COVID-19: Public Health England review of disparities in risks and outcomes
Today, Public Health England have published findings of their review into how different factors have affected COVID-19 risk and outcomes.
The review looked at different factors including:
- age and sex
- where people live
The review was a descriptive presentation of surveillance data on disparities in the risk and outcomes from COVID-19. Public Health England state that these findings will help improve understanding of the COVID-19 pandemic and will help guide the future public health response to it.
- The mortality rates from COVID-19 in the most deprived areas were more than double the least deprived areas, for both males and females.
- Survival among confirmed cases, after adjusting for sex, age group, ethnicity and region was lower in the most deprived areas.
- People in deprived areas are more likely to be diagnosed and to have poor outcomes
- Poor outcomes from COVID-19 infection in deprived areas remain after adjusting for age, sex, region and ethnicity, but the role of comorbidities requires further investigation.
- Among deaths with COVID-19 mentioned on the death certificate, a higher percentage mentioned diabetes, hypertensive diseases, chronic kidney disease, chronic obstructive pulmonary disease and dementia than all cause death certificates.
- Diabetes was mentioned on 21% of death certificates where COVID-19 was also mentioned.
- Diabetes was more likely to be mentioned on the death certificate in more deprived areas.
- The same inequalities were seen for hypertensive disease.
- Several studies, although measuring the different outcomes from COVID-19, report an increased risk of adverse outcomes in obese or morbidly obese people.
- Patients living with obesity may not be equally exposed to COVID-19 or may have other underlying conditions, which influence their outcome from COVID-19.
- However, there are limitations in the availability of appropriately linked data to understand the relationship between obesity, underlying health conditions, socioeconomic characteristics including ethnicity and risk of adverse outcomes from COVID-19.
- This review confirms that the impact of COVID-19 has replicated existing health inequalities and, in some cases, has increased them.
- The largest disparity found was by age. Among people already diagnosed with COVID19, people who were 80 or older were seventy times more likely to die than those under 40.
- Risk of dying among those diagnosed with COVID-19 was higher in:
- those living in the more deprived areas
- Black, Asian and Minority Ethnic (BAME) groups
- Analyses did not take into account the existence of comorbidities, which are strongly associated with the risk of death from COVID-19
- Some analyses outlined in this review are provisional and will continue to be improved.
- Further work is planned to obtain, link and analyse data that will complement these
- PHE is seeking to obtain and link additional datasets that measure body mass index (BMI), a more comprehensive range of comorbidities and other sociodemographic characteristics such as ethnicity to understand the combination of these risks further.
Public Health England Recommendations:
- The results of this review should be widely discussed and considered by all those involved in and concerned with the national and local response to COVID-19.
- Relevant guidance, certain aspects of recording and reporting of data, and key policies should be adapted to recognise and wherever possible mitigate or reduce the impact of COVID-19 on the population groups that are shown in this review to be more affected by the infection and its adverse outcomes.
- As the numbers of new COVID-19 cases decrease, monitoring the infection among those most at risk will become increasingly important. It seems likely that it will be difficult to control the spread of COVID-19 unless these inequalities can be addressed.
Katharine Jenner - Campaign Director of Action on Sugar and Action on Salt, Queen Mary University of London says:
"This report is another in a long line of reports that clearly shows the devastating effect inequalities has in widening health outcomes, in this case for Covid-19. Before the PHE review we already knew that those living with obesity had an increased risk of adverse outcomes from Covid-19, yet no action was being taken to address it. In our evidence-based report released last week we provided Boris Johnson with a plan of action to support and treat those living with obesity and related health conditions, which disproportionately effects those from disadvantaged groups.
Although there is an element of personal responsibility in both the treatment and prevention of obesity, this can only be achieved with equitable access to healthy, affordable food – this is far from a reality for millions of Britains.
It is even more critical than ever for the food & drink industry, including the hospitality sector, to stop flooding us with unhealthy food options to keep us healthy – both now and in the future."