Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland

The impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health restrictions in Sydney, Australia

OBJECTIVE

To investigate the impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health measures.

METHODS

Aggregated data from the NSW Notifiable Conditions Information Management System linked to Australian Census data, by periods of strict and relaxed measures, were used.

RESULTS

During strict measures, residents of areas of lower socioeconomic status (SES) had a higher risk of infection, with the lowest areas having greater risk compared with the highest areas ((hazard ratio (HR)) 7.15, 95% confidence interval (CI) 6.24-8.19). The risk of infection was lower for those aged 40 and over and was higher for males (HR 1.34, 95% CI 1.27-1.40); those in living in areas with larger household sizes (HR 1.56, 95% CI 36-1.78); and individuals in areas with a large proportion of residents born in South Asia (HR 1.18; 95% CI 1.07-1.29), South East Asia (HR 1.20, 95% CI 1.07-1.36) and the Middle East and North Africa (HR 1.67, 95% CI 1.47-1.90). During relaxed restrictions, the impact of variables attenuated but remained significant.

CONCLUSIONS

Minorities, those residing in lower SES areas and those living in larger households had worse COVID-19 outcomes during strict public health measures.

IMPLICATIONS FOR PUBLIC HEALTH

Decision-makers should tailor services to avoid inequities.

Risk of death in England following a positive SARS-CoV-2 test: A retrospective national cohort study (March 2020 to September 2022)

BACKGROUND

We aimed to estimate the relative risk of mortality following a first positive SARS-CoV-2 test during the first, second, and third waves of the COVID-19pandemic in England by age, sex, and vaccination status, taking into account pre-existing health conditions and lifestyle factors.

METHODS

We conducted a retrospective cohort study of all individuals registered with the National Health Service (NHS) in England from 1 March 2020 to September 2022. Data for all individuals were obtained and linked including primary care records, hospital admission episodes, SARS-CoV-2 test results, vaccinations, and death registrations. We fitted Cox Proportional Hazards models with time dependent covariates for confirmed SARS-CoV-2 infection to model the risk of subsequent mortality.

RESULTS

The hazard ratio for death after testing positive for subsequent, compared with those not testing positive, amongst unvaccinated individuals, ranged from 11 to 89 by age and sex, in the first four weeks following a positive test in wave one and reduced to 14 to 50 in wave three. This hazard was further reduced amongst those who had three vaccines to between 1.4 and 7 in wave three.

CONCLUSIONS

This study provides robust estimates of increased mortality risk among those who tested positive over the first three waves of the COVID-19 pandemic in England. The estimates show the impact of various factors affecting the risk of mortality from COVID-19. The results provide the first step towards estimating the magnitude and pattern of mortality displacement due to COVID-19, which is essential to understanding subsequent mortality rates in England.