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  • Factors associated with dea...
    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

    The Lancet regional health. Europe, 07/2021, Volume: 6
    Journal Article

    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. 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. 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). 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. 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.