| Summary: | Objectives: Few studies report contributors to the excess mortality in England during the first wave of
coronavirus disease 2019 (COVID-19) infection. We report the absolute excess risk (AER) of mortality and
excess mortality rate (EMR) from a nationally representative COVID-19 sentinel surveillance network including
known COVID-19 risk factors in people aged 45 years and above.
Methods: Pseudonymised, coded clinical data were uploaded from contributing primary care providers
( N = 1,970,314, ≥45years). We calculated the AER in mortality by comparing mortality for weeks 2 to 20
this year with mortality data from the Office for National Statistics (ONS) from 2018 for the same weeks.
We conducted univariate and multivariate analysis including preselected variables. We report AER and
EMR, with 95% confidence intervals (95% CI).
Results: The AER of mortality was 197.8/10,0 0 0 person years (95%CI:194.30–201.40). The EMR for male
gender, compared with female, was 1.4 (95%CI:1.35–1.44, p < 0.00); for our oldest age band ( ≥75 years)
10.09 (95%CI:9.46–10.75, p < 0.00) compared to 45–64 year olds; Black ethnicity’s EMR was 1.17 (95%CI:
1.03–1.33, p < 0.02), reference white; and for dwellings with ≥9 occupants 8.01 (95%CI: 9.46–10.75,
p < 0.00). Presence of all included comorbidities significantly increased EMR. Ranked from lowest to highest
these were: hypertension, chronic kidney disease, chronic respiratory and heart disease, and cancer
or immunocompromised.
Conclusions: The absolute excess mortality was approximately 2 deaths per 100 person years in the first
wave of COVID-19. More personalised shielding advice for any second wave should include ethnicity,
comorbidity and household size as predictors of risk.
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