Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study
Date
2020Author
Clark, Andrew
Jit, Mark
Warren-Gash, Charlotte
Guthrie, Bruce
Wang, Harry H X
Mercer, Stewart W
Sanderson, Colin
McKee, Martin
Troeger, Christopher
Ong, Kanyin L
Checchi, Francesco
Perel, Pablo
Joseph, Sarah
Gibbs, Hamish P
Banerjee, Amitava
Eggo, Rosalind M
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Abstract
Background The risk of severe COVID-19 if an individual becomes infected is known to be higher in older individuals
and those with underlying health conditions. Understanding the number of individuals at increased risk of severe
COVID-19 and how this varies between countries should inform the design of possible strategies to shield or vaccinate
those at highest risk.
Methods We estimated the number of individuals at increased risk of severe disease (defined as those with at least one
condition listed as “at increased risk of severe COVID-19” in current guidelines) by age (5-year age groups), sex, and
country for 188 countries using prevalence data from the Global Burden of Diseases, Injuries, and Risk Factors Study
(GBD) 2017 and UN population estimates for 2020. The list of underlying conditions relevant to COVID-19 was
determined by mapping the conditions listed in GBD 2017 to those listed in guidelines published by WHO and public
health agencies in the UK and the USA. We analysed data from two large multimorbidity studies to determine
appropriate adjustment factors for clustering and multimorbidity. To help interpretation of the degree of risk among
those at increased risk, we also estimated the number of individuals at high risk (defined as those that would require
hospital admission if infected) using age-specific infection–hospitalisation ratios for COVID-19 estimated for
mainland China and making adjustments to reflect country-specific differences in the prevalence of underlying
conditions and frailty. We assumed males were twice at likely as females to be at high risk. We also calculated the
number of individuals without an underlying condition that could be considered at increased risk because of their
age, using minimum ages from 50 to 70 years. We generated uncertainty intervals (UIs) for our estimates by running
low and high scenarios using the lower and upper 95% confidence limits for country population size, disease
prevalences, multimorbidity fractions, and infection–hospitalisation ratios, and plausible low and high estimates for
the degree of clustering, informed by multimorbidity studies.
Findings We estimated that 1·7 billion (UI 1·0–2·4) people, comprising 22% (UI 15–28) of the global population, have
at least one underlying condition that puts them at increased risk of severe COVID-19 if infected (ranging from <5% of
those younger than 20 years to >66% of those aged 70 years or older). We estimated that 349 million (186–787) people
(4% [3–9] of the global population) are at high risk of severe COVID-19 and would require hospital admission if
infected (ranging from <1% of those younger than 20 years to approximately 20% of those aged 70 years or older). We
estimated 6% (3–12) of males to be at high risk compared with 3% (2–7) of females. The share of the population at
increased risk was highest in countries with older populations, African countries with high HIV/AIDS prevalence, and
small island nations with high diabetes prevalence. Estimates of the number of individuals at increased risk were most
sensitive to the prevalence of chronic kidney disease, diabetes, cardiovascular disease, and chronic respiratory disease.
Interpretation About one in five individuals worldwide could be at increased risk of severe COVID-19, should they
become infected, due to underlying health conditions, but this risk varies considerably by age. Our estimates are
uncertain, and focus on underlying conditions rather than other risk factors such as ethnicity, socioeconomic
deprivation, and obesity, but provide a starting point for considering the number of individuals that might need to be
shielded or vaccinated as the global pandemic unfolds.
Funding UK Department for International Development, Wellcome Trust, Health Data Research UK, Medical
Research Council, and National Institute for Health Research.
Palabras clave
COVID-19; Modelling study; Increased riskLink to resource
https://doi.org/10.1016/S2214-109X(20)30264-3Collections
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