{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:01:44Z","timestamp":1792184504732,"version":"4.4.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["220283\/Z\/20\/Z"],"award-info":[{"award-number":["220283\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107731\/Z\/15\/Z"],"award-info":[{"award-number":["107731\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000288","name":"Royal Society","doi-asserted-by":"crossref","award":["107731\/Z\/15\/Z"],"award-info":[{"award-number":["107731\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/501100000288","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Excess mortality captures the total effect of the Coronavirus Disease 2019 (COVID-19) pandemic on mortality and is not affected by misspecification of cause of death. We aimed to describe how health and demographic factors were associated with excess mortality during, compared to before, the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We analysed a time series dataset including 9,635,613 adults (\u226540 years old) registered at United Kingdom general practices contributing to the Clinical Practice Research Datalink. We extracted weekly numbers of deaths and numbers at risk between March 2015 and July 2020, stratified by individual-level factors. Excess mortality during Wave 1 of the UK pandemic (5 March to 27 May 2020) compared to the prepandemic period was estimated using seasonally adjusted negative binomial regression models. Relative rates (RRs) of death for a range of factors were estimated before and during Wave 1 by including interaction terms. We found that all-cause mortality increased by 43% (95% CI 40% to 47%) during Wave 1 compared with prepandemic. Changes to the RR of death associated with most sociodemographic and clinical characteristics were small during Wave 1 compared with prepandemic. However, the mortality RR associated with dementia markedly increased (RR for dementia versus no dementia prepandemic: 3.5, 95% CI 3.4 to 3.5; RR during Wave 1: 5.1, 4.9 to 5.3); a similar pattern was seen for learning disabilities (RR prepandemic: 3.6, 3.4 to 3.5; during Wave 1: 4.8, 4.4 to 5.3), for black or South Asian ethnicity compared to white, and for London compared to other regions. Relative risks for morbidities were stable in multiple sensitivity analyses. However, a limitation of the study is that we cannot assume that the risks observed during Wave 1 would apply to other waves due to changes in population behaviour, virus transmission, and risk perception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The first wave of the UK COVID-19 pandemic appeared to amplify baseline mortality risk to approximately the same relative degree for most population subgroups. However, disproportionate increases in mortality were seen for those with dementia, learning disabilities, non-white ethnicity, or living in London.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1003870","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T13:23:20Z","timestamp":1641475400000},"page":"e1003870","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Factors associated with excess all-cause mortality in the first wave of the COVID-19 pandemic in the UK: A time series analysis using the Clinical Practice Research Datalink"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8739-4601","authenticated-orcid":true,"given":"Helen","family":"Strongman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1538-2526","authenticated-orcid":true,"given":"Helena","family":"Carreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7853-0528","authenticated-orcid":true,"given":"Bianca L.","family":"De Stavola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5364-8757","authenticated-orcid":true,"given":"Krishnan","family":"Bhaskaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Leon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"key":"pmed.1003870.ref001","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"EJ Williamson","year":"2020","journal-title":"Nature"},{"key":"pmed.1003870.ref002","first-page":"2020","article-title":"Comparison of COVID-19 outcomes among shielded and non-shielded populations: A general population cohort study of 1.3 million.","author":"BD Jani","year":"2020","journal-title":"medRxiv"},{"key":"pmed.1003870.ref003","article-title":"Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study.","author":"ID Saragih","year":"2021","journal-title":"Geriatr Nurs (Minneap)."},{"key":"pmed.1003870.ref004","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jaip.2020.11.054","article-title":"Prevalence of Comorbid Asthma and Related Outcomes in COVID-19: A Systematic Review and Meta-Analysis","volume":"9","author":"S Liu","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"pmed.1003870.ref005","doi-asserted-by":"crossref","first-page":"12493","DOI":"10.18632\/aging.103579","article-title":"Epidemiological, comorbidity factors with severity and prognosis of COVID-19: A systematic review and meta-analysis.","volume":"12","author":"X Fang","year":"2020","journal-title":"Aging (Albany NY)."},{"key":"pmed.1003870.ref006","article-title":"Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study.","volume":"371","author":"AK Clift","year":"2020","journal-title":"BMJ"},{"key":"pmed.1003870.ref007","first-page":"29","article-title":"Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis.","author":"S Sze","year":"2020","journal-title":"EClinicalMedicine."},{"key":"pmed.1003870.ref008","first-page":"2020","article-title":"Ethnic differences in COVID-19 infection, hospitalisation, and mortality: An OpenSAFELY analysis of 17 million adults in England.","author":"R Mathur","year":"2020","journal-title":"medRxiv"},{"key":"pmed.1003870.ref009","article-title":"Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data.","author":"L Cummins","year":"2021","journal-title":"Influenza Other Respir Viruses."},{"key":"pmed.1003870.ref010","doi-asserted-by":"crossref","first-page":"100109","DOI":"10.1016\/j.lanepe.2021.100109","article-title":"Factors associated with deaths due to COVID-19 versus other causes: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform","volume":"6","author":"K Bhaskaran","year":"2021","journal-title":"Lancet Reg Heal\u2013Eur"},{"key":"pmed.1003870.ref011","first-page":"e81","article-title":"COVID-19: a need for real-time monitoring of weekly excess deaths","author":"DA Leon","year":"2020","journal-title":"Lancet. 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Excess mortality in England: weekly reports. [cited 2021 May 10]. 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