Largest Analysis Reveals Risk Factors for COVID-19 Death


Author: Oxford University(i) : Contact: ox.ac.uk

Published: 2020-05-09

Synopsis:

Risk factors for COVID-19 causes of death by analyzing NHS health data from 17.4M UK adults revealed in the largest analysis of Coronavirus patient records to date.

Key Points:

  • People of Asian and Black ethnic backgrounds are at a higher risk of death and this is only partially attributable to pre-existing clinical risk factors or deprivation.
  • Results confirmed that men are at increased risk from COVID-19 death, as well as people of older ages and those with uncontrolled diabetes.

Main Digest

Largest Analysis Reveals Risk Factors for COVID-19 Death revealed in world’s of patient records to date. Largest study to date, analyzing NHS health data from 17.4 million UK adults between 01 February 2020 and 25 April 2020, has given the strongest evidence to date on risk factors associated with COVID-19 death.

Academics at the University of Oxford and the London School of Hygiene & Tropical Medicine (LSHTM), working on behalf of NHS England and in partnership with NHSX, have analyzed the pseudonymised health data of over 17.4 million UK adults to discover the key factors associated with death from COVID-19 .

Illustration of a globe of the world wearing a breathing mask.
Illustration of a globe of the world wearing a breathing mask.

Oxford University’s Medical Sciences Division is one of the largest biomedical research centers in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine and life sciences, and it is home to the UK’s top-ranked medical school. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and health care delivery.

This is the largest study on COVID-19 conducted by any country to date, and therefore gives the strongest evidence on risk factors associated with COVID-19 death.

  • Among the 17.4 million adults in the sample, there were 5,707 deaths in hospitals attributed to COVID-19.
  • Key factors related to COVID-19 death included being male, older age, uncontrolled diabetes and severe asthma.
  • A deprived background was also found to be a major risk factor: this was also only partially attributable to other clinical risk factors.
  • People of Asian and Black ethnic backgrounds are at a higher risk of death and, contrary to prior speculation, this is only partially attributable to pre-existing clinical risk factors or deprivation.

Compared to white people, people of Asian and Black ethnic origin were found to be at a higher risk of death. Previously, commentators and researchers have reasonably speculated that this might be due to higher prevalence of medical problems such as cardiovascular disease or diabetes among BME communities, or higher deprivation. The findings, based on detailed data, show that this only accounts for a small part of the excess risk. Consequently, further work must be done to fully understand why BME people are at such increased risk of death.

Additionally, people from deprived social backgrounds were also found to be at a higher risk of death, which also could not be explained by other risk factors.

Results confirmed that men are at increased risk from COVID-19 death, as well as people of older ages and those with uncontrolled diabetes. People with more severe asthma were also found to be at increased risk of death from COVID-19.

The study linked data about patients that had been hospitalized with COVID-19 with data held in primary care records processed by TPP. This was carried via the OpenSAFELY analytics platform, a new secure mechanism which allowed the GP records to be linked where they are stored for individual care. This minimizes the security risks associated with transferring and storing data elsewhere, to deliver analyzes quickly and safely while preserving patient privacy. All identifiable data remains in control of the NHS and data is pseudonymised before it can be accessed by researchers.

Professor Liam Smeeth, Professor of Clinical Epidemiology at LSHTM, NHS doctor and co-lead on the study, says: ‘We need highly accurate data on which patients are most at risk in order to manage the pandemic and improve patient care. The answers provided by this OpenSAFELY analysis are of crucial importance to countries around the world. For example, it is very concerning to see that the higher risks faced by people from BME backgrounds are not attributable to identifiable underlying health conditions’.

The London School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research, postgraduate studies and continuing education in public and global health. LSHTM has a strong international presence with over 3,000 staff and 4,000 students working in the UK and countries around the world, and an annual research income of £180 million. LSHTM is one of the highest-rated research institutions in the UK, is partnered with two MRC University Units in The Gambia and Uganda, and was named University of the Year in the Times Higher Education Awards 2016. Their mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

Dr Ben Goldacre, Director of the DataLab in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, NHS doctor and co-lead on the study, says: ‘During a global health emergency we need answers quickly and accurately. That means we need very large, very current datasets. The UK has phenomenal coverage and quality of data. We owe it to patients to keep their data secure; and we owe it to the global community to make good use of this data. That’s why we have developed a new highly secure model, taking the analytics to where the data already resides.’

Within the division, the Nuffield Department of Primary Care Health Sciences is the largest, top-ranked centre for academic primary care in the UK and leads world-class research and training to rethink the way healthcare is delivered in general practice and other community settings. The department’s main research focus on the prevention, early diagnosis and management of common illness, bringing together academics from many different backgrounds to work together to produce benefits for the NHS, for populations and for patients.

Further analysis using OpenSAFELY are already underway, including investigation into the effects of specific drugs routinely prescribed in primary care. The platform can also be used to evaluate COVID-19 spread with innovative approaches to modelling; predict local health service needs; assess the indirect health impacts of the pandemic; track the impact of national interventions; and inform exit from lockdown.

Research in the public interest to deepen our understanding of the COVID-19 virus and inform the government’s response is supported by the COPI notices and is in accordance with data protection law. Studies such as this require ethical approval to proceed. Primary care data is not held in the NHS COVID-19 data store; therefore, this important research was carried out with the support of TPP, one of the main GP system suppliers. Pseudonymised data was accessed by the academics for the research under strict controls. No identifiable data can be extracted from the platform.

Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the third year running, and at the heart of this success is their ground-breaking research and innovation. Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Their work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of their research sparks imaginative and inventive insights and solutions.

This paper is being released prior to peer review, as with most other research into COVID-19.
https://opensafely.org/outputs/2020/05/covid-risk-factors

(i)Source/Reference: Oxford University. Disabled World makes no warranties or representations in connection therewith. Content may have been edited for style, clarity or length.

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