Study of 17 million patients pinpoints COVID-19 mortality risk factors

By Angela Betsaida B. Laguipo, BSNJul 10 2020

The coronavirus disease (COVID-19) has spread to 188 countries and territories, infecting more than 12.23 million people. As the pandemic spreads, new information emerges about the infection’s mode of transmission, risk factors, and mutation.

Now, an analysis of 17 million people in England, the most extensive study of its kind, sheds light on certain factors that can increase a person’s chances of dying from COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The study, which is published in the journal Nature, provides detailed information on the size of the risk tied with pre-existing health conditions, including diabetes and obesity. The study echoes previous work that indicates a higher COVID-19 death risk for males, the elderly, and people with more significant deprivation.

Novel Coronavirus SARS-CoV-2 Creative rendition of SARS-COV-2 virus particles. Note: not to scale. Credit: NIAID

OpenSAFELY

The researchers established the OpenSAFELY, a secure health analytics platform that covers about 40 percent of all patients in England. The primary care records of more than 17 million people were tied to 10,926 COVID-19 related deaths.

This is a continuation and expansion of the initial findings of the researchers on factors tied to about 5,707 COVID-19-related deaths in hospitals, which were released in May.

Study findings

Previous findings showed that certain groups of people are vulnerable to developing severe COVID-19. In the current study, the researchers found that males had a 1.59-fold-higher risk of dying from COIVD-19 than women.

Age is a factor that may increase the risk of developing severe disease and dying from the infection. The elderly, those who are 80 years old and above, had a 20-fold-increased risk compared to those who are 50 to 59 years old.

Black and Asian people were 1.62 to 1.88 times more likely to die from COVID-19, compared to white people, after considering medical conditions.  However, the increased risk was associated with pre-existing clinical risk factors and deprivation, the researchers said.

Further, the team revealed that those who are most deprived among the participants were 1.8 times more likely to die form COVID-19, highlighting that socioeconomic factors may play a pivotal role in the risk of COVID-19 death.

Akin to previous findings, people with pre-existing or underlying medical conditions are at a higher risk of dying from COVID-19. These include people with diabetes, morbid obesity with a BMI of over 40, severe asthma, and respiratory, chronic heart, liver, autoimmune, and neurological diseases.

The team identified one limitation of the study, which is the inclusion of clinically suspected and not-laboratory-confirmed COVID-19 cases. This may show that some patients may be incorrectly identified as COVID-19 positive patients.

“These analyses provide a preliminary picture of how key demographic characteristics and a range of comorbidities, a priori selected as being of interest in COVID-19, are jointly associated with poor outcomes,” the researchers explained in the study.

“We generated early insights into risk factors for COVID-19 related death using an unprecedented scale of 17 million patients’ detailed primary care records, maintaining privacy, in the context of a global health emergency,” the team concluded.

Study implications

With the findings of the study echoing previous results, policies in many countries to protect the most vulnerable people should continue to be in effect. Older people and those with pre-existing diseases should stay at home and practice social distancing measures to prevent infection.

Further, even if countries have eased lockdown measures to avoid economic turmoil, vulnerable people need to practice safety and infection control measures. They should avoid non-essential travel outside their homes, practice physical distancing, wash their hands regularly, and perform disinfection regularly.

Nursing homes and retirement facilities should also safeguard the welfare of their patients by reducing visits from outsiders and choosing alternative ways for the patients to be with their families. Patients with underlying health conditions should also make sure that their condition is controlled through medications and boost their immune systems to reduce the risk of infection.

The team also emphasized that further research is needed to evaluate how non-white backgrounds and deprivation contribute to higher death risk from COVID-19.

“The underlying causes of higher risk of COVID-19 related death among those from non-white backgrounds, and deprived areas, require further exploration; we would suggest collecting data on occupational exposure and living conditions as first steps,” the team concluded.

So far, the coronavirus pandemic has taken more than 554,000 lives, from a staggering 12.23 million infections. The number of infected people is believed to be much higher since there are silent spreaders or those who do not manifest symptoms of the disease and a lack of test kits globally.