Abstract
ObjectiveTo investigate factors contributing to excess deaths of older patients during the initial 2020 lockdown beyond those attributable to confirmed COVID‐19.MethodsRetrospective cohort study comparing patients treated between 23 March 2020 and 14 June 2020, deemed exposed to the pandemic/lockdown, to patients treated between 18 December 2019 and 10 March 2020, deemed to be unexposed. Data came from electronic clinical records from secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment area population ∼0.86 million). Eligible patients were aged 65 years or over at baseline with at least 14 days' follow‐up, excluding patients diagnosed with confirmed or suspected SARS‐CoV‐2 infection. The primary outcome was all‐cause mortality.FindingsIn the two cohorts, 3,073 subjects were exposed to lockdown and 4,372 subjects were unexposed; the cohorts were followed up for an average of 74 and 78 days, respectively. After controlling for confounding by sociodemographic factors, smoking status, mental comorbidities, and physical comorbidities, patients with dementia suffered an additional 53% risk of death (HR = 1.53, 95% CI = 1.02–2.31), and patients with severe mental illness suffered an additional 123% risk of death (HR = 2.23, 95% CI = 1.42–3.49). No significant additional mortality risks were identified from physical comorbidities, potentially due to low statistical power in that respect.ConclusionDuring lockdown people with dementia or severe mental illness had a higher risk of death without confirmed COVID‐19. These data could inform future health service responses and policymaking to help prevent avoidable excess death during future outbreaks of this or a similar infectious disease.
Highlights
The novel coronavirus disease COVID‐19 was declared a pandemic by the World Health Organization on 11 March 2020.1 To minimize the spread of COVID‐19, social isolation or social distancing have been implemented globally
We found that older people with dementia or serious mental illness had a higher risk of death without confirmed COVID‐19 under the circumstance of lockdown
This study focuses on risk factors for deaths occurring after lockdown among older adults known to secondary care mental health services who did not have confirmed COVID‐19
Summary
The novel coronavirus disease COVID‐19 was declared a pandemic by the World Health Organization on 11 March 2020.1 To minimize the spread of COVID‐19, social isolation or social distancing (as part of more general measures designed to cut infection, collectively referred to as ‘lockdown’) have been implemented globally. Day‐to‐day contacts were reduced by requiring people to stay at home, closing most businesses and venues, and stopping all gatherings of more than two people in public.[2] Increasing evidence indicates that this has been an effective prevention and control measure.[3] besides the deaths directly attributable to COVID‐19, a large number of extra indirect deaths have occurred during lockdown.[4,5,6] For example, in England and Wales, in addition to the 45,511 deaths associated with COVID‐19 infection from 14 Mar 2020 to 29 May 2020, a further 12,522 excess deaths have been reported.[6] More detailed information about these excess deaths is sparse, making it difficult to design strategies to ameliorate them We hypothesized that both physical diseases and mental disorders would contribute
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