Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications
Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications
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COVID-19 大流行期间死亡率模式的变化：基于人群的模型以了解姑息治疗的影响
DOI：
10.1101/2020.06.07.20124693
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Bone A
中科院分区：
文献类型：
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作者：
Bone A
2019冠状病毒病（COVID-19）在全球范围内直接和间接造成了高死亡率。目的探索COVID-19大流行期间的死亡率模式以及对姑息治疗、服务规划和研究的影响。设计描述性分析和基于人口的常规数据建模。参与者和设置2020年3月7日至5月15日期间在英格兰和威尔士登记的所有死亡。我们按年龄、性别和死亡地点描述了以下死亡率类别：（1）基线死亡（通常在特定时期发生的死亡）;（2）COVID-19死亡;（3）非直接归因于COVID-19的额外死亡。我们使用简单的模型和明确的假设，估计了在没有大流行的情况下死于COVID-19的人可能在生命的最后一年的比例。结果在大流行的前10周，有101，614例基线死亡，41，105例COVID-19死亡和14，520例额外死亡。养老院死亡人数增加了220%，而家庭和医院死亡人数分别增加了77%和90%。临终关怀死亡人数下降了20%。其他死亡发生在老年人中（86%年龄在75岁以上），大多数发生在养老院（56%）和家中（43%）。我们估计22%（13%-31%）的COVID-19死亡发生在那些在没有大流行的情况下可能处于生命最后一年的人中。结论COVID-19大流行导致姑息治疗需求激增。卫生和社会护理系统必须确保提供姑息治疗，以支持严重的COVID-19患者，特别是在护理院。
BackgroundCOVID-19 has directly and indirectly caused high mortality worldwide.AimTo explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research.DesignDescriptive analysis and population-based modelling of routine data.Participants and settingAll 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.ResultsDuring 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.ConclusionThe 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.