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Over 20% Worldwide Have Conditions
That Raise Risk of Severe COVID-19
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Mark Mascolini
One in 5 people worldwide (1.7 billion) has at least one condition like chronic kidney disease or diabetes that boosts risk of severe COVID-19, according to global analysis by researchers at the London School of Hygiene & Tropical Medicine and colleagues at other centers [1]. The authors note that these underlying conditions will remain undiagnosed in some people and the higher COVID-19 risk “may be quite modest.”
These findings appear in medRxiv, which presents research not yet peer-reviewed or accepted for publication.
Some policymakers want to identify—and protect—groups at increased risk for severe COVID-19. To support that effort, British, Chinese, and US investigators combined large international databases and big multimorbidity studies to devise a tool that rapidly estimates numbers and percentages of country populations that should be targeted for policies shielding them from COVID-19.
The researchers created a list of conditions that may boost risk of severe COVID-19 from current World Health Organization, UK, and US guidelines. They mapped those conditions to 11 categories of underlying health conditions in the Global Burden of Disease Study for 2017. The researchers extracted COVID-19 prevalence estimates by age, sex, and country for cardiovascular disease, chronic kidney disease, chronic respiratory disease, diabetes, and 7 other conditions. They scrutinized data from two large multimorbidity studies to figure statistical adjustment factors for clustering and multimorbidity.
The analysis estimated that 1.7 billion people—22% of the global population—has at least one condition that could raise their risk of severe COVID-19. Prevalence of one or more conditions did not differ much between men and women and stood at about 10% by age 25, 33% by age 50, and 66% by age 70. At-risk groups represented 31% of the population in Europe and 16% in Africa. Among these 1.7 billion at-risk individuals, 0.4 billion had 2 or more risky underlying conditions. African countries with a high HIV prevalence and island countries with high diabetes prevalence included large shares of the overall at-risk population.
The most prevalent conditions among people 50 or older were chronic kidney disease, cardiovascular disease, chronic respiratory disease, and diabetes. Almost one quarter (23%) of the working population (ages 15 to 64) had at least one underlying condition, usually chronic kidney disease or diabetes.
The researchers stress that many people with an underlying condition will not have that condition diagnosed and most will not end up with severe COVID-19 if infected with SARS-CoV-2. But “because severe COVID-19 outcomes are disproportionately found in individuals with underlying conditions, protecting these groups may be one of the most effective ways to reduce mortality and demand for hospital beds.”
The authors propose that, until scientists develop an effective SARS-CoV-2 vaccine, at-risk populations like those spotlighted in this study can be shielded by more intensive physical-distancing measures than people in the wider population. They acknowledge that such measures “could cause considerable economic disruption” to these individuals and to the wider economy. If face masks prove effective in preventing SARS-CoV-2 transmission from people wearing them, masks could provide “a practical way of reducing exposure among those who are unable to avoid contact with others.”
Reference
1. Clark A, Jit M, Warren-Gash C, et al. How many are at increased risk of severe COVID-19 disease? Rapid global, regional and national estimates for 2020. medRxiv preprint doi: https://doi.org/10.1101/2020.04.18.20064774. (medRxiv presents research not yet peer-reviewed or accepted for publication.)
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