ABSTRACT
BackgroundEthnic minorities have experienced disproportionate COVID-19 mortality rates. We estimated associations between household composition and COVID-19 mortality in older adults ([≥] 65 years) using a newly linked census-based dataset, and investigated whether living in a multi-generational household explained some of the elevated COVID-19 mortality amongst ethnic minority groups. MethodsUsing retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 27th July 2020), we followed adults aged 65 years or over living in private households in England from 2 March 2020 until 27 July 2020 (n=10,078,568). We estimated hazard ratios (HRs) for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographical factors, socio-economic characteristics and pre-pandemic health. We conducted a causal mediation analysis to estimate the proportion of ethnic inequalities explained by living in a multi-generational household. ResultsLiving in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the HRs for living in a multi-generational household with dependent children were 1.13 [95% confidence interval 1.01-1.27] and 1.17 [1.01-1.35] for older males and females. The HRs for living in a multi-generational household without dependent children were 1.03 [0.97 - 1.09] for older males and 1.22 [1.12 - 1.32] for older females. Living in a multi-generational household explained between 10% and 15% of the elevated risk of COVID-19 death among older females from South Asian background, but very little for South Asian males or people in other ethnic minority groups. ConclusionOlder adults living with younger people are at increased risk of COVID-19 mortality, and this is a notable contributing factor to the excess risk experienced by older South Asian females compared to White females. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent. FundingThis research was funded by the Office for National Statistics.
ABSTRACT
ObjectivesTo identify the risk of general practitioner mortality from COVID and the impact of measures to mitigate this risk on the level and socioeconomic distribution of primary care provision in the English NHS DesignCross sectional study SettingAll GP practices providing primary care under the NHS in England Participants45,858 GPs and 6,771 GP practices in the English NHS Main outcome measuresNumbers of high-risk GPs, high-risk single-handed GP practices, patients associated with these high-risk single-handed practices and the regional and socioeconomic distribution of each. Mortality rates from COVID by age, sex and ethnicity were used to attribute risk to GPs and the Index of Multiple Deprivation was used to determine socioeconomic distributions of the outcomes. ResultsOf 45,858 GPs in our sample 3,632 (7.9%) were classified as high risk or very high risk. Of 6,771 GP practices in our sample 639 (9.4%) were identified as single-handed practices and of these 209 (32.7%) were run by a GP at high or very high risk. These 209 single-handed practices care for 710,043 patients. GPs at the highest levels of risk from COVID, and single-handed practices run by high-risk GPs were concentrated in the most deprived neighbourhoods in the country. London had the highest proportion of both GPs and single-handed GP practices at very high risk of COVID mortality with 1,160 patients per 100,000 population registered to these practices. ConclusionsA significant proportion of GPs working in England, particularly those serving patients in the most deprived neighbourhoods, are at high risk of dying from COVID. Many of these GPs run single-handed practices. These GPs are particularly concentrated in London. There is an opportunity to provide additional support to mitigate COVID risk for GPs, GP practices and their patients. Failure to do so will likely exacerbate existing health inequalities. What is already knownO_LIKnown risk factors for morbidity and mortality from COVID-19 include age, sex, ethnicity and certain underlying health conditions. C_LIO_LINHS England have suggested that NHS staff who may be at higher risk from COVID are risk assessed and have their activities adjusted accordingly, including ceasing face to face patient contact. C_LI What this study addsO_LIThis study applies risk scoring to calculate the number of GPs practicing in England who are likely to be at high or very high risk of death from COVID. We examine the potential effect of removing GPs at high or very high risk from COVID from face to face patient contacts, estimating the number of GPs and patients likely to be affected, and relating this to deprivation and geography. C_LIO_LIWe estimate that of 45,858 GPs in our sample, 2,253 (4.9%) were classified as high risk, and 1,379 (3%) as very high risk from COVID. These are likely to be conservative estimates. C_LIO_LIGPs at high risk of COVID are more likely to work in areas of high socioeconomic deprivation. C_LIO_LIAlmost one in three single-handed GP practices (32.7%, or 209 out of 639) is run by a GP we estimate to be at high or very high risk from COVID. If these GPs did not see patients face to face, 710,043 patients would be left without face to face GP appointments. Single-handed GP practices in areas of high socioeconomic deprivation are more likely to be run by GPs at higher risk of COVID. C_LI
ABSTRACT
BackgroundDeaths during the COVID-19 pandemic result directly from infection and exacerbation of other diseases and indirectly from deferment of care for other conditions, and are socially and geographically patterned. We quantified excess mortality in regions of England and Wales during the pandemic, for all causes and for non-COVID-19 associated deaths. MethodsWeekly mortality data for 1 Jan 2010 to 1 May 2020 for England and Wales were obtained from the Office of National Statistics. Mean-dispersion negative binomial regressions were used to model death counts based on pre-pandemic trends and exponentiated linear predictions were subtracted from: i) all-cause deaths; and ii) all-cause deaths minus COVID-19 related deaths for the pandemic period (07-13 March to 25 April to 8 May). FindingsBetween 7 March and 8 May 2020, there were 47,243 (95%CI: 46,671 to 47,815) excess deaths in England and Wales, of which 9,948 (95%CI: 9,376 to 10,520) were not associated with COVID-19. Overall excess mortality rates varied from 49 per 100,000 (95%CI: 49 to 50) in the South West to 102 per 100,000 (95%CI: 102 to 103) in London. Non-COVID-19 associated excess mortality rates ranged from -1 per 100,000 (95%CI: -1 to 0) in Wales (i.e. mortality rates were no higher than expected) to 26 per 100,000 (95%CI: 25 to 26) in the West Midlands. InterpretationThe COVID-19 pandemic has had markedly different impacts on the regions of England and Wales, both for deaths directly attributable to COVID-19 infection and for deaths resulting from the national public health response. FundingNone