Deaths involving COVID-19 by religious group

Deaths involving COVID-19 by religious group, England: 24 January 2020 to 28 February 2021
ONS 13 May 2021

• This article reports age-standardised rates of death involving the coronavirus (COVID-19) by religious group and uses statistical models to adjust for location, measures of disadvantage, occupation, living arrangements, and pre-existing health conditions. It compares the risk of COVID-19 mortality in two discrete periods aligned to each wave of the pandemic.
• The findings show that the patterns of excess COVID-19 mortality risk by religious group have changed over the course of the pandemic; after adjustments, the Hindu population and Muslim men were disproportionately affected throughout the pandemic; for other religious groups, the excess risk relative to the Christian group was only observed in the first wave (Jewish and Buddhist men) or second wave (Sikh men and women and Muslim women).

Consequences of the emergency response to COVID-19: a whole health care system review in a single city in the United Kingdom.

Consequences of the emergency response to COVID-19: a whole health care system review in a single city in the United Kingdom.
BMC Emerg Med 21, 55 (2021). https://doi.org/10.1186/s12873-021-00450-2

• A review of the entire pathway of care of patients (n=552) whose death was registered in Salford during the 8 week period of the first wave (primary care, secondary care, 111 and 999 calls) was carried out in order to create a single record of healthcare prior to death. 
• 18% of deaths contained themes consistent with some degree of avoidability. In people aged ≥75 years who lived at home this was 53%, in care home residents 29% and in patients with learning disability 44% (n = 9). Common themes were; delays in patients presenting to care providers (10%), delays in testing (17%), avoidable exposure to COVID-19 (26%), delays in provider response (5%), and sub-optimal care (11%). For avoidability scores of 2 or 3 (indicating more than 50% chance of avoidability), 44% of cases had > 2 themes.

Analyses of associations between arts engagement and mortality

The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing
BMJ 2019;367:l6377.  18 December 2019. doi.org/10.1136/bmj.l6377

• A paper examining data from more than 6000 participants in the English Longitudinal Study of Ageing (ELSA) over 14 years, has concluded that “receptive arts engagement (going to museums, art galleries, exhibitions, the theatre, concerts, or the opera) could have a protective association with longevity in older adults." 
• There was no evidence of moderation by sex, socioeconomic status, or social factors. 
• More than 40% of patients with lung disease, depression, or loneliness reported never engaging with the arts despite robust evidence of the potential benefits.

Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018:

Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study
The Lancet Public Health December 05, 2019 DOI:https://doi.org/10.1016/S2468-2667(19)30219-1

• A cross-sectional study of 2·5 million premature deaths in England (2003-2018) found that one in three was attributable to neighbourhood deprivation measured by upstream determinants of health including income, employment, education, and crime.The biggest contributors were ischaemic heart disease , respiratory cancers and chronic obstructive pulmonary disease.
• See the tableaux map to explore the data at LA level.

Cancer survival: index for CCGs

Cancer survival: index for Clinical Commissioning Groups
PHE 29 November 2019

• One-year cancer survival (all-cancers combined, 3 cancers combined, breast, colorectal and lung) in CCGs in England for patients diagnosed in the period 2002 to 2017 and followed up to 2018. 
• One-, 5- and 10-year index of cancer survival estimates are also available by Sustainability and Transformation Partnerships and Cancer Alliances.

What is happening to life expectancy in the UK

What is happening to life expectancy in the UK
Kings Fund updated 22 October 2019

• How overall life expectancy has changed over time, along with considerations such as the difference in life expectancy between males and females, geographical inequalities, how the UK compares with other countries,

Outcomes of hospital admissions among frail older people: a 2-year cohort study

Outcomes of hospital admissions among frail older people: a 2-year cohort study
British Journal of General Practice 2019; 69 (685): e555-e560. DOI:https://doi.org/10.3399/bjgp19X704621

• This study compared 2 year mortality for cohorts of patients from two populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 admissions.="" after="" ambulatory="" and="" are="" discharged="" even="" experience="" following="" found="" frailty="" from="" hospital="" hours="" increased="" individuals="" inpatient="" it="" li="" longer="" mortality="" resource="" short="" stays.="" that="" those="" use="" was="" who="" with="">

Abstract

Compendium: Mortality

Compendium: Mortality
NHS Digital updated 29 March 2019

• A set of publications with mortality data extracted from the Primary Care Mortality Database for a range of indicators including cancers, accidental falls and stroke.

Suicide Prevention Profile

Suicide Prevention Profile
PHE updated February 2019

• The Suicide Prevention Profile has been produced to help develop understanding at a local level and support an intelligence driven approach to suicide prevention. It collates and presents a range of publically available data on suicide, associated prevalence, risk factors, and service contact among groups at increased risk. 
• This update contains new data on female age-specific suicide rates by STP.

Recent trends in mortality in England: review and data packs

Recent trends in mortality in England: review and data packs
PHE 11 December 2018
A report on recent trends in life expectancy and mortality in England.

• After decades of progress, since 2011 improvement in age-standardised mortality rates and life expectancy has slowed down considerably, for both males and females. For some age groups, and for some parts of England, improvement has stopped altogether. 
• Inequality in life expectancy has widened, and there has been a slowdown in improvement in mortality from heart disease and stroke – 2 leading causes of death. 
• A number of other factors, operating simultaneously, have also potentially contributed to the slowdown in life expectancy.  These include:
• a large increase in deaths in the winters 
• more older people living with dementia and other long-term conditions, 
• an increase in death rates from accidental poisoning, in particular, drug misuse.

Prevention is better than cure: Vision for prevention

Prevention is better than cure: our vision to help you live well for longer
DHSC 5 November 2018

• The document sets out the government’s vision for:
• stopping health problems from arising in the first place
• supporting people to manage their health problems when they do arise
• The goal is to improve healthy life expectancy by at least 5 extra years, by 2035, and to close the gap between the richest and poorest.
• A collection of case studies has been published, showing examples of good practice in preventing health problems from happening.

Read Matt Hancock's speech to the International Association of National Public Health Institutes (IANPHI) when he launched the policy.

A Fair, Supportive Society for those with LD

A Fair, Supportive Society
Institute of Health Equity 5 November 2018

• This report, commissioned by NHS England, highlights that those with learning disabilities will die 15-20 years sooner on average than the general population. Much of the government action needed to improve life expectancy for people with disabilities is likely to reduce health inequalities for everyone. 
• The report recommends that action should focus on the ‘social determinants of health’, particularly addressing poverty, poor housing, discrimination and bullying.

Child death review: statutory and operational guidance

Child death review: statutory and operational guidance (England)
DHSC 15 October 2018

• Statutory and operational guidance for CCGs and local authorities as child death review partners.

What is happening to life expectancy in the UK?

What is happening to life expectancy in the UK?
Kings Fund 15 August 2018

• How overall life expectancy has changed over time, along with considerations such as the difference in life expectancy between males and females, geographical inequalities, how the UK compares with other countries, and possible factors in the more recent slowdown in mortality improvements in the UK.

Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers

Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers
National Quality Board 11 July 2018

• This guidance is for NHS trusts, NHS foundation trusts and for services provided through NHS England specialised commissioning. It consolidates existing guidance and provides perspectives from family members who have experienced a bereavement within the NHS. It details how trusts should support and engage families after a loved one’s death in their organisation’s care.
• This guidance is complemented by Information for families following a bereavement (Annex 1) 
• Responsibilities of CCGs

Medication errors in the NHS in England

Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK.
Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York, 23 February 2018

• Analysis of 36 studies which reported error rates in primary care, care homes and secondary care, ranging from 0.2% to 90.6%. Errors were more likely in older people, or in the presence of co-morbidity and polypharmacy. 
• 72% of medication errors have little/no potential for harm. 
• Prescribing in primary care accounts for 33.9% of all potentially clinically significant errors.
• Non-steroidal anti-inflammatory drugs, anticoagulants and antiplatelets cause over a third of admissions due to avoidable ADRs. Gastrointestinal (GI) bleeds are implicated in half of the deaths from primary care ADRs. Older people are more likely to suffer avoidable ADRs.
• Error rates in the UK are similar to those in other comparable health settings such as the US and other countries in the EU.

SUMMARY

Mortality risks and A&E admissions at weekends

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records
Lancet 9 May 2017 DOI: http://dx.doi.org/10.1016/S0140-6736(17)30782-1

• This analysis of mortality rate (within 30 days) of emergency admission to four NHS hospitals used a range of common haematology and biochemistry test results or other proxies for workload did not find an association between hospital workload and mortality. It is suggested that the weekend effect arises from patient-level differences at admission rather than reduced hospital staffing or services.

Abstract:

Learning from deaths in the NHS: national guidance

Learning from deaths in the NHS: national guidance
National Quality Board, 15 March 2017

• The National Quality Board has published a framework to help standardise and improve how NHS providers identify, report, investigate and learn from deaths. 
• Also published with the guidance is a suggested Dashboard which provides a format for data publication by Trusts.

Why did mortality in England and Wales increase in 2013-14?

Two research papers examine the increase in mortality in England and Wales 2013-14.

Why has mortality in England and Wales been increasing? An iterative demographic analysis
Journal for the Royal Society of Medicine, 16 February 2017

• An examination of the causes and ages at death contributing to life expectancy changes between 2013 and 2015 in England and Wales has found that the long-term decline in mortality has reversed, with approximately 30,000 extra deaths compared to what would be expected if trends in 2006–2014 had continued.
• These excess deaths are largely in the older population, who are most dependent on health and social care. The major contributor, based on reported causes of death, was dementia but caution was advised in this interpretation. 

What caused the spike in mortality in England and Wales in January 2015?

Journal of the Royal Society of Medicine, 16 February 2017

• The four possible causes of mortality spikes in a population are proposed as; data artefact; environmental shock (eg natural disaster or extreme weather event); a major epidemic or a widespread failure of the health and social care system.
• Given limitations of the evidence and its complexity, the researches cannot reach a firm conclusion about what has happened, but they point to possible lines of further inquiry, and discount some possible explanations. 
• While the reduced efficacy of the influenza vaccine being used may have played some role in the January 2015 mortality spike, this is likely to have been limited. 
• The research excludes common sources of data artefact. 
• Instead, the evidence points to a major failure of the health system, possibly exacerbated by failings in social care.

The 'weekend effect' is about both admissions and mortality rates

Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission
J Health Serv Res Policy 1355819616649630, May 6, 2016 as doi:10.1177/1355819616649630

• This retrospective analysis of data from 2013-14 of hospital A&E and community admissions and mortality within 30 days of admission considers whether it is the number of deaths or the number of admissions that is driving the elevation of mortality rates at weekends.
• HSJ commentary by authors (Subscription required)

Abstract

• Objective Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends.
• Method Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends.
• Results Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010).
• Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054).
• The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths.
• Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.