Asthma deaths in Scotland during the first peak of COVID-19: Did reduced hospital admission result in excess asthma mortality?

Introduction During the first wave of the COVID-19 pandemic in the UK there was a reduction in A&E attendances and hospital admissions. Monthly excess deaths peaked in April 2020; driven by COVID-19.¹ We investigated whether hospital admissions due to asthma were reduced in April 2020 compared to the previous five years and if this was accompanied by an increase in asthma deaths.

Methods Five-year data were obtained from Public Health Scotland from the time period January 2015 to June 2020. Hospital admission data was sourced from Public Health Scotland’s Scottish Morbidity Records, death certificate data from National Records of Scotland and A&E attendance data from Public Health Scotland. Data were analysed using statistical process control charts.

Results A&E presentations in April 2020 reduced to 44% of April 2019. Hospital admissions for all conditions reduced, as did asthma admissions (figure 1a) [218 in April 2020 versus previous 5 year mean of 418]. 7958 deaths occurred in April 2020; an excess of 2731 from previous 5-year mean. In 130 deaths asthma was recorded on the death certificate as either the underlying or the contributory cause, giving rise to around 100 apparent excess deaths versus the previous 5-year mean of 27.5 (figure 1b). Asthma was recorded as the underlying cause of death in 7 cases, comparable with the previous 5 year mean of 9.2 deaths (figure 1c).

The age distribution of those with asthma on the death certificate was: 97 ≥65, 27 aged 45–65, 6 aged 18–44 and 0 <18 years. Of the 123 patients with asthma recorded as a contributory cause, 81 had COVID-19 recorded as the underlying cause of death. All 7 patients with asthma recorded as underlying cause of death were elderly and the location of death was: 3 at home, 2 in residential care, 1 in hospital and 1 in a hospice.

Conclusions Reduced acute healthcare utilisation by people with asthma during the first peak of COVID-19 did not appear to result in increased mortality where asthma was the primary underlying cause of death.