Pre-Existing Conditions and Hospitals

Hospital death figures provide a partial view of the pandemic.

On Boxing Day, columnist Paul Embery wrote on social media:

The number of Covid-related deaths in England involving individuals under the age of 60 and free from a pre-existing condition is 377. This is for the entire period of the pandemic.

Julia Hartley-Brewer, a talkRADIO presenter, added:

Just 377 healthy people under 60 have died of Covid. That’s not a typo. There are no zeros missing. 377. Yes, that’s sad but we have locked down an entire country for a virus that mostly kills the very old & the very sick. The rest of us should be free to decide our own risks.

Twitter users shared these posts over 3,000 times each.

The statistic only refers to deaths in hospital in England. These deaths must have a positive COVID-19 test result. People also die outside of hospital. Having a pre-existing condition is a broad category. Patients could have common conditions, or received treatment for their mental health.

NHS England statistics

NHS England publishes daily statistics on COVID-19 deaths in hospitals. Before 19th June, this meant all hospital deaths with a positive COVID-19 test result. Confirmation of that positive result can come after death.

After then, NHS England recorded hospital deaths within 28 days of a positive test result. That change reflects refinement in the daily measure in England.

The cited statistics only refer to deaths in hospital. Up to 4pm on 16th December 2020, NHS England recorded about 45,500 COVID-19 deaths. By 17th December 2020, there were around 57,700 reported COVID-19 deaths in England.

The statistics come from the COVID-19 Patient Notification System. (Image: NHS England)

The statistics refer to a large number of pre-existing conditions. The spreadsheet also gives a detailed breakdown of recorded deaths by different conditions.

Having a pre-existing condition does not mean a person is “very sick”. There were over 1,500 recorded deaths where patients received mental health treatment. The list includes conditions, such as diabetes, which can be mild.

More than 11,600 recorded deaths were among people with diabetes. Over 3,100 had asthma. Patients who died with COVID-19 can have more than one prior condition.

About a quarter of deceased COVID-19 patients had diabetes. (Image: NHS England)

London School of Hygiene & Tropical Medicine and other organisations analysed UK health records. About one in four people were “at risk due to a record of at least one underlying health condition”.

That figure relates to the UK population as at 5th March 2019. The analysis focuses on risk factors relating to severe COVID-19. This analysis has not undergone peer review.

Death registrations by age group

The NHS England figures count patients who died in hospital, with a positive test result. These figures do not people count who die elsewhere. It does not count untested patients or those who only had false negative results.

We can look at death registrations in England and Wales instead. The Office for National Statistics publishes a weekly report on death registrations.

Clinicians certify deaths “to the best of their knowledge and belief”. The Medical Certificate of Cause of Death has two parts:

  • Part I: The sequence of diseases or conditions that led to the death.
  • Part II: Other significant factors, which contributed to the death.

These death registrations figures are for England and Wales, up to 11th December. Registered deaths were above the five-year average in age groups 15 years and over.

This does not include deaths where the age is missing or not coded. (Image: ONS)

Among those aged 65 and over, there were around 65,100 deaths involving COVID-19. For these deaths, clinicians believe COVID-19 was the cause or a contributory factor.

Registered deaths among those aged 65 and over were about 59,200 above the five-year average. This is for deaths registered between 28th December 2019 and 11th December 2020. The statistics cover weeks 1 to 50 in England and Wales.

In the same period, there were about 7,500 deaths involving COVID-19 among those aged 64 and under. For those aged 64 and under, registered deaths were around 8,600 higher than the five-year average.

Up to 11th December, there were about 71,800 registered deaths involving COVID-19. Of these deaths in England and Wales, about 65,600 deaths had COVID-19 as its underlying cause. The 2019 population estimate for England and Wales was around 59.4m. Over 1 in 1,000 people in these nations have died due to this disease.

Life expectancy

Being 60 years of age does not mean that person is “very old”. At 60 years-old, we expect an average man to live to 85. Average life expectancy for women at 60 years-old is 87. This is a 2018-based projection for the UK.

There is a 1 in 4 chance of a 60 year-old man reaching 92. (Image: ONS)

By 70 years of age, life expectancy increases by a further year. An average 80 year-old person in the UK expects to live for about 10 more years.

Researchers at the University of Glasgow and other institutions estimated:

For men the average [years of life lost] on adjusting for number and type of [long-term conditions] as well as age was 13.1 (12.2–14.1). For women this value was 10.5 (9.7–11.3).

Different models arrive at different estimates. Dr McAllister and others concluded there was a large burden in years of life lost.

These figures are mean averages. The estimated distribution of years of life lost has a right skew. Some people lost many years of life due to dying from this disease.

Lighter colours indicate that simulation had more health conditions. (Image: Wellcome Open Research)

It is not only about life and death. This is a novel virus. Researchers are studying the extent of post-viral syndromes from those who recover. A pre-print analysis of Zoe COVID Symptom Study app users suggested:

558 (13.3%) had symptoms lasting >=28 days, 189 (4.5%) for >=8 weeks and 95 (2.3%) for >=12 weeks.

Recovered people could have long-term health problems, affecting their quality of life.

One figure does not tell the whole story.

This blog looks at the use of statistics in Britain and beyond. It is written by RSS Statistical Ambassador and Chartered Statistician @anthonybmasters.

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