Thread by @DipeshGopal

1/ THREAD summarising @PHE_uk report

More likely to die from #COVIDー19 if you are:

Older
Male
From certain parts, e.g. London, NW
From a deprived background
From a ethnic minority background
A low-skilled (key) worker
A migrant
Living in a care home
Have a medical condition

https://twitter.com/PHE_uk/status/1267819010864762885

2/

Data limitations

- most lab confirmed cases were from hospital deaths - most severe cases?
- the case definition/testing of COVID-19 changed through the pandemic

- ethnicity matched from 2011 census

- lack of data on vulnerable groups: migrants, sex workers, homelessness

3/

Appraisal

- no discussion/action plan

- lessons learnt due to led by Equalities Minister (@KemiBadenoch) who had never heard of @MichaelMarmot's @TheMarmotReview until mentioned in Parliament yesterday:

https://twitter.com/i/status/1268522758473908225

- I’m worried very little will change

4/

@TheMarmotReview found that UK life expectancy is slowing down with widening inequalities in societies between rich and poor. This was associated with cuts to public spending over the last 2 decades.

🔗:

https://twitter.com/DipeshGopal/status/1234089003693039616

5/ Age

Women < age 60, Men > age 60 more likely to die. Why use 60 years?

≥ 80 year old, 70x increased likelihood of death compared to those < 40 years old

Most excess deaths (75%) in ≥ 75 years

Fewer deaths than expected in children under 15 years of age

6a/ Sex/Age

Men more at risk 46% cases, 60% deaths, 70% ITU admissions.

More female cases compared to male cases.

Men - higher clinical (not testing) diagnosis rates > age 60

6b/ Sex/Age

Women - higher testing diagnosis rate for many age groups 0-59 and >80

6c/ Sex/Age

Men more likely to be admitted to hospital and critical care.

6d/ Sex/Age

Men more likely to die 1.3-2.1 x compared to women over all age groups.

6e/ Age/Sex

More excess deaths in all age groups except in < 15 years age group

#COVIDー19 pushed the age standardised mortality rate up for men > women

6f/ Age/Sex

Is the data valid?

Similar to Chinese data: thelancet.com/journals/lance…

Similar to other international data but 90% Chinese studies (systematic review): medrxiv.org/content/10.110…

7a/ Geography

Highest death rates in London then NorthWest, NorthEast then West Midlands.

London death rate 3x than the lowest rates in SW

Urban > rural positive case rates

Number of positive cases decreasing but NW have highest number of positive cases on 9th May

7b/ Geography

Highest infection rate for men in London and highest for women in NorthWest as of 13 May.

7c/ Geography

Hospitalisations for all regions are down but a recent up tick in some regions

7d/ Geography

Number of #COVIDー19 positive deaths are decreasing but currently highest in Yorkshire and Humber where London was highest at peak

7e/ Geography

"death rates were highly clustered. Authorities, which are largely urban areas, in London, the NW, the W Midlands and the NE had the highest death rates.

For males, the eight authorities with the highest death rates among confirmed cases are in London.

8a/ Deprivation

2x mortality rates in men and women comparing most deprived vs least deprived areas even when controlling for ethnicity

Unable to comment on underlying health conditions

8b/ Deprivation

High diagnosis rates may be due to geographic proximity to infections/high proportion of workers in occupations that are more likely to be exposed.

#COVIDー19 is NOT the great equaliser.

More cases overall/both sexes in more deprived vs less deprived

8c/ Deprivation

People from more likely to die of #COVIDー19 regardless of sex or time in pandemic.

8d/ Deprivation

The deprivation gradient of mortality from all causes in previous years is mirrored in #COVIDー19

People from more deprived background are more likely to die from #COVIDー19 compared to people from less deprived background.

8e/ Deprivation

There are higher #COVIDー19 deaths where diabetes is mentioned on death certificates in people from most deprived backgrounds compared to least deprived backgrounds

9a/ Ethnicity

People of Bangladeshi ethnicity had 2x mortality risk compared to people of White British ethnicity.

People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had 10-50% higher mortality risk compared to White British.

9b/ Ethnicity

No data about occupation.

Suggested causes, more likely to:

➡️ live in overcrowded conditions
➡️ live in urban areas
➡️ live in deprived ares
➡️ have jobs that expose them to higher risk
➡️ be born abroad - culture/language
➡️ have more health conditions

9c/ Ethnicity

People from ethnic minority backgrounds are more likely to be diagnosed with #COVIDー19 compared to white British people.

9d/ Ethnicity

People from ethnic minority background (black and minority ethnic, BAME) more likely to be admitted to ITU compared to white British people

9e/ Ethnicity

People from ethnic minority background (black and minority ethnic, BAME) more likely to die from #COVIDー19 compared to white British People.

9f/ Ethnicity

Higher all cause mortality in BAME compared to white people

All cause mortality was higher in all groups but

Black British people: 3 - 4 times higher
Asian people: 2.4 - 3 times higher
White people: 1.6 - 2 times higher

10a/ Occupation

This bit in report taken from @ONS: ons.gov.uk/peoplepopulati…

10b/ Occupation

Highest #COVIDー19 mortality rate for men working as:

security guards
taxi drivers and chauffeurs
bus and coach drivers
chefs
sales and retail assistants
lower skilled workers in construction and processing plants

AND men and women working in social care

10c/ Occupation

Highest #COVIDー19 mortality rate amongst security workers in 'lower-skilled'* workers group.

*this is the term used in the report. These are the people that allow our countries to run. Should be 'essential'

10d/ Occupation

Highest #COVIDー19 mortality rate for taxi drivers compared to all other drivers. This is probably due to the close contact involved in the job.

10e/ Occupation

Women in caring/leisure/related roles have the highest risk of #COVIDー19 mortality

10f/ Occupation

Social care workers had a higher mortality rate from #COVIDー19 cf health care workers

@ONS did not find that healthcare workers had higher rates of death involving COVID-19 compared with the general population.

Is this due to distancing/PPE?

11a/ Inclusion Health Groups

Migrants from Africa, Middle East, Caribbean at higher risk compared to migrants from UK/EU:

- 1-2%: absolute risk increase
- 50-100%: relative risk increase

11b/ Inclusion Health Groups

No data on deaths in homeless populations

12/ Care home deaths

Increasing proportions of #COVIDー19 deaths up to 8 May

20457 excess deaths during the pandemic time period 20 Mar to 7 May

Care home deaths made up 27% of all UK deaths from #COVIDー19

There were 16016 excess deaths in hospitals

13a/ Co-morbidities

Looking at death certification, diabetes mentioned on 21% of all death certificates.

This proportion higher in ethnic minority groups vs British white people.

Data awaited on body mass index and other co-morbidities for detailed analysis

13b/ Co-morbidities

Most at risk:

➡️ Cardiovascular disease: high blood pressure, heart disease

➡️ Chronic Kidney disease

➡️ Respiratory (lung) conditions: COPD

➡️ Diabetes

13c/ Co-morbidities

Data from other studies (@ICNARC, etc) showed patients who were more severely obese had increased mortality risk from #COVIDー19.

Higher prevalence of high blood pressure for people who died from #COVIDー19 who were from minority background cf white people

<< ENDS >>

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