Bhaskaran Krishnan, Bacon Sebastian, Evans Stephen Jw, Bates Chris J, Rentsch Christopher T, MacKenna Brian, Tomlinson Laurie, Walker Alex J, Schultze Anna, Morton Caroline E, Grint Daniel, Mehrkar Amir, Eggo Rosalind M, Inglesby Peter, Douglas Ian J, McDonald Helen I, Cockburn Jonathan, Williamson Elizabeth J, Evans David, Curtis Helen J, Hulme William J, Parry John, Hester Frank, Harper Sam, Spiegelhalter David, Smeeth Liam, Goldacre Ben
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Lancet Reg Health Eur. 2021 Jul;6:100109. doi: 10.1016/j.lanepe.2021.100109. Epub 2021 May 8.
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.
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 February 2020 and with >1 year of continuous prior registration; the cut-off date for deaths was 9 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.
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]).
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.
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.
2019冠状病毒病（COVID-19）导致的死亡率与年龄和既有疾病密切相关，其他病因导致的死亡率亦是如此。我们旨在研究与COVID-19导致的死亡相比，特定因素与COVID-19以外病因导致的死亡之间的差异关联。
我们代表英国国民保健服务体系（NHS England）在OpenSAFELY平台上开展了一项队列研究。英格兰的初级医疗数据与国家死亡登记数据相链接。我们纳入了2020年2月1日数据库中所有年龄≥18岁且有超过1年连续既往登记记录的成年人；死亡截止日期为2020年11月9日。通过对这两种结局拟合年龄和性别调整的逻辑模型，估计个体水平特征与COVID-19死亡和非COVID死亡之间的关联，死亡原因根据死亡证明上是否将COVID-19编码列为根本死因进行分类。
共纳入17,456,515名个体。17,063人死于COVID-19，134,316人死于其他原因。大多数与COVID-19死亡相关的因素与非COVID死亡也有类似关联，但关联程度有所不同。高龄与COVID-19死亡的关联比与非COVID死亡更强（例如，≥80岁与50 - 59岁相比，比值比分别为40.7 [95%置信区间37.7 - 43.8]和29.6 [28.9 - 30.3]），男性、贫困、肥胖和一些合并症也是如此。吸烟、癌症病史和慢性肝病与非COVID死亡的关联比与COVID-19死亡更强。所有非白人种族的COVID-19死亡几率均高于白人（黑人的比值比：2.20 [1.96 - 2.47]，南亚裔：2.33 [2.16 - 2.52]），但非COVID死亡几率低于白人（黑人：0.88 [0.83 - 0.94]，南亚裔：0.
