Place and Underlying Cause of Death During the COVID-19 Pandemic: Retrospective Cohort Study of 3.5 Million Deaths in England and Wales, 2014 to 2020

Wu, Jianhua; Mafham, Marion; Mamas, Mamas; Rashid, Muhammad; Kontopantelis, Evangelos; Deanfield, John E.; de Belder, Mark A.; Gale, Chris P.

Objective To describe the place and cause of death during the COVID-19 pandemic to assess its impact on excess mortality. Methods This national death registry included all adult (aged≥18 years) deaths in England and Wales between 1st January 2014 and 30th June 2020. Daily deaths during COVID-19 pandemic were compared against the expected daily deaths estimated using Farrington surveillance algorithm for daily historical data between 2014 and 2020, by place and cause of death. Results Between 2nd March and 30th June 2020, there was an excess mortality of 57860 (a proportional increase of 35%) compared with the expected deaths, of which 50603 (87%) were COVID-19 related. At home, only 14% of 16190 excess deaths were related to COVID-19, with 5 963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% of the 25611 excess deaths related to COVID-19, 5539 of which were due to respiratory disease and most of these (4315 deaths) involved COVID-19. In hospital, there were 16174 fewer deaths than expected which did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected. Conclusion The COVID-19 pandemic has resulted a large excess of deaths in care homes, which were poorly characterised and likely the result of undiagnosed COVID-19. There was a smaller, but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.