Place of death in France: impact of the first wave (March–May 2020) of the Covid-19 epidemic

BACKGROUND: The Covid-19 epidemic entailed a major public health issue in France challenging the efficiency of the public health system. The distribution of deaths by place in France may have been affected by the epidemic and mitigation actions. This article presents mortality rate ratios by place of death in France during the first lockdown (17 March – 10 May, 2020) of the Covid-19 epidemic. METHODS: We considered five places of death recorded in death certificates. Deaths in 2020 were compared to deaths from 2015 to 2019. We employed quasi-Poisson regressions in order to stablish mortality rate ratios (MRR) during the Covid-19 epidemic, for all-cause and non-Covid-19 deaths. Analysis was conducted in Metropolitan France, and for three groups of regions defined according to the intensity of the first COVID-19 epidemic wave. RESULTS: A significant increase in all-cause and non-COVID-19 mortality at home was observed for all age groups. Also, an increase in mortality was observed in nursing homes, mostly due to Covid-19. Non-covid-19 mortality in public hospitals decreased significantly in all the country. These trends were mainly observed for cancers. CONCLUSIONS: Overall mortality increased during the first wave of the Covid-19 epidemic. Most Covid-19 deaths took place in public hospitals and nursing homes at old ages. There was a displacement of non-Covid-19 mortality from public hospitals to home and nursing homes, particularly in the most highly exposed area. Among hypotheses to explain such a displacement, population avoidance of hospital care, or redeployment of hospital activity in this emergent context can be cited. Further analysis is needed to understand the reasons of the increase in non-Covid-19 mortality in nursing homes and at home.