Risk, Riskier, Riskiest
- Richard Cree
- May 20, 2020
- 2 min read
Updated: May 21, 2020
Tuesday 19th May 2020
Figures for 18th May
UK COVID Deaths 160 / Total 34,796
James Cook Hospital – Total COVID deaths – 217
All COVID cases within South Tees Hospitals Trust – 56
James Cook Critical Care COVID cases – 8 (6 ventilated)
James Cook Critical Care non-COVID cases – 31 (16 ventilated)
I’m working a night shift overnight tonight but I thought I would share some new data on the factors that increase your likelihood of dying from COVID-19. I know this is not cheery stuff but it is interesting...
Using GP electronic records linked to the COVID-19 death notification system, the OpenSAFELY study looked at nearly 17.5 million patients during the period between 1st February and 25th April 2020. It studied in detail, 5683 patients who died in hospital from COVID-19. This is the largest cohort study conducted by any country to date.
They found that death from COVID-19 was strongly associated with being male, being elderly and coming from a deprived area. The older and more deprived you were, the worse your chance of dying.
Existing health conditions were important with uncontrolled diabetes, recent diagnosis of cancer, chronic respiratory disease (such as COPD or severe asthma), chronic liver disease, stroke or dementia, chronic kidney disease and immunosuppression being the most important. Interestingly, hypertension on its own (once age and sex was taken into account) was not associated with much of an increased risk of death unlike earlier reports.
Obesity was also important with risk rising with increasing body mass index (BMI). Morbidly obese people appeared twice as likely to die as people with an ideal body weight.
There may be a slight protective effect amongst current smokers. This has been suggested elsewhere. However, the authors concluded that even if this were true it would be massively outweighed by the adverse health risks of smoking, meaning that overall, smokers would be more likely to die.
As has previously been reported, Black and Asian people had a much higher chance of death. Previous studies have speculated that this is due to more chronic medical problems like diabetes or an association with higher deprivation but in this study, this did not appear to be the case. The authors speculate that one reason for the difference might be the higher numbers of BAME people working in ‘front-line’ professions and being more likely to be infected.
Risk of death increased with increasing deprivation and this seemed to be independent of chronic health problems suggesting that social factors are important. There may be significantly higher virus transmission rates in deprived areas leading to higher death rates.
Only today I was reading about a rise in cases in the local area when compared to the last few days. It’s still too early to say whether this is a sustained rise or an anomaly but when looking at this study it certainly becomes easier to understand the higher death rate in Middlesbrough when compared to other parts of the country.
Real vs. perceived risk?
Thank you Richard. I'm continuing to hope our local higher transmission rate than in neighbouring areas results in a lower rate from now.
best wishes
Jon
Hi Bex Thanks. I agree with you – it will be interesting to look at race and social inequality when this is all over. I suspect it will not look pretty. Cheers, Richard
Hi Jon You’re right – it’s the chance of death in the population as a whole. So both factors come into play. Firstly your chance of being infected is important. Here, deprivation plays a part along with health problems that reduce your immunity to infection. Next, your chance of dying once infected then becomes important which is more to do with your health, although deprivation clearly affects this as well. Trying to tease out the detail becomes very difficult. Areas that had a high rate of infection initially should see lower transmission rates later, unless movement of population (e.g. business commuting) brings more infection into that area. The male/female divide will be multifactorial. In part it will be genetic but men are more…
I do think we will see a lot more evidence to highlight that covid was definitely a race and class issue.
BAME individuals are likely to be the worst paid, often living in deprived areas, as you say but I’d also go as far to say many will be less likely to speak out against PPE inadequacies or delay medical help due to anticipated discrimination, language barriers or tensions around citizenship.
I’ve looked at the evidence about obesity and being overweight myself, for the first time in my life I am exercising and making changes. I know others are too. I do think the frustration about not being able to visit my mum is making me jog that little bit…
Thank you, as always, Richard for taking up your time in writing this. What isn't totally clear to me (maybe I'm being dim) is what is meant by the chance of dying from Covid-19.
When looking at the factors which increase the chances of death, is that the chances (1) among the population as a whole, or (2) the chances once infected (or once admitted to hospital)?
If (1) it is more obvious how this could be relevant to increasing the chance of death, due to an increased chance of infection. If (2) it is much less obvious why deprivation is relevant, unless it is due to other health or well-being factors which deprivation may contribute to. Although what is…