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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

Rhiannon Owen Orcid Logo, James D van Oppen Orcid Logo, Jane Lyons, Ashley Akbari Orcid Logo, Gareth Davies Orcid Logo, Fatemeh Torabi Orcid Logo, Keith R Abrams Orcid Logo, Ronan Lyons Orcid Logo

Eurosurveillance, Volume: 29, Issue: 50, Start page: 2400085

Swansea University Authors: Rhiannon Owen Orcid Logo, Jane Lyons, Ashley Akbari Orcid Logo, Gareth Davies Orcid Logo, Fatemeh Torabi Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.2807/1560-7917.es.2024.29.50.2400085

Abstract

Background: The COVID-19 pandemic resulted in increased mortality directly and indirectly associated with COVID-19. Aim: To 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...

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Published in: Eurosurveillance
ISSN: 1560-7917
Published: European Centre for Disease Control and Prevention (ECDC) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa67163
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Aim: To 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. Methods: Two 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. Results: COVID-19 deaths peaked in January 2021 (54.9/100,000 person-months, 95% confidence interval (CI): 52.4&#x2013;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&#x2013;1.36), infectious diseases (excluding respiratory infections) (RR: 2.09, 95% CI: 1.27&#x2013; 3.43), circulatory system (RR: 1.41, 95% CI: 1.28&#x2013;1.56), trauma (RR: 2.04, 95% CI: 1.57&#x2013; 2.65), digestive system (RR: 1.54, 95% CI: 1.25&#x2013;1.91), nervous system (RR: 1.63; 95% CI: 1.34&#x2013;2.00) and mental and behavioural disorders (RR: 1.85, 95% CI: 1.58&#x2013;2.16). Mortality associated with respiratory diseases (unrelated to COVID-19) were lower than expected (minimum RR: 0.52, 95% CI: 0.45&#x2013;0.60). All-cause mortality was lower in least deprived communities compared with most deprived (RR: 0.61, 95% CI: 0.60&#x2013;0.62), and the magnitude of this effect increased during the pandemic. Conclusions: All-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.</abstract><type>Journal Article</type><journal>Eurosurveillance</journal><volume>29</volume><journalNumber>50</journalNumber><paginationStart>2400085</paginationStart><paginationEnd/><publisher>European Centre for Disease Control and Prevention (ECDC)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1560-7917</issnElectronic><keywords/><publishedDay>12</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-12-12</publishedDate><doi>10.2807/1560-7917.es.2024.29.50.2400085</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Not Required</apcterm><funders>This work is supported by the Academy of Medical Sciences/the Wellcome Trust/ the Government Department of Business, Energy and Industrial Strategy/the British Heart Foundation/Diabetes UK Springboard Award (SBF006/1122) and the Con-COV team funded by the Medical Research Council (MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government&#x2019;s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). The funders have no role in study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. Researchers are independent of the funders.</funders><projectreference/><lastEdited>2025-02-04T11:06:24.6759157</lastEdited><Created>2024-07-23T11:53:55.7803283</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Rhiannon</firstname><surname>Owen</surname><orcid>0000-0001-5977-376X</orcid><order>1</order></author><author><firstname>James D van</firstname><surname>Oppen</surname><orcid>0000-0002-2570-7112</orcid><order>2</order></author><author><firstname>Jane</firstname><surname>Lyons</surname><orcid/><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Gareth</firstname><surname>Davies</surname><orcid>0000-0001-9005-1618</orcid><order>5</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>6</order></author><author><firstname>Keith R</firstname><surname>Abrams</surname><orcid>0000-0002-7557-1567</orcid><order>7</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>8</order></author></authors><documents><document><filename>67163__33481__2e836480c864457aa3f26cd1cdbddbc5.pdf</filename><originalFilename>67163.VOR.pdf</originalFilename><uploaded>2025-02-04T11:03:28.5350719</uploaded><type>Output</type><contentLength>491226</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This article is copyright of the authors or their affiliated institutions, 2024. 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spelling 2025-02-04T11:06:24.6759157 v2 67163 2024-07-23 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 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false 1b74fa5125a88451c52c45bcf20e0b47 Jane Lyons Jane Lyons true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 98490239b86cc892a382416d048cdb3c 0000-0001-9005-1618 Gareth Davies Gareth Davies true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2024-07-23 MEDS Background: The COVID-19 pandemic resulted in increased mortality directly and indirectly associated with COVID-19. Aim: To 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. Methods: Two 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. Results: COVID-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. Conclusions: All-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. Journal Article Eurosurveillance 29 50 2400085 European Centre for Disease Control and Prevention (ECDC) 1560-7917 12 12 2024 2024-12-12 10.2807/1560-7917.es.2024.29.50.2400085 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Not Required This work is supported by the Academy of Medical Sciences/the Wellcome Trust/ the Government Department of Business, Energy and Industrial Strategy/the British Heart Foundation/Diabetes UK Springboard Award (SBF006/1122) and the Con-COV team funded by the Medical Research Council (MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). The funders have no role in study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. Researchers are independent of the funders. 2025-02-04T11:06:24.6759157 2024-07-23T11:53:55.7803283 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Rhiannon Owen 0000-0001-5977-376X 1 James D van Oppen 0000-0002-2570-7112 2 Jane Lyons 3 Ashley Akbari 0000-0003-0814-0801 4 Gareth Davies 0000-0001-9005-1618 5 Fatemeh Torabi 0000-0002-5853-4625 6 Keith R Abrams 0000-0002-7557-1567 7 Ronan Lyons 0000-0001-5225-000X 8 67163__33481__2e836480c864457aa3f26cd1cdbddbc5.pdf 67163.VOR.pdf 2025-02-04T11:03:28.5350719 Output 491226 application/pdf Version of Record true This article is copyright of the authors or their affiliated institutions, 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. true eng http://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Rhiannon Owen
Jane Lyons
Ashley Akbari
Gareth Davies
Fatemeh Torabi
Ronan Lyons
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 0d30aa00eef6528f763a1e1589f703ec
1b74fa5125a88451c52c45bcf20e0b47
aa1b025ec0243f708bb5eb0a93d6fb52
98490239b86cc892a382416d048cdb3c
f569591e1bfb0e405b8091f99fec45d3
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv 0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
1b74fa5125a88451c52c45bcf20e0b47_***_Jane Lyons
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
98490239b86cc892a382416d048cdb3c_***_Gareth Davies
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Rhiannon Owen
Jane Lyons
Ashley Akbari
Gareth Davies
Fatemeh Torabi
Ronan Lyons
author2 Rhiannon Owen
James D van Oppen
Jane Lyons
Ashley Akbari
Gareth Davies
Fatemeh Torabi
Keith R Abrams
Ronan Lyons
format Journal article
container_title Eurosurveillance
container_volume 29
container_issue 50
container_start_page 2400085
publishDate 2024
institution Swansea University
issn 1560-7917
doi_str_mv 10.2807/1560-7917.es.2024.29.50.2400085
publisher European Centre for Disease Control and Prevention (ECDC)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: The COVID-19 pandemic resulted in increased mortality directly and indirectly associated with COVID-19. Aim: To 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. Methods: Two 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. Results: COVID-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. Conclusions: All-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.
published_date 2024-12-12T08:18:53Z
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score 11.056336

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