Child mortality in England during the first year of the COVID-19 pandemic

  1. David Odd
  2. Sylvia Stoianova
  3. Tom Williams
  4. Peter Fleming
  5. Karen Luyt

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Abstract

To quantify the relative risk (RR) of childhood deaths across the whole of England during the first year of the COVID-19 pandemic, compared with a similar period of 2019.

Design

This work is based on data collected by the National Child Mortality Database (NCMD). Deaths from 1 April 2020 until 31 March 2021 (2020–2021) were compared with those from the same period of 2019–2020. RR and excess mortality were derived for deaths in 2020–2021 vs 2019–2020.

Setting

All deaths reported to NCMD in England of children under 18 years of age, between April 2019 and March 2021.

Participants

6490 deaths of children, under the age of 18 years, reported to the NCMD over the study period.

Results

Children had similar demographics in the 2 years. There were 356 (198–514) fewer deaths in 2020–2021 than in 2019–2020 (RR 0.90 (0.85 to 0.94), p<0.001). Deaths from infection (RR 0.49 (0.38 to 0.64)) and from other underlying medical conditions (RR 0.75 (0.68 to 0.82)) were lower in 2020–2021 than 2019–2020, and weak evidence (RR 0.50 (0.23 to 1.07), p=0.074) that this was also true of deaths from substance abuse.

Conclusions

Childhood mortality in England during the first year of the SARS-CoV-2 pandemic was lower than expected, with over 300 fewer deaths than the preceding 12 months. The greatest reduction was in children less than 10 years old. It is important that we learn from this effect that potentially offers alternative ways to improve the outcome for the most vulnerable children in our society.

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  1. Version published to 10.1136/archdischild-2021-323370
  2. ScreenIT

    SciScore for 10.1101/2021.08.23.21262114: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    The main limitation of this work is precision of the estimates, due to small numbers. Death in childhood is fortunately a rare event; with absolute mortality across the 2 years of around 27 per 100,000 children per year. While we had adequate precision to identify an overall reduction in deaths, and the likely causal conditions (e.g. infection) in which this occurred, we had less power to identify small, but still potentially important differences that might indicate which children were most affected by the broad social changes, and for which children the effects were less clear. The coincidence of maximum lockdown regulations and the maximum reduction in mortality for younger children suggests that the lockdown regulations including social distancing and reduction of social mixing appeared most beneficial to younger children and perhaps to certain ethnic groups. However, we had limited statistical power and interpretation requires caution. In addition, population measures were derived from ONS data and, particularly in the case of ethnicity, may not be up to date. However, estimates were compared between years and, as the absolute risk is low, error is likely only from population change between the two years. Like all work using routine data, case ascertainment may not be 100%, although reporting to NCMD is a statutory requirement and cohort completeness has previously been reported as good4, though we had missing data for some measures (e.g. ethnicity). For this work, the l...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.08.23.21262114v1 on medRxiv