Paper information
- Authors
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- Krishnan Bhaskaran,
- Seb Bacon,
- Stephen Evans,
- Chris Bates,
- Christopher Rentsch,
- Brian MacKenna,
- Laurie Tomlinson,
- Alex Walker,
- Anna Schultze,
- Caroline Morton,
- Daniel Grint,
- Amir Mehrkar,
- Rosalind Eggo,
- Peter Inglesby,
- Ian Douglas,
- Helen McDonald,
- Jonathan Cockburn,
- Elizabeth Williamson,
- Dave Evans,
- Helen Curtis,
- Will Hulme,
- John Parry,
- Frank Hester,
- Sam Harper,
- David Spiegelhalter,
- Liam Smeeth,
- Ben Goldacre
- Citation
- Bhaskaran, K., Bacon, S., Evans, S., Bates, C., Rentsch, C. T., MacKenna, B., Tomlinson, L., Walker, A. J., Schultze, A., Morton, C. E., Grint, D., Mehrkar, A., Eggo, R. M., Inglesby, P., Douglas, I., McDonald, H. I., Cockburn, J., Williamson, E., Evans, D., Smeeth, L. (2021). 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. the Lancet Regional Health. Europe, 6, 100109. https://doi.org/10.1016/j.lanepe.2021.100109
- Categories
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.