Providing timely evidence of Covid-19 related deaths in Northern Ireland - meeting report

The RSS Northern Ireland local group held an online meeting on Wednesday, March 31 2021, at 2pm. This talk followed a session from Northern Ireland Statistical Research Agency (NISRA) statistical staff that afternoon and featured Dr Jos Ijpelaar from the Administrative Research Unit at NISRA.

Dr Ijpelaar opened by reminding people that the first case of Covid-19 in NI occurred on 28 February, the first death on 18 March and the first lock-down started on 23 March 2020. The workload on NISRA's Vital Statistics Unit (VSU) had increased with demands for information on Covid-19 mortality emanating from many sources. The ADR was called upon to assist, but was hampered by the closure of its secure environment and other work in hand. The VSU routinely produces weekly deaths, monthly deaths and the Registrar General's Quarterly report.

The ARU undertook the following additional analyses: Covid-19 related deaths in NI, Excess Mortality and Covid-19 related deaths and Covid-19 related deaths and pre-existing conditions. The definition of a Covid-19 related death is: a death with mention of Covid-19, coronavirus, SARS-Cov-2, etc anywhere on the Medical Certificate of Cause of Death (MCCD), including suspected or probable cases. And the definition of an underlying cause of death is: disease or injury which initiated the train of morbid events leading directly to death.

Thus equipped, Jos showed the Covid-19 mortality rates per thousand by age: 0.09 (0-59), 1.2 (50-69), 4.14 (70-79), 15.58 (80-89) and 40.05 (90+ yrs.). Of the 2,893 total deaths, 1,003 were aged 80-89 and 550 were aged 90+ yrs. Mortality was higher in males and Jos showed a graph of the geographical spread with a broad band of higher mortality lying W-E across central NI.

Excess deaths were defined as: the difference between observed deaths from all causes in a period minus the expected number of deaths. In the period 2015-2019 the excess averaged 401 (range 375-475), but in 2020 there were 1,903, a fourfold increase. The geographical distribution showed highs in Co. Antrim, South Down and North Tyrone, but the spatial pattern was difficult to interpret. Covid-19 related deaths occurred most frequently in hospital, then in care homes and least frequently at home, while excess deaths showed the opposite pattern - least in hospital, then care homes and mostly at home. Dementia and Alzheimer’s was the most common underlying cause given for the excess deaths (13.1% of the average deaths in 2015-2019).

Covid-19 was the underlying  cause for 1,626 (88%) of the 1,831 Covid-19 related deaths from March to December 2020. This proportion was higher in March-August (90.0%) compared to September-December (87.7%). Some 9.7% of Covid-19 deaths had no pre-existing conditions, while 50.2% of Covid-19 deaths had
one or two pre-existing conditions. On average, there were 2.4 pre-existing conditions per Covid-19 death and 49 deaths had 7+ conditions. The top three conditions recorded were: dementia and Alzheimer's disease 32.2%, diabetes 20.6% and hypertensive diseases 20.4%.

Dr Ijpelaar concluded by considering the next steps which he suggested would involve, inter alia, measuring the impact of vaccination and the effect of delayed interventions in non-Covid-19 related deaths.

This enjoyable and wide-ranging talk highlighted many topical issues and was well received by the online audience of 40+ participants. Jos was asked about his views on delayed interventions, especially in relation to cancer studies. He felt there would of course be an impact, but this had yet to be quantified in NI. This was important future work. Another participant wondered if NI should abandon HMG's 'containment' strategy and aim instead for complete elimination, given the success of the vaccination programme. Jos felt this question would be better directed to the policy-makers.

The audience thanked Jos and showed its appreciation in the usual way.

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