Who is dying from COVID-19 in the United Kingdom? A review of cremation authorisations from a single South Wales' crematorium

Abstract

Only studies in the UK on individuals dying from coronavirus disease 2019 (COVID-19) in hospital have been published, to date. Cremation law requires collection of clinical information that can improve understanding of deaths in both hospital and community settings. Age, sex, date and place of death, occupation, comorbidities and where infection acquired was recorded for all deaths from COVID-19, between 6 April and 30 May, for whom an application was made for cremation at a South Wales' crematorium. Of 752 cremations, 215 (28.6%) were COVID-19 (115 (53.5%) male and 100 (46.5%) female). Median age was 82 years (youngest patient 47 and the oldest 103 years). Over half the deaths (121/215: 56.3%) were over 80 years. Males' odds of dying in hospital, rather than the community were 1.96 times that of females (95% confidence intervals (CI) 1.03–3.74, P = 0.054) despite being of similar age and having a similar number of comorbidities. Only 21 (9.8%) of 215 patients had no comorbidities recorded. Patients dying in care homes were significantly older than those dying in hospital (median 88 years (interquartile (IQ) range 82–93 years) vs. 80 years (IQ range 71–87 years): P < 0.0001). Patients dying in hospital had significantly more comorbidities than those dying in care homes (median 2: IQ range 1–3 vs. 1: IQ range 1–2: P < 0.001). Sixty three (29.3%) of infections were hospital acquired and a further 55 (25.6%) acquired in care homes. In a series, of hospital and community deaths, persons over 80 with an average two comorbidities predominated. Men were more likely to die in hospital. Half the infections were acquired in hospitals or care homes with implications for management of the pandemic.

A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

“…It is also important to appreciate that as studies typically reported all-cause mortalityand information on age, frailty, and co-morbidities were not available at the individual patient level -the causal contribution of nosocomial COVID-19 exposure remains to be determined. Examination of linked primary care and mortality data within the United Kingdom (62,63) suggests that COVID-19 amplifies the risk of death by a factor associated with the levels of circulating virus and an individuals' underlying diagnoses (62). Shah et al describe how active SARS-CoV-2 infection often led to decisions to forgo anticancer treatment in hospitalised patients with haematological malignancies (51).…”