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. 2021 Mar 11;21(1):484.
doi: 10.1186/s12889-021-10427-2.

UK prevalence of underlying conditions which increase the risk of severe COVID-19 disease: a point prevalence study using electronic health records

Jemma L Walker  1   2   3 , Daniel J Grint  1   2 , Helen Strongman  2 , Rosalind M Eggo  2 , Maria Peppa  1   2 , Caroline Minassian  2 , Kathryn E Mansfield  2 , Christopher T Rentsch  2 , Ian J Douglas  2 , Rohini Mathur  2 , Angel Y S Wong  2 , Jennifer K Quint  4 , Nick Andrews  1   2   3 , Jamie Lopez Bernal  1   3 , J Anthony Scott  1   2 , Mary Ramsay  1   3 , Liam Smeeth  1   2 , Helen I McDonald  5   6
Affiliations

UK prevalence of underlying conditions which increase the risk of severe COVID-19 disease: a point prevalence study using electronic health records

Jemma L Walker et al. BMC Public Health. .

Abstract

Background: Characterising 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.

Methods: We 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.

Results: On 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.

Conclusions: The 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.

Keywords: COVID-19; Electronic health records; Prevalence; Risk factors; United Kingdom.

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Conflict of interest statement

JLW, DJG, NA, JAS, LS, MR, HM received grants from the NIHR HPRU in Immunisation to support the submitted work. RME received grants from HDR UK (MR/S003975/1) and UK MRC (MC_PC 19065). JKQ reports grants and personal fees from AZ, grants from Asthma UK, grants and personal fees from BI, grants and personal fees from Bayer, grants and personal fees from Insmed, grants and personal fees from GSK, grants from The Health Foundation, grants from MRC, grants from British Lung Foundation, outside the submitted work; RM reports personal fees from AMGEN, outside the submitted work; JAS reports grants from National Institute for Health Research, during the conduct of the study; grants from MRC, grants from Wellcome Trust, grants from GAVI The Vaccine Alliance, grants from Bill & Melinda Gates Foundation, outside the submitted work; LS reports grants from Wellcome, grants from MRC, grants from NIHR, grants from GSK, grants from BHF, grants from Diabetes UK, outside the submitted work; and Is a Trustee of the British Heart Foundation. The PHE Immunisation and Countermeasures Department provides vaccine manufacturers with post-marketing surveillance reports which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports.

Figures

Fig. 1
Fig. 1
Age and sex distribution of 2019 study population (N = 2,706,053) compared to mid-2019 national population estimates [22]
Fig. 2
Fig. 2
Age distributions of the at-risk population and underlying health conditions on 5 March 2019, N = 2,706,053
Fig. 3
Fig. 3
2019 point prevalence of the at-risk population by age and sex across the UK, N = 2,706,053
Fig. 4
Fig. 4
Point prevalence of the England at-risk population by region comparing 2014 (N = 4,730,254) and 2019 (N = 2,706,053). The 2019 study population did not include any individuals in the North East or East Midlands regions; x-axis scale starts at 20,000/100,000
See this image and copyright information in PMC

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