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Factors associated with Covid-19 deaths in records of 17M adult NHS patients

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Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#21

Post by forgot_again »

lettergram wrote: post #19

I think one of the key takeaways is in the abstract: > People from Asian and black groups are at markedly increased risk of in-hospital death from COVID-19, and contrary to some prior speculation is only partially attributable to pre-existing clinical risk factors or deprivation

What does deprivation mean here?

Early in the outbreak I remember seeing some research that indicated people of Asian descent (East Asian) are genetically predisposed to more severe cases of this coronavirus, something to do with higher expression of the ACE-2 receptor.

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#25

Post by JPKab »

lettergram wrote: post #19

I think one of the key takeaways is in the abstract: > People from Asian and black groups are at markedly increased risk of in-hospital death from COVID-19, and contrary to some prior speculation is only partially attributable to pre-existing clinical risk factors or deprivation

Deprivation equals poverty.

Asian in Britain will primarily be Indian/Pakistani descent.

I wonder if this is vitamin d related? Darker complexion of black and Asian could cause higher risks of vitamin d deficiency in UK.

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#26

Post by mindviews »

Here's a link to the paper: https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v...

This is interesting data. I want to see Vitamin D status included in a large population study like this because I've been following two smaller studies covering about a thousand cases total that shows Vitamin D deficiency has a risk ratio of 10 to 20 (more even than being age 80+ in the above study). The studies:

[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561

[2] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484

Table 1 in each of those papers show Vitamin D status vs Outcomes. The correlation between Vitamin D status, where Normal is >30 ng/ml (or 75 nmol/L), and death rates is stark.

From [1] (which had n=780 cases) here is the punchline: "98.9% of Vitamin D deficient cases died while only 1.1% of them were active cases. 87.8% of Vitamin D insufficient cases died while only 12.2% of them were active cases. Only 4.1% of cases with normal Vitamin D levels died while 95.9% of them were active cases."

From [2] (which had n=212 cases) here is the punchline: "Of the 212 (100.0%) cases of Covid-2019, 49 (23.1%) were identified mild, 59 (27.8%) were ordinary, 56 (26.4%) were severe, and 48 (22.6%) were critical (Table 1). Mean serum 25(OH)D level was 23.8 ng/ml. Serum 25(OH)D level of cases with mild outcome was 31.2 ng/ml, 27.4 ng/ml for ordinary, 21.2 ng/ml for severe, and 17.1 ng/ml for critical."

Note: the classification for outcomes was "(1) mild – mild clinical features without pneumonia diagnosis, (2) ordinary – confirmed pneumonia in chest computer tomography with fever and other respiratory symptoms, (3) severe – hypoxia (at most 93% oxygen saturation) and respiratory distress or abnormal blood gas analysis results (PaCO2 >50 mm Hg or PaO2 I want to see a dozen more studies like [1] and [2] to see if this holds up to replication with larger populations.

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#27

Post by eloff »

JPKab wrote: post #25
lettergram wrote: post #19

I think one of the key takeaways is in the abstract: > People from Asian and black groups are at markedly increased risk of in-hospital death from COVID-19, and contrary to some prior speculation is only partially attributable to pre-existing clinical risk factors or deprivation

Deprivation equals poverty. Asian in Britain will primarily be Indian/Pakistani descent. I wonder if this is vitamin d related? Darker complexion of black and Asian could cause higher risks of vitamin d deficiency in UK.

Very likely it explains at least part of the difference.

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#28

Post by avereveard »

hristov wrote: post #17
MontagFTB wrote: post #10

From the paper: > The overall cumulative incidence of COVID-19 hospital death at 80 days from the study start date was How do those rates compare to the seasonal flu in the UK?

It is not very useful to compare them with flu because people are much more likely to have flu than to have covid. These rates seem very small but remember that the study started in the beginning of february, when there were likely only a handful if any covid carriers in the uk. If you could preselect a group of people that you know had covid and measure their death rate, the numbers are likely to be much higher. Thi…

also people with conditions vaccinate at a higher rate against the seasonal flu, further shifting the ratio

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#29

Post by eloff »

hristov wrote: post #17
MontagFTB wrote: post #10

From the paper: > The overall cumulative incidence of COVID-19 hospital death at 80 days from the study start date was How do those rates compare to the seasonal flu in the UK?

It is not very useful to compare them with flu because people are much more likely to have flu than to have covid. These rates seem very small but remember that the study started in the beginning of february, when there were likely only a handful if any covid carriers in the uk. If you could preselect a group of people that you know had covid and measure their death rate, the numbers are likely to be much higher. Thi…

Also flu deaths have been greatly exaggerated. Which explains how with a supposed 50k flu deaths in a year in the USA, it has never inundated hospitals like this.

Re: Factors associated with Covid-19 deaths in records of 17M adult NHS patients

#30

Post by logjammin »

phunge wrote: post #15
Ozzie_osman wrote: post #13

What is a hazard ratio? Ie if the hazard ratio is 1.25 (for severe asthma), what does that mean concretely?

A hazard rate can be thought of as a patient's one day probability of mortality. A hazard ratio is a ratio of two hazard rates, so 1.25 would mean that people in one group were dying at a 1.25x rate relative to a comparison group.

I'd quibble slightly with the interpretation of the Hazard Ratio (or rate) here and say that it's more like "the instantaneous relative risk (or probability, if you like) of the event of interest [in this case mortality but not necessarily] between those with confirmed coronavirus and those without it, given that both groups have survived until time t and holding [set of covariates of interest, e.g. race, age, etc] constant."

Don't mean to sound like a pedant here even though it totally reads that way. I figured with enough epidemiology in the news these days, people may see a lot of "Hazard ratios" or "Cox regression" or "survival analysis" and be at risk of some confusion. I work with these concepts and I get tripped up myself sometimes.

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