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Human Phenotype

Transmission

Seroprevalence
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    The COVID-19 mortality effects of underlying health conditions in India: a modelling study

    Authors: Paul Novosad; Radhika Jain; Alison Campion; Sam Asher

    doi:10.1101/2020.07.05.20140343 Date: 2020-07-08 Source: medRxiv

    Objective: To model how known COVID-19 comorbidities will affect mortality rates and the age TRANS distribution of mortality in a large lower middle income country (India), as compared with a high income country (England), and to identify which health conditions drive any differences. Design: Modelling study. Setting: England and India. Participants: 1,375,548 respondents aged TRANS 18 to 99 to the District Level Household Survey-4 and Annual Health Survey in India. Additional information on health condition prevalence SERO on individuals aged TRANS 18 to 99 was obtained from the Health Survey for England and the Global Burden of Diseases, Risk Factors, and Injuries Studies (GBD). Main outcome measures: The primary outcome was the proportional increase in age TRANS-specific mortality in each country due to the prevalence SERO of each COVID-19 mortality risk factor ( diabetes MESHD, hypertension HP hypertension MESHD, obesity HP obesity MESHD, chronic heart disease MESHD, respiratory illness MESHD, kidney disease MESHD, liver disease MESHD, and cancer MESHD, among others). The combined change in overall mortality and the share of deaths under 60 from the combination of risk factors was estimated in each country. Results: Relative to England, Indians have higher rates of diabetes MESHD (10.6% vs. 8.5%), chronic respiratory disease MESHD (4.8% vs. 2.5%), and kidney disease MESHD (9.7% vs. 5.6%), and lower rates of obesity HP obesity MESHD (4.4% vs. 27.9%), chronic heart disease MESHD (4.4% vs. 5.9%), and cancer MESHD (0.3% vs. 2.8%). Population COVID-19 mortality in India relative to England is most increased by diabetes MESHD (+5.4%) and chronic respiratory disease MESHD (+2.3%), and most reduced by obesity HP obesity MESHD (-9.7%), cancer MESHD (-3.2%), and chronic heart disease MESHD (-1.9%). Overall, comorbidities lower mortality in India relative to England by 9.7%. Accounting for demographics and population health explains a third of the difference in share of deaths under age TRANS 60 between the two countries. Conclusions: Known COVID-19 health risk factors are not expected to have a large effect on aggregate mortality or its age TRANS distribution in India relative to England. The high share of COVID-19 deaths from people under 60 in low- and middle-income countries (LMICs) remains unexplained. Understanding mortality risk associated with health conditions prevalent in LMICs, such as malnutrition HP malnutrition MESHD and HIV MESHD/ AIDS MESHD, is essential for understanding differential mortality. Keywords: COVID-19, India, low- and middle-income countries, comorbidity

    How many are at increased risk of severe COVID-19 disease? Rapid global, regional and national estimates for 2020

    Authors: Andrew Clark; Mark Jit; Charlotte Warren-Gash; Bruce Guthrie; Harry HX Wang; Stewart W Mercer; Colin Sanderson; Martin McKee; Christopher Troeger; Kanyin I Ong; Francesco Checchi; Pablo Perel; Sarah Joseph; Hamish P Gibbs; Amitava Banerjee; LSHTM CMMID COVID-19 working group; Rosalind M Eggo

    doi:10.1101/2020.04.18.20064774 Date: 2020-04-22 Source: medRxiv

    Background The risk of severe COVID-19 disease is known to be higher in older individuals and those with underlying health conditions. Understanding the number of individuals at increased risk of severe COVID-19 illness, and how this varies between countries may inform the design of possible strategies to shield those at highest risk. Methods We estimated the number of individuals at increased risk of severe COVID-19 disease by age TRANS (5-year age groups TRANS), sex and country (n=188) based on prevalence SERO data from the Global Burden of Disease MESHD ( GBD MESHD) study for 2017 and United Nations population estimates for 2020. We also calculated the number of individuals without an underlying condition that could be considered at-risk because of their age TRANS, using thresholds from 50-70 years. The list of underlying conditions relevant to COVID-19 disease was determined by mapping conditions listed in GBD to the guidelines published by WHO and public health agencies in the UK and US. We analysed data from two large multimorbidity studies to determine appropriate adjustment factors for clustering and multimorbidity. Results We estimate that 1.7 (1.0 - 2.4) billion individuals (22% [15-28%] of the global population) are at increased risk of severe COVID-19 disease. The share of the population at increased risk ranges from 16% in Africa to 31% in Europe. Chronic kidney disease HP Chronic kidney disease MESHD ( CKD MESHD), cardiovascular disease MESHD ( CVD MESHD), diabetes MESHD and chronic respiratory disease MESHD ( CRD MESHD) were the most prevalent conditions in males TRANS and females TRANS aged TRANS 50+ years. African countries with a high prevalence SERO of HIV MESHD/ AIDS MESHD and Island countries with a high prevalence SERO of diabetes MESHD, also had a high share of the population at increased risk. The prevalence SERO of multimorbidity (>1 underlying conditions) was three times higher in Europe than in Africa (10% vs 3%). Conclusion Based on current guidelines and prevalence SERO data from GBD, we estimate that one in five individuals worldwide has a condition that is on the list of those at increased risk of severe COVID-19 disease. However, for many of these individuals the underlying condition will be undiagnosed or not severe enough to be captured in health systems, and in some cases the increase in risk may be quite modest. There is an urgent need for robust analyses of the risks associated with different underlying conditions so that countries can identify the highest risk groups and develop targeted shielding policies to mitigate the effects of the COVID-19 pandemic.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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