ArticlePloS one2021
Risk factors for excess all-cause mortality during the first wave of the COVID-19 pandemic in England: A retrospective cohort study of primary care data.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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15 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- The impact of the COVID-19 pandemic on mortality in people with dementia without COVID-19: a systematic review and meta-analysis.BMC geriatrics · 2022Pooled it
- Inequalities in all-cause mortality by ethnicity in the United Kingdom: a systematic review and meta-analysis.The Lancet regional health. Europe · 2025Article
- Understanding excess mortality during COVID in Belgium: the influence of pre-existing health status and social factors.Archives of public health = Archives belges de sante publique · 2025Article
- Risk factors for all-cause mortality during the COVID-19 pandemic compared with the pre-pandemic period in an adult population of Arkhangelsk, Russia.Scientific reports · 2025Article
- Contribution of infection to mortality in people with type 2 diabetes: a population-based cohort study using electronic records.The Lancet regional health. Europe · 2025Article
- Increased frequency and mortality in persons with neurological disorders during COVID-19.Brain : a journal of neurology · 2024Article
- An update of the reported effects of the COVID-19 pandemic on person with intellectual disability and their carers: a scoping review.Annals of medicine · 2023Article
- Individual and contextual risk factors for mortality in nursing home residents during the first wave of COVID-19 in France: a multilevel analysis of a nationwide cohort study.Age and ageing · 2023Article
- Evaluating Ethnic Variations in the Risk of Infections in People With Prediabetes and Type 2 Diabetes: A Matched Cohort Study.Diabetes care · 2023Article
- Article
- The 10-month mortality rate among older patients treated for digestive system cancer during the first wave of the COVID-19 pandemic: The CADIGCOVAGE multicentre cohort study.Journal of geriatric oncology · 2023Article
- How Did the Two Years of the COVID-19 Pandemic Affect the Outcomes of the Patients with Inflammatory Rheumatic Diseases in Lithuania?Medicina (Kaunas, Lithuania) · 2023Article
- Associations between mortality from COVID-19 and other causes: A state-level analysis.PloS one · 2023Article
- Relationship of frailty with excess mortality during the COVID-19 pandemic: a population-level study in Ontario, Canada.Aging clinical and experimental research · 2022Article
- Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe COVID-19 pandemic's first wave in England during spring 2020 resulted in an approximate 50% increase in all-cause mortality. Previously, risk factors such as age and ethnicity, were identified by studying COVID-related deaths only, but these were under-recorded during this period.
objectiveTo use a large electronic primary care database to estimate the impact of risk factors (RFs) on excess mortality in England during the first wave, compared with the impact on total mortality during 2015-19.
methodsMedical history, ethnicity, area-based deprivation and vital status data were extracted for an average of 4.8 million patients aged 30-104 years, for each year between 18-March and 19-May over a 6-year period (2015-2020). We used Poisson regression to model total mortality adjusting for age and sex, with interactions between each RF and period (pandemic vs. 2015-19). Total mortality during the pandemic was partitioned into "usual" and "excess" components, assuming 2015-19 rates represented "usual" mortality. The association of each RF with the 2020 "excess" component was derived as the excess mortality ratio (EMR), and compared with the usual mortality ratio (UMR).
resultsRFs where excess mortality was greatest and notably higher than usual were age >80, non-white ethnicity (e.g., black vs. white EMR = 2.50, 95%CI 1.97-3.18; compared to UMR = 0.92, 95%CI 0.85-1.00), BMI>40, dementia, learning disability, severe mental illness, place of residence (London, care-home, most deprived). By contrast, EMRs were comparable to UMRs for sex. Although some co-morbidities such as cancer produced EMRs significantly below their UMRs, the EMRs were still >1. In contrast current smoking has an EMR below 1 (EMR = 0.80, 95%CI 0.65-0.98) compared to its UMR = 1.64.
conclusionsStudying risk factors for excess mortality during the pandemic highlighted differences from studying cause-specific mortality. Our approach illustrates a novel methodology for evaluating a pandemic's impact by individual risk factor without requiring cause-specific mortality data.
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