity, and some comorbidities. Smoking, history of cancer and chronic liver disease had stronger associations with non-COVID than COVID-19 death. All non-white ethnic groups had higher odds than white of COVID-19 death (OR for Black 2.20 [1.96-2.47], South Asian 2.33 [2.16-2.52]), but lower odds than white of non-COVID death (Black 0.88 [0.83-0.94], South Asian 0.78 [0.75-0.81]).

INTERPRETATION:

Similar associations of most individual-level factors with COVID-19 and non-COVID death suggest that COVID-19 largely multiplies existing risks faced by patients, with some notable exceptions. Identifying the unique factors contributing to the excess COVID-19 mortality risk among non-white groups is a priority to inform efforts to reduce deaths from COVID-19.

FUNDING:

Wellcome, Royal Society, National Institute for Health Research, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, Health Data Research UK.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Language: English Journal: Lancet Reg Health Eur Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Language: English Journal: Lancet Reg Health Eur Year: 2021 Document Type: Article