Excess mortality in mental health service users during the COVID-19 pandemic described by ethnic group: South London and Maudsley data.

  1. Robert Stewart
  2. Matthew Broadbent
  3. Jayati Das-Munshi

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Abstract

The COVID-19 pandemic in the UK was accompanied by excess all-cause mortality at a national level, only part of which was accounted for by known infections. Excess mortality has previously been described in people who had received care from the South London and Maudsley NHS Foundation Trust (SLaM), a large mental health service provider for 1.2m residents in south London. SLaM’s Clinical Record Interactive Search (CRIS) data resource receives 24-hourly updates from its full electronic health record, including regularly sourced national mortality on all past and present SLaM service users. SLaM’s urban catchment has high levels of deprivation and is ethnically diverse, so the objective of the descriptive analyses reported in this manuscript was to compare mortality in SLaM service users from 16 th March to 15 th May 2020 to that for the same period in 2019 within specific ethnic groups: i) White British, ii) Other White, iii) Black African/Caribbean, iv) South Asian, v) Other, and vi) missing/not stated. For Black African/Caribbean patients (the largest minority ethnic group) this ratio was 3.33, compared to 2.47 for White British patients. Considering premature mortality (restricting to deaths below age 70), these ratios were 2.74 and 1.96 respectively. Ratios were also high for those from Other ethnic groups (2.63 for all mortality, 3.07 for premature mortality).

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    SciScore for 10.1101/2020.07.13.20152710: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: CRIS has received approval as a data source for secondary analyses (Oxford Research Ethics Committee C, reference 18/SC/0372).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Considering limitations, it is important to bear in mind that the data are derived from a single site. Because complete data are being provided for that site with no hypothetical source population intended, calculation of confidence intervals was not felt to be appropriate for the descriptive data provided in this report; applicability to other mental healthcare providers cannot therefore be inferred and would need specific investigation. We additionally aim to provide further output on age-and sex-standardised mortality ratios in a future report. Profiles of services, patient populations and catchment morbidity are also likely to vary. Delays in national registrations might result in an underestimate of more recent deaths. No attempt was made to investigate modification or confounding by other factors such as age, gender, socioeconomic status or comorbid physical health conditions; however, these are unlikely to vary substantially between the at-risk population in 2019 and that in 2020. Mortality numbers clearly include all deaths and not just those attributable to COVID-19 infection. Finally, conflation of ethnic groups into the broad categories defined here was pragmatically driven by the need for sufficiently large group sizes. It is inevitably approximate and may fail to reflect varying experiences between constituent groups (e.g. between Black African and Black Caribbean groups; between Indian, Pakistani and Bangladeshi groups).

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.07.13.20152710 on medRxiv