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

Abstract

<jats:p>Abstract Background: Covid 19 is pandemic in the UK. To date only studies in the UK on hospital deaths have been published in the peer reviewed literature. Legal requirements for cremation in England and Wales require the collection of information that can be used to improve understanding of Covid 19 deaths in both hospital and community settings. Aim: To document demographic and clinical characteristics, including likely place of infection, of individuals dying of Covid 19 to inform public health policy Design: A comprehensive case series of deaths from Covid 19 between 6 April and 30 May. Setting: A crematorium in South Wales Participants: Individuals for whom an application was made for cremation. Main outcome measures: Age, sex, date and place of death, occupation, comorbidities, where infection acquired. Results: Of 752 cremations, 215(28.6%) were Covid-19 of which 115 (53.5%) were male and 100 (46.5%) female. The median age was 82 years, with the youngest patient being 47 years 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 nursing homes were significantly older than those dying in hospital(median 88y (IQ range 82-93y) v 80y (IQ range 71-87y): p&lt;0.0001). Patients dying in hospital had significantly more comorbidities than those dying in nursing homes (median 2: IQ range 1-3 v. 1: IQ range 1-2: p &lt;0.001). Conclusions: In a representative series, comprising both hospital and community deaths, persons over 80 with an average 2 comorbidities predominated. Although men and women were represented in similar proportions, men were more likely to die in hospital. Over half the infections were acquired in either hospitals or nursing and residential homes with implications for the management of the pandemic, historically and in the future.</jats:p>