TY - JOUR
T1 - Factors associated with deaths due to COVID-19 versus other causes
T2 - population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform
AU - Bhaskaran, Krishnan
AU - Bacon, Sebastian
AU - Evans, Stephen Jw
AU - Bates, Chris J
AU - Rentsch, Christopher T
AU - MacKenna, Brian
AU - Tomlinson, Laurie
AU - Walker, Alex J
AU - Schultze, Anna
AU - Morton, Caroline E
AU - Grint, Daniel
AU - Mehrkar, Amir
AU - Eggo, Rosalind M
AU - Inglesby, Peter
AU - Douglas, Ian J
AU - McDonald, Helen I
AU - Cockburn, Jonathan
AU - Williamson, Elizabeth J
AU - Evans, David
AU - Curtis, Helen J
AU - Hulme, William J
AU - Parry, John
AU - Hester, Frank
AU - Harper, Sam
AU - Spiegelhalter, David
AU - Smeeth, Liam
AU - Goldacre, Ben
N1 - © 2021 The Author(s).
PY - 2021/7/31
Y1 - 2021/7/31
N2 - 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 1 st February 2020 and with >1 year of continuous prior registration; the cut-off date for deaths was 9 th 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.
AB - 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 1 st February 2020 and with >1 year of continuous prior registration; the cut-off date for deaths was 9 th 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.
U2 - 10.1016/j.lanepe.2021.100109
DO - 10.1016/j.lanepe.2021.100109
M3 - Article
C2 - 33997835
SN - 2666-7762
VL - 6
SP - 100109
JO - The Lancet Regional Health-Europe
JF - The Lancet Regional Health-Europe
ER -
