Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank

Junren Wang; Jianwei Zhu; Huazhen Yang; Yao Hu; Yajing Sun; Zhiye Ying; Yuanyuan Qu; Unnur Valdimarsdottir; Fang Fang; Huan Song

doi:10.1136/bmjopen-2020-046931

Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank

BMJ Open. 2021 Jun 4;11(6):e046931. doi: 10.1136/bmjopen-2020-046931.

Authors

Junren Wang^{1

2}, Jianwei Zhu³, Huazhen Yang^{1

2}, Yao Hu^{1

2}, Yajing Sun^{1

2}, Zhiye Ying^{1

2}, Yuanyuan Qu^{1

2}, Unnur Valdimarsdottir^{4

5

6}, Fang Fang^#⁷, Huan Song^#^{8

2

4}

Affiliations

¹ West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China.
³ Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁴ Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁵ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
⁸ West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China songhuan@wchscu.cn.

^# Contributed equally.

Abstract

Objective: To assess the impact of the COVID-19 outbreak on cardiovascular disease (CVD) related mortality and hospitalisation.

Design: Community-based prospective cohort study.

Setting: The UK Biobank.

Participants: 421 372 UK Biobank participants who were registered in England and alive as of 1 January 2020.

Primary and secondary outcome measures: The primary outcome of interest was CVD-related death, which was defined as death with CVD as a cause in the death register. We retrieved information on hospitalisations with CVD as the primary diagnosis from the UK Biobank hospital inpatient data. The study period was 1 January 2020 to June 30 2020, and we used the same calendar period of the three preceding years as the reference period. In order to control for seasonal variations and ageing of the study population, standardised mortality/incidence ratios (SMRs/SIRs) with 95% CIs were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period.

Results: We observed a distinct increase in CVD-related deaths in March and April 2020, compared with the corresponding months of the three preceding years. The observed number of CVD-related deaths (n=218) was almost double in April, compared with the expected number (n=120) (SMR=1.82, 95% CI 1.58 to 2.07). In addition, we observed a significant decline in CVD-related hospitalisations from March onwards, with the lowest SIR observed in April (0.45, 95% CI 0.41 to 0.49).

Conclusions: There was a distinct increase in the number of CVD-related deaths in the UK Biobank population at the beginning of the COVID-19 outbreak. The shortage of medical resources for hospital care and stress reactions to the pandemic might have partially contributed to the excess CVD-related mortality, underscoring the need of sufficient healthcare resources and improved instructions to the public about seeking healthcare in a timely way.

Keywords: COVID-19; cardiology; epidemiology; health services administration & management.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biological Specimen Banks
COVID-19*
Disease Outbreaks
England / epidemiology
Humans
Prospective Studies
Risk Factors
SARS-CoV-2
United Kingdom / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding