Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

  1. Anna E Bone
  2. Anne M Finucane
  3. Javiera Leniz
  4. Irene J Higginson
  5. Katherine E Sleeman

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Abstract

COVID-19 has directly and indirectly caused high mortality worldwide.

Aim:

To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research.

Design:

Descriptive analysis and population-based modelling of routine data.

Participants and setting:

All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions.

Results:

During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic.

Conclusion:

The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

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  1. Version published to 10.1177/0269216320944810
  2. ScreenIT

    SciScore for 10.1101/2020.06.07.20124693: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    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:
    Strengths and limitations: This is the first paper to estimate and characterise population-level patterns of mortality during the COVID-19 pandemic in relation to palliative care. We have produced simple models with explicit assumptions to raise questions and stimulate discussion. We calculated additional deaths for each age and gender group separately to improve precision. However, this study has limitations. We have been limited by the available official data, including the lack of historical data on place of death by week in England and Wales. We have used data for England and Wales, and patterns are likely to vary by country and region, particularly with respect to care home deaths. The infection fatality ratio and risk of dying multipliers for those in their last year of life were based on latest available data, and this might change over the course of the pandemic. This study has focused on mortality only. Other aspects of palliative care that are important to consider, for example symptom control, support with difficult conversations, advance care planning, and complex clinical decision-making.27 There are also longer-term needs among those surviving COVID-19, such as rehabilitation and palliative care, which are likely to be significant and important for service planning but were not modelled here. We have produced population-based models that are useful for strategic health service planning but are not directly applicable to clinical decision-making at an individual ...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.07.20124693v1 on medRxiv