Excess deaths from COVID-19 correlate with age and socio-economic status. A database study in the Stockholm region

Abstract

Background

The COVID-19 pandemic has affected the entire health care system, internationally as well as in Sweden. We aimed to study excess deaths (all death causes, but also COVID-19-related deaths) during the COVID-19 pandemic regarding age, socio-economic status, the situation in nursing homes, and place of death for nursing home residents.

Design

We performed a descriptive regional registry data study using VAL, the Stockholm Regional Council’s central data warehouse, which covers almost all health care use in the county of Stockholm. T tests and chi-square tests were used for comparisons.

Results

Compared with 2016–2019, there were excess deaths in March–May 2020 (p < 0.0001), mainly explained by COVID-19, but in April there were also unexplained excess deaths. Individuals dying from COVID-19 were older than patients dying from other causes (p < 0.0001). There were more patient deaths among people residing in less advantaged socio-economic areas (p < 0.0001). Nursing home residents dying from COVID-19 were more often admitted to acute hospitals than residents dying from other causes (p < 0.0001). Also, the proportion of admissions of nursing home residents dying from other causes increased from April to May 2020 (p < 0.0001).

Conclusions

Dying from COVID-19 mainly affects the elderly, nursing home residents, and persons from less advantaged socio-economic groups. The pandemic has resulted in an increase in acute admissions of dying nursing home residents to acute hospitals.

Keywords:

• COVID-19
• excess deaths
• hospital care
• nursing homes

Acknowledgements

The authors thank Region Stockholm for generously providing us with the data for the study. The Stockholm Sjukhem Foundation is acknowledged for providing excellent facilities in their Research & Development unit. David Boniface is acknowledged for linguistic revision.

Disclosure statement

The authors have nothing to disclose.

Additional information

Funding

Dr Strang reports grants from the Stockholm Sjukhem Foundation’s Jubilee Fund [519102] during the conduct of the study.

Notes on contributors

Peter Strang

Peter Strang is an oncologist and professor in palliative medicine, Karolinska Institutet in Stockholm.

Per Fürst

Per Fürst is a geriatrician and consultant in palliative medicine at the Palliative Care Unit, Stockholms Sjukhem, Stockholm.

Torbjörn Schultz

Torbjörn Schultz, BA is a Senior Analyst at R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden.