Amitava Banerjee and colleagues1 present the estimated prevalence of serious underlying medical conditions indicative of susceptibility to severe COVID-19 and mortality in England.
Their results are useful for targeting prevention strategies towards people at a higher risk for severe outcomes, to forecast the demand on health systems, to avert the strain on acute care facilities, and for clinicians and their patients who are at a higher risk for severe disease to optimise control of their underlying conditions and adopt precautions for the prevention of COVID-19. Nonetheless, caution is merited in interpreting these results.
The authors assume an identical effect of COVID-19 on mortality, irrespective of the underlying medical conditions, although early data suggest otherwise.2 As data emerge on the death rates by underlying conditions and the effect of multiple conditions, it will be important to re-parameterise mortality projections. Moreover, their model does not account for disparities in the prevalence of underlying medical conditions and mortality risk across sociodemographic groups. Data from several countries show that the COVID-19 pandemic is disproportionally affecting minorities and populations with a low income. Barriers related to employment, income, housing, and access to essential services exist, and might impede the adoption of crucial mitigation strategies, such as physical distancing. Mitigation strategies, though essential for controlling an epidemic and with clear benefits for all populations, might have greater collateral negative consequences for some people than others.3
A population health perspective that accounts for the broader determinants of health might help to guide clinical and public health decisions to not exacerbate existing health and sociodemographic inequities.4
© 2020 Pool/Getty Images
Acknowledgments
We declare no competing interests.
References
- 1.Banerjee A, Pasea L, Harris S. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet. 2020;395:1715–1725. doi: 10.1016/S0140-6736(20)30854-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368 doi: 10.1136/bmj.m1198. [DOI] [PubMed] [Google Scholar]
- 3.Armitage R, Nellums LB. Considering inequalities in the school closure response to COVID-19. Lancet Glob Health. 2020;8 doi: 10.1016/S2214-109X(20)30116-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Silverstein M, Hsu HE, Bell A. Addressing social determinants to improve population health: the balance between clinical care and public health. JAMA. 2019;322:2379–2380. doi: 10.1001/jama.2019.18055. [DOI] [PubMed] [Google Scholar]