Background
COVID-19 moderate- and high-risk population definitions in national guidance for England [7] | Study definition |
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Anyone aged 70 years or older (regardless of medical conditions) is defined as at moderate risk. | The study definition of the at-risk population for all ages comprised individuals with any of the underlying health conditions in national guidance, incorporating high risk groups as indicated. Detailed inclusion criteria for each condition were based on national guidance defining influenza clinical risk groups, to reflect risk of respiratory infection [8]. |
Among individuals aged less than 70 years, people at moderate risk from coronavirus infection include people who: • have a lung condition that’s not severe (such as asthma, chronic obstructive pulmonary disease, emphysema or bronchitis) o high risk have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe chronic obstructive pulmonary disease) • have heart disease (such as heart failure) • have diabetes • have chronic kidney disease • have liver disease (such as hepatitis) • have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy) • have a condition that means they have a high risk of getting infections o high risk have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell) o high risk have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma) • are taking medicine that can affect the immune system (such as low doses of steroids) o high risk are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine) o high risk have had an organ transplant o high risk are having chemotherapy or antibody treatment for cancer, including immunotherapy o high risk are having an intense course of radiotherapy (radical radiotherapy) for lung cancer o high risk are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors) o high risk have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine • are very obese (a BMI of 40 or above) | |
• are pregnant o high risk have a serious heart condition and are pregnant | The prevalence of pregnancy was estimated separately from the general at-risk population. |
Methods
Data sources
Index dates
Study population
Definition of at-risk population
Statistical analysis
Sensitivity analyses
Results
Characteristics of the study population
Scotland | Northern Ireland | Wales | England | ||||||
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N = 801,352 | N = 205,092 | N = 708,670 | N = 990,939 | ||||||
n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | ||
Demographics | Mean age (SD) | 42.3 (22.6) | 40.7 (22.7) | 42.6 (23.2) | 40.8 (22.8) | ||||
Female | 403,151 | 50,309 (50,199–50,418) | 102,545 | 50,000 (49,783–50,216) | 356,080 | 50,246 (50,130–50,363) | 496,988 | 50,153 (50,055–50,252) | |
Ethnicity | |||||||||
White | 427,954 | 53,404 (53,295–53,513) | 55,293 | 26,960 (26,768–27,153) | 226,425 | 31,951 (31,842–32,059) | 570,706 | 57,592 (57,495–57,690) | |
South Asian | 9325 | 1164 (1140–1187) | 764 | 373 (347–400) | 7440 | 1050 (1026–1074) | 48,334 | 4878 (4835–4920) | |
Black | 3989 | 498 (482–513) | 335 | 163 (146–182) | 2861 | 404 (389–419) | 27,947 | 2820 (2788–2853) | |
Other | 9360 | 1168 (1145–1192) | 1102 | 537 (506–570) | 4497 | 635 (616–653) | 20,106 | 2029 (2001–2057) | |
Mixed | 2323 | 290 (278–302) | 253 | 123 (109–140) | 2219 | 313 (300–326) | 12,376 | 1249 (1227–1271) | |
Not recorded | 348,401 | 43,477 (43,368–43,585) | 147,345 | 71,843 (71,648–72,038) | 465,228 | 65,648 (65,537–65,759) | 311,470 | 31,432 (31,340–31,523) | |
Underlying health conditions contributing to the at-risk population | Chronic liver disease | 4125 | 515 (499–531) | 681 | 332 (308–358) | 2150 | 303 (291–316) | 2525 | 255 (245–265) |
Chronic heart disease | 39,804 | 4967 (4920–5015) | 9740 | 4749 (4657–4842) | 34,459 | 4862 (4813–4913) | 37,040 | 3738 (3701–3775) | |
Chronic respiratory disease (other than asthma) | 28,529 | 3560 (3520–3601) | 7846 | 3826 (3743–3910) | 24,192 | 3414 (3372–3456) | 26,821 | 2707 (2675–2739) | |
Current asthma (only) | 47,164 | 5886 (5834–5937) | 14,636 | 7136 (7025–7249) | 51,783 | 7307 (7247–7368) | 61,762 | 6233 (6185–6280) | |
Chronic neurological disease | 29,631 | 3698 (3656–3739) | 6729 | 3281 (3204–3359) | 23,850 | 3365 (3324–3408) | 27,488 | 2774 (2742–2806) | |
Diabetes mellitus | 54,987 | 6862 (6807–6917) | 15,878 | 7742 (7627–7858) | 59,995 | 8466 (8401–8531) | 61,925 | 6249 (6202–6297) | |
Organ transplant recipient | 748 | 93 (87–100) | 182 | 89 (76–103) | 653 | 92 (85–99) | 894 | 90 (84–96) | |
Asplenia/sickle cell disease | 1062 | 133 (125–141) | 244 | 119 (105–135) | 905 | 128 (120–136) | 1337 | 135 (128–142) | |
Other immunosuppression | 7199 | 898 (878–919) | 1616 | 788 (750–827) | 4181 | 590 (572–608) | 6419 | 648 (632–664) | |
Chronic kidney disease | 54,845 | 6844 (6789–6900) | 17,296 | 8433 (8313–8554) | 53,280 | 7518 (7457–7580) | 69,894 | 7053 (7003–7104) | |
Severe obesity (BMI ≥40 kg/m2) | 21,249 | 3315 (3271–3359) | 5256 | 3299 (3211–3387) | 21,431 | 3803 (3753–3853) | 21,282 | 2762 (2725–2799) | |
At-risk population based on underlying health conditions | At-risk population overallb | 196,378 | 24,506 (24,412–24,600) | 53,945 | 26,303 (26,112–26,494) | 187,695 | 26,486 (26,383–26,588) | 223,587 | 22,563 (22,481–22,646) |
among those aged < 70 years | 126,695 /696,563 | 18,189 (18,098–18,279) | 36,178 /180,643 | 20,027 (19,843–20,213) | 117,628 /603,155 | 19,502 (19,402–19,602) | 143,305 /866,280 | 16,543 (16,464–16,621) | |
among those aged ≥70 years | 69,683 /104,789 | 66,498 (66,212–66,784) | 17,767 /24,449 | 72,670 (72,106–73,228) | 70,067 /105,515 | 66,405 (66,119–66,690) | 80,282 /124,659 | 64,401 (64,135–64,667) | |
of school age (5–18 years) | 9680 /127,199 | 7610 (7465–7757) | 3737 /35,846 | 10,425 (10,111–10,746) | 10,105 /115,258 | 8767 (8605–8932) | 13,915 /175,447 | 7931 (7805–8059) | |
of working age (19–65 years) | 99,786 /508,725 | 19,615 (19,506–19,724) | 27,944 /129,274 | 21,616 (21,392–21,842) | 91,644 /433,284 | 21,151 (21,030–21,273) | 111,409 /618,404 | 18,016 (17,920–18,112) | |
among males | 93,319 /398,201 | 23,435 (23,304–23,567) | 25,691 /102,534 | 25,056 (24,791–25,323) | 89,178 /352,556 | 25,295 (25,151–25,439) | 106,989 /493,908 | 21,662 (21,547–21,777) | |
among females | 103,059 /403,151 | 25,563 (25,429–25,698) | 28,251 /102,545 | 27,550 (27,277–27,824) | 98,513 /356,080 | 27,666 (27,519–27,813) | 116,594 /496,988 | 23,460 (23,342–23,578) | |
Multimorbidity | 58,076 | 7247 (7191–7304) | 16,248 | 7922 (7806–8040) | 55,556 | 7839 (7777–7902) | 60,994 | 6155 (6108–6203) | |
Cancer survivors | Incident cancer in previous year | 3439 | 429 (415–444) | 899 | 438 (410–468) | 3164 | 446 (431–462) | 3742 | 376 (364–388) |
Incident cancer in previous 5 years | 12,847 | 1603 (1576–1631) | 3344 | 1630 (1576–1686) | 12,451 | 1757 (1726–1788) | 14,663 | 1480 (1456–1504) |
COVID-19 at-risk population
Age 2 to 69 years | Age ≥ 70 years | Estimated total number of individuals in the at-risk population | |||
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Age-standardised prevalence of at least one underlying health condition /100,000 (95% CI) | Office for National Statistics mid-2019 population estimate | Estimated number of individuals aged 2–69 years with at least one underlying health condition (95% CI) | Office for National Statistics mid-2019 population estimate | ||
Scotland | 18,046 (17,956–18,137) | 4,615,093 | 832,848 (828,694–837,019) | 744,701 | 1,577,549 |
Northern Ireland | 19,672 (19,490–19,855) | 1,622,687 | 319,213 (316,266–322,182) | 224,851 | 544,064 |
Wales | 19,519 (19,418–19,619) | 2,609,759 | 509,389 (506,776–512,011) | 480,234 | 989,623 |
England | 16,573 (16,495–16,652) | 47,467,071 | 7,866,870 (7,829,660–7,904,217) | 7,556,976 | 15,423,846 |
Composition by underlying health conditions
Variation by age
Variation by sex
Variation by region
Differences between 2014 and 2019 prevalence estimates
Cancer survivors
Pregnancy
Scotland N = 205,542 | Northern Ireland N = 55,559 | Wales N = 177,412 | England N = 743,327 | |||||
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Among all women aged 11–49 years | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) |
Pregnant or any underlying health conditionb | 34,051 | 16,566 (16,406–16,728) | 9234 | 16,620 (16,311–16,932) | 31,140 | 17,552 (17,376–17,730) | 117,680 | 15,832 (15,749–15,915) |
Any underlying health conditionb | 31,389 | 15,271 (15,116–15,428) | 8317 | 14,970 (14,674–15,269) | 28,733 | 16,196 (16,024–16,368) | 102,121 | 13,738 (13,660–13,817) |
Pregnant | 3067 | 1492 (1440–1545) | 1069 | 1924 (1811–2042) | 2834 | 1597 (1540–1657) | 17,755 | 2389 (2354–2424) |
Prevalence of underlying health conditions, b stratified by pregnancy status, among women aged 11–49 years | ||||||||
Pregnant with an underlying health conditionb | 405 | 13,205 (12,026–14,455) | 152 | 14,219 (12,179–16,458) | 427 | 15,067 (13,769–16,458) | 2196 | 12,368 (11,887–12,862) |
Not pregnant, with an underlying health conditionb | 30,984 | 15,303 (15,146–15,460) | 8165 | 14,984 (14,686–15,287) | 28,306 | 16,214 (16,041–16,388) | 99,925 | 13,772 (13,693–13,851) |
Linked secondary care records
Individuals in England eligible for secondary care data linkage in 2014 N = 1,802,468 | Individuals in England eligible for secondary care data linkage in 2019 N = 744,496 | |||||||
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Standalone primary care data | Both primary and secondary care data | Standalone primary care data | Both primary and secondary care data | |||||
n | Point prevalence /100,000 (95% CI) | N | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | n | Point prevalence /100,000 (95% CI) | |
Underlying health conditions contributing to the at-risk population | ||||||||
Chronic liver disease | 4499 | 250 (242–257) | 8104 | 450 (440–459) | 2022 | 272 (260–284) | 3941 | 529 (513–546) |
Chronic heart disease | 87,217 | 4839 (4807–4870) | 108,711 | 6031 (5997–6066) | 29,399 | 3949 (3905–3993) | 39,083 | 5250 (5199–5300) |
Chronic respiratory disease | 53,358 | 2960 (2936–2985) | 63,562 | 3526 (3500–3553) | 21,345 | 2867 (2829–2905) | 26,407 | 3547 (3505–3589) |
Current asthma (only) | 125,548 | 6965 (6928–7003) | 136,702 | 7584 (7546–7623) | 48,009 | 6449 (6393–6505) | 53,030 | 7123 (7065–7182) |
Chronic neurological disease | 60,482 | 3356 (3329–3382) | 69,932 | 3880 (3852–3908) | 21,818 | 2931 (2892–2969) | 26,284 | 3530 (3489–3573) |
Diabetes mellitus | 110,144 | 6111 (6076–6146) | 114,149 | 6333 (6297–6369) | 48,461 | 6509 (6453–6566) | 50,760 | 6818 (6761–6876) |
Organ transplant recipient | 1470 | 82 (77–86) | 1732 | 96 (92–101) | 707 | 95 (88–102) | 838 | 113 (105–120) |
Asplenia/sickle cell disease | 2545 | 141 (136–147) | 2878 | 160 (154–166) | 1089 | 146 (138–155) | 1346 | 181 (171–191) |
Other immunosuppression | 14,134 | 784 (771–797) | 32,537 | 1805 (1786–1825) | 5035 | 676 (658–695) | 7663 | 1029 (1006–1052) |
Chronic kidney disease | 159,241 | 8835 (8793–8876) | 159,379 | 8842 (8801–8884) | 54,661 | 7342 (7283–7401) | 54,774 | 7357 (7298–7417) |
Severe obesity (BMI ≥40 kg/m2) | 36,668 | 2581 (2555–2607) | 36,668 | 2581 (2555–2607) | 16,706 | 2898 (2855–2942) | 16,706 | 2898 (2855–2942) |
At-risk populationa | ||||||||
At-risk populationa | 450,601 | 24,999 (24,936–25,062) | 483,071 | 26,801 (26,736–26,865) | 175,420 | 23,562 (23,466–23,659) | 188,716 | 25,348 (25,249–25,447) |
among those aged < 70 years | 276,158 | 17,756 (17,696–17,816) | 303,528 | 19,516 (19,453–19,578) | 112,168 | 17,286 (17,194–17,378) | 123,038 | 18,961 (18,866–19,057) |
among those aged ≥70 years | 174,443 | 70,579 (70,399–70,759) | 179,543 | 72,643 (72,466–72,818) | 63,252 | 66,157 (65,856–66,457) | 65,678 | 68,694 (68,399–68,988) |
Multimorbidity | 133,803 | 7423 (7385–7462) | 155,802 | 8644 (8603–8685) | 48,009 | 6449 (6393–6505) | 56,827 | 7633 (7573–7693) |
Cancer survivors | ||||||||
Incident cancer in previous year | 8343 | 463 (453–473) | 10,680 | 593 (581–604) | 2936 | 394 (380–409) | 3806 | 511 (495–528) |
Incident cancer in previous 5 years | 31,195 | 1731 (1712–1750) | 36,815 | 2042 (2022–2063) | 11,708 | 1573 (1544–1601) | 13,854 | 1861 (1830–1892) |