Abstract
BackgroundCharacterising the size and distribution of the population at risk of severe COVID-19 is vital for effective policy and planning. Older age, and underlying health conditions, are associated with higher risk of death from COVID-19. This study aimed to describe the population at risk of severe COVID-19 due to underlying health conditions across the United Kingdom.MethodsWe used anonymised electronic health records from the Clinical Practice Research Datalink GOLD to estimate the point prevalence on 5 March 2019 of the at-risk population following national guidance. Prevalence for any risk condition and for each individual condition is given overall and stratified by age and region with binomial exact confidence intervals. We repeated the analysis on 5 March 2014 for full regional representation and to describe prevalence of underlying health conditions in pregnancy. We additionally described the population of cancer survivors, and assessed the value of linked secondary care records for ascertaining COVID-19 at-risk status.ResultsOn 5 March 2019, 24.4% of the UK population were at risk due to a record of at least one underlying health condition, including 8.3% of school-aged children, 19.6% of working-aged adults, and 66.2% of individuals aged 70 years or more. 7.1% of the population had multimorbidity. The size of the at-risk population was stable over time comparing 2014 to 2019, despite increases in chronic liver disease and diabetes and decreases in chronic kidney disease and current asthma. Separately, 1.6% of the population had a new diagnosis of cancer in the past 5 y.ConclusionsThe population at risk of severe COVID-19 (defined as either aged ≥70 years, or younger with an underlying health condition) comprises 18.5 million individuals in the UK, including a considerable proportion of school-aged and working-aged individuals. Our national estimates broadly support the use of Global Burden of Disease modelled estimates in other countries. We provide age- and region- stratified prevalence for each condition to support effective modelling of public health interventions and planning of vaccine resource allocation. The high prevalence of health conditions among older age groups suggests that age-targeted vaccination strategies may efficiently target individuals at higher risk of severe COVID-19.
Highlights
Characterising the size and distribution of the population at risk of severe COVID-19 is vital for effective policy and planning
The high prevalence of health conditions among older age groups suggests that age-targeted vaccination strategies may efficiently target individuals at higher risk of severe COVID-19
This is reflected in United Kingdom (UK) national guidance describing individuals at moderate or high risk of severe COVID-19 (Table 1), which is based on age and underlying health conditions [7]
Summary
Characterising the size and distribution of the population at risk of severe COVID-19 is vital for effective policy and planning. The burden of mortality from COVID-19 rises steeply with age [1] This is due to a combination of age itself, and the prevalence of underlying health conditions. Many of the relevant underlying health conditions are more common at older ages, and people with underlying health conditions account for the majority of COVID-19-related hospital and intensive care admissions [6]. This is reflected in United Kingdom (UK) national guidance describing individuals at moderate or high risk of severe COVID-19 (Table 1), which is based on age and underlying health conditions [7]. Vaccination planning requires at-risk population size for vaccine numbers, and age and regional distribution for modelling impact on regional transmission, since vaccine response typically decreases with older age [12]
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