Global, regional, and national estimates of the population at increased risk of severe Covid-19 due to underlying health conditions in 2020

A modelling study

Dados Bibliográficos

ID23373336
AutoresAndrew Clark (0000-0002-2983-4469, London School of Hygiene & Tropical Medicine, autor correspondente), Mark Jit (0000-0001-6658-8255, London School of Hygiene & Tropical Medicine), Charlotte Warren-Gash, Charlotte Warren‐Gash (0000-0003-4524-3180, London School of Hygiene & Tropical Medicine), Bruce Guthrie (0000-0003-4191-4880, University of Edinburgh), Haoxiang Wang (0000-0002-0361-6527, Sun Yat-sen University), Harry H X Wang, Stewart W Mercer (0000-0002-1703-3664, University of Edinburgh), Colin Sanderson (0000-0002-4838-6112, London School of Hygiene & Tropical Medicine), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine), Christopher Troeger (University of Washington), Sok King Ong (0000-0001-8176-8561, University of Washington), Kanyin L Ong, Francesco Checchi (0000-0001-9030-5382, London School of Hygiene & Tropical Medicine), Pablo Perel (0000-0002-2342-301X, London School of Hygiene & Tropical Medicine), Sarah Joseph (0000-0003-3153-9925, Imperial College London), Hubert Gibbs (0000-0003-4413-453X, London School of Hygiene & Tropical Medicine), Hamish P Gibbs, Amitava Banerjee (0000-0001-8741-3411, University College London), Rosalind M Eggo (0000-0002-0362-6717, London School of Hygiene & Tropical Medicine), Emily Nightingale (0000-0002-9265-1841), Emily S Nightingale, Kathleen O'Reilly (0000-0003-2298-3610), Kathleen M O’Reilly (0000-0002-4892-8022), Thibaut Jombart (0000-0003-2226-8692), W John Edmunds (0000-0002-9179-2917), Alicia Rosello (0000-0002-0737-5679), Fiona Yueqian Sun (0000-0003-2042-0734), Keletso E Atkins (0000-0001-5250-0558), Katherine E Atkins, Nikos I Bosse (0000-0002-7750-5280), Samuel Clifford (0000-0002-3774-3882), Timothy Russell (0000-0001-5610-6080), Timothy W Russell, Arminder Deol (0000-0002-7154-5505), Arminder K Deol, Yang Liu (0000-0003-1220-7044), Simon R Procter (0000-0002-0380-1503), Quentin J Leclerc (0000-0003-4761-001X), Graham Medley (0000-0002-0030-7278), Gwen Knight, James D Munday (0000-0002-6206-7134), Adam J Kucharski (0000-0001-8814-9421), Carl A B Pearson (0000-0003-0701-7860), Petra Klepac (0000-0003-4132-3933), Kiesha Prem (0000-0003-0528-798X), Rein Mgj Houben (0000-0003-4132-7467), Rein M G J Houben, Akira Endo (0000-0003-1576-7864), Stefan Flasche (0000-0002-5808-2606), Nicholas G Davies (0000-0002-1740-1412), Charlie Diamond (0000-0002-3565-3648), Kevin van Zandvoort (0000-0002-7770-0537), Stephan Funk (0000-0002-2842-3406), Sebastian Funk, Megan Auzenbergs (0000-0003-1724-4485), Eleanor M Rees (0000-0002-4993-2795), Damien C Tully (0000-0002-7620-9340), Jon C Emery (0000-0001-6644-7604), Billy J Quilty (0000-0002-9094-3728), Sam Abbott (0000-0001-8057-8037), Christian Julián Villabona‐Arenas (0000-0001-9928-3968), Ch Julian Villabona-Arenas, Stéphane Hué (0000-0002-8580-6905), Joel Hellewell (0000-0003-2683-0849), Amy Gimma (0000-0003-2645-7212), Christopher I Jarvis (0000-0002-0812-2446)
Ano2020
Volume8
Fascículo8
Páginase1003-e1017
Data de publicação2020-08-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoThe Lancet Global Health (JOURNAL)
Identificadores do periódicoISSN: 2214-109X • E-ISSN: 2572-116X
EditoraElsevier BV (PUBLISHER)
DOI10.1016/s2214-109x(20)30264-3
PMID32553130
OpenAlexW3034823740
IdiomaEN
Citações recebidas100
Referências citadas26

BACKGROUND: The risk of severe COVID-19 if an individual becomes infected 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 and how this varies between countries should inform the design of possible strategies to shield or vaccinate those at highest risk. METHODS: We estimated the number of individuals at increased risk of severe disease (defined as those with at least one condition listed as "at increased risk of severe COVID-19" in current guidelines) by age (5-year age groups), sex, and country for 188 countries using prevalence data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 and UN population estimates for 2020. The list of underlying conditions relevant to COVID-19 was determined by mapping the conditions listed in GBD 2017 to those listed in guidelines published by WHO and public health agencies in the UK and the USA. We analysed data from two large multimorbidity studies to determine appropriate adjustment factors for clustering and multimorbidity. To help interpretation of the degree of risk among those at increased risk, we also estimated the number of individuals at high risk (defined as those that would require hospital admission if infected) using age-specific infection-hospitalisation ratios for COVID-19 estimated for mainland China and making adjustments to reflect country-specific differences in the prevalence of underlying conditions and frailty. We assumed males were twice at likely as females to be at high risk. We also calculated the number of individuals without an underlying condition that could be considered at increased risk because of their age, using minimum ages from 50 to 70 years. We generated uncertainty intervals (UIs) for our estimates by running low and high scenarios using the lower and upper 95% confidence limits for country population size, disease prevalences, multimorbidity fractions, and infection-hospitalisation ratios, and plausible low and high estimates for the degree of clustering, informed by multimorbidity studies. FINDINGS: We estimated that 1·7 billion (UI 1·0-2·4) people, comprising 22% (UI 15-28) of the global population, have at least one underlying condition that puts them at increased risk of severe COVID-19 if infected (ranging from 66% of those aged 70 years or older). We estimated that 349 million (186-787) people (4% [3-9] of the global population) are at high risk of severe COVID-19 and would require hospital admission if infected (ranging from <1% of those younger than 20 years to approximately 20% of those aged 70 years or older). We estimated 6% (3-12) of males to be at high risk compared with 3% (2-7) of females. The share of the population at increased risk was highest in countries with older populations, African countries with high HIV/AIDS prevalence, and small island nations with high diabetes prevalence. Estimates of the number of individuals at increased risk were most sensitive to the prevalence of chronic kidney disease, diabetes, cardiovascular disease, and chronic respiratory disease. INTERPRETATION: About one in five individuals worldwide could be at increased risk of severe COVID-19, should they become infected, due to underlying health conditions, but this risk varies considerably by age. Our estimates are uncertain, and focus on underlying conditions rather than other risk factors such as ethnicity, socioeconomic deprivation, and obesity, but provide a starting point for considering the number of individuals that might need to be shielded or vaccinated as the global pandemic unfolds. FUNDING: UK Department for International Development, Wellcome Trust, Health Data Research UK, Medical Research Council, and National Institute for Health Research.

China · Coronavirus disease 2019 (COVID-19) · Disease · Environmental health · Geography · Infectious disease (medical specialty) · Mainland China · Population · Public health · Risk assessment · Chronic Disease Management Strategies · COVID-19 Clinical Research Studies · COVID-19 epidemiological studies · Demography · Epidemiology · Medicine