Direct and indirect effects of the COVID-19 pandemic on mortality: an individual-level population-scale analysis using linked electronic health records, Wales, United Kingdom, 2016 to 2022
Year: 2024
Type: article
Study design: Observational Study
Abstract: BackgroundThe COVID-19 pandemic resulted in increased mortality directly and indirectly associated with COVID-19.AimTo assess the impact of the COVID-19 pandemic on all-cause and disease-specific mortality and explore potential health inequalities associated with area-level deprivation in Wales.MethodsTwo population-based cohort studies were derived from multi-sourced, linked demographic, administrative and electronic health record data from 2016 to 2019 (n = 3,113,319) and 2020 to 2022 (n = 3,571,471). Data were analysed using generalised linear models adjusting for age, sex, area-level deprivation and time at risk.ResultsCOVID-19 deaths peaked in January 2021 (54.9/100,000 person-months, 95% confidence interval (CI): 52.4-57.5). The pandemic indirectly affected deaths, with higher than expected maximum relative mortality rates (RR) related to cancer (RR: 1.24, 95% CI: 1.13-1.36), infectious diseases (excluding respiratory infections) (RR: 2.09, 95% CI: 1.27- 3.43), circulatory system (RR: 1.41, 95% CI: 1.28-1.56), trauma (RR: 2.04, 95% CI: 1.57- 2.65), digestive system (RR: 1.54, 95% CI: 1.25-1.91), nervous system (RR: 1.63; 95% CI: 1.34-2.00) and mental and behavioural disorders (RR: 1.85, 95% CI: 1.58-2.16). Mortality associated with respiratory diseases (unrelated to COVID-19) were lower than expected (minimum RR: 0.52, 95% CI: 0.45-0.60). All-cause mortality was lower in least deprived communities compared with most deprived (RR: 0.61, 95% CI: 0.60-0.62), and the magnitude of this effect increased during the pandemic.ConclusionsAll-cause and disease-specific mortality directly and indirectly associated with COVID-19 increased during the COVID-19 pandemic. Socioeconomic disparities were exacerbated during this time.
Source: Eurosurveillance
Institutions: Swansea University, University of Sheffield, University of Warwick
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funders: Wellcome Trust, Scottish Government, Public Health Wales, National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, Diabetes UK, Swansea University, Public Health Agency, Welsh Ambulance Services NHS Trust, Chief Scientist Office, Scottish Government Health and Social Care Directorate, Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division
OpenAlex ID: W4405376040