Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales

Abstract

Background: COVID-19 poses one of the most profound public health crises for a hundred years. As of mid-May 2020, across the world, almost 300,000 deaths and over 4 million confirmed cases were registered. Reaching over 30,000 deaths by early May, the UK had the highest number of recorded deaths in Europe, second in the world only to the USA. Hospitalization and death from COVID-19 have been linked to demographic and socioeconomic variation. Since this varies strongly by location, there is an urgent need to analyse the mismatch between health care demand and supply at the local level. As lockdown measures ease, reinfection may vary by area, necessitating a real-time tool for local and regional authorities to anticipate demand.

Methods: Combining census estimates and hospital capacity data from ONS and NHS at the Administrative Region, Ceremonial County (CC), Clinical Commissioning Group (CCG) and Lower Layer Super Output Area (LSOA) level from England and Wales, we calculate the number of individuals at risk of COVID-19 hospitalization. Combining multiple sources, we produce geospatial risk maps on an online dashboard that dynamically illustrate how the pre-crisis health system capacity matches local variations in hospitalization risk related to age, social deprivation, population density and ethnicity, also adjusting for the overall infection rate and hospital capacity.

Results: By providing fine-grained estimates of expected hospitalization, we identify areas that face higher disproportionate health care burdens due to COVID-19, with respect to pre-crisis levels of hospital bed capacity. Including additional risks beyond age-composition of the area such as social deprivation, race/ethnic composition and population density offers a further nuanced identification of areas with disproportionate health care demands.

Conclusions: Areas face disproportionate risks for COVID-19 hospitalization pressures due to their socioeconomic differences and the demographic composition of their populations. Our flexible online dashboard allows policy-makers and health officials to monitor and evaluate potential health care demand at a granular level as the infection rate and hospital capacity changes throughout the course of this pandemic. This agile knowledge is invaluable to tackle the enormous logistical challenges to re-allocate resources and target susceptible areas for aggressive testing and tracing to mitigate transmission.

Keywords: Age; COVID-19; Deprivation; England; Ethnicity; Hospital capacity; Local; NHS; Population density; Regional; Wales.

Fig. 1

Regional baseline hospital bed capacity (per 1,000) for general care (a) and critical care (b) in case of a 10% overall infection. England & Wales

Fig. 2

County expected hospitalization (per 1,000) for general care (a) and critical care (b) in case of a 10% overall infection. England & Wales

Fig. 3

County excess need for hospital beds relative to baseline capacity (per 1,000) for general care (a) and critical care (b) in case of a 10% overall infection. England & Wales

Fig. 4

LSOA local differences in expected general care hospitalization (per 1,000) in case of a 10% overall infection. London

Fig. 5

CCG expected age-based hospitalization risk in combination with social deprivation (a) and population density (b). England

Fig. 6

LSOA local differences in age-based hospitalization risk combined with social deprivation. London

Fig. 7

LSOA local differences in age-based hospitalization risk combined with ethnic risk groups. London

Fig. 8

LSOA local differences in age-based hospitalization risk combined with social deprivation. Manchester