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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.

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.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2024-12-12
2024-12-19
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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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Rhiannon+K+Owen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Owen Rhiannon K</a>, <a href="/search?value1=James+D+van+Oppen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Oppen James D</a>, <a href="/search?value1=Jane+Lyons&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lyons Jane</a>, <a href="/search?value1=Ashley+Akbari&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Akbari Ashley</a>, <a href="/search?value1=Gareth+Davies&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davies Gareth</a>, <a href="/search?value1=Fatemeh+Torabi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Torabi Fatemeh</a>, <a href="/search?value1=Keith+R+Abrams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Abrams Keith R</a>, <a href="/search?value1=Ronan+A+Lyons&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lyons Ronan A</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(50):pii=2400085. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.50.2400085" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.50.2400085</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 06 Feb 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 14 Jul 2024 </span> </p>
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