Excess mortality in 2020 compared to 2019
Compared with 2019, the relative survival model showed males to have a 13.2% greater risk of mortality than females (RHR = 1.13, 95% CI = 1.1 to 1.17, P<0.0001) but older people had a 1.8% reduced risk of mortality (RHR = 0.982, 95% CI = 0.978 to 0.982, P<0.0001).
Large household size, including communal establishments was strongly associated with a higher hazard of mortality in 2020 compared to 2019 (Table 2). Compared with single occupancy, households of 2–4 had a lower RHR, rising to 47% relative hazard in households of 5–8, then increasing fivefold for dwellings of ≥9 occupants (RHR = 5.1, 95% CI = 4.87 to 5.31, P<0.0001) (Table 2).
Table 2. Estimated relative hazard rates in the RCGP RSC population
Association of SARS-CoV-2 status with mortality
The cohort with known SARS-CoV-2 status (n = 56 628) were divided into definite cases confirmed by laboratory test (8.4%, n = 4742), probable cases with a firm clinical diagnosis (4.8%, n = 2710), possible infections (74.9%, n = 42 390), and those with a negative test (12.0%, n = 6786). For details of SARS-CoV-2 status across all study variables see Supplementary Table 2.
A total of 2110 (3.7%) individuals with recorded SARS-CoV-2 status died during the study period. The crude and adjusted rates of mortality were highest in those of male sex, aged ≥75 years, of probable or definite SARS-CoV-2 status, and living in households of single occupancy and ≥9 people (Table 3).
Table 3. Mortality, unadjusted and adjusted for sex, age, SARS-CoV-2 status, and household size in people with known SARS-CoV-2 status
In multivariable analyses (Table 4), the odds of mortality were higher in those with probable and definite SARS-CoV-2 cases. Those of male sex (OR = 1.77, 95% CI = 1.37 to 2.03, P<0.0001), aged 65–74 years (OR 7.93, 95% CI = 6.42 to 9.77, P<0.0001), and aged ≥75 years were all associated with higher odds of mortality (OR = 18.71, 95% CI = 15.17 to 23.08, P<0.0001).
Table 4. Multivariable adjusted odds ratios for all-cause mortality in the RCGP RSC cohort with known SARS-COV-2 status
Compared with single occupancy, households with ≥9 occupants (including communal dwellings) were associated with higher mortality (OR = 2.8, 95% CI = 2.28 to 3.45, P<0.0001). Conurbations had a higher odds of mortality compared with city and town, with no difference in rural areas. Compared with white ethnicity, black ethnicity was associated with increased mortality (OR = 1.84, 95% CI = 1.33 to 2.54, P = 0.0002).
No change was seen in association of mortality with socioeconomic status, measured using IMD quintile. Ex-smokers had lower odds of mortality (OR = 0.57, 95% CI = 0.45 to 0.72, P = 0.0001), with no reduction of odds in current smokers. People diagnosed with chronic diseases and with learning disabilities (OR = 1.97, 95% CI = 1.22 to 3.18, P = 0.0056) had a higher odds of mortality, with the exception of diabetes and hypertension.
Analyses using complete cases only produced very similar findings (see Supplementary Table S3 for details). The only differences were that a clinical diagnosis of URTI was associated with a lower OR of mortality and that of a LRTI with a higher OR of mortality compared with not having these conditions (OR = 0.63, 95% CI = 0.50 to 0.79, P = 0.0001; OR = 1.35, 95% CI = 1.17 to 1.56, P = 0.0001). Additionally, there was a positive association between a diagnosis of type 2 diabetes and mortality (OR = 1.15, 95% CI = 1.01 to 1.32, P = 0.034).