Factors associated with COVID-19-related death using OpenSAFELY

• Published in: Nature (London) Vol. 584; no. 7821; pp. 430 - 436
• Main Authors: Williamson, Elizabeth J., Walker, Alex J., Bhaskaran, Krishnan, Bacon, Seb, Bates, Chris, Morton, Caroline E., Curtis, Helen J., Mehrkar, Amir, Evans, David, Inglesby, Peter, Cockburn, Jonathan, McDonald, Helen I., MacKenna, Brian, Tomlinson, Laurie, Douglas, Ian J., Rentsch, Christopher T., Mathur, Rohini, Wong, Angel Y. S., Grieve, Richard, Harrison, David, Forbes, Harriet, Schultze, Anna, Croker, Richard, Parry, John, Hester, Frank, Harper, Sam, Perera, Rafael, Evans, Stephen J. W., Smeeth, Liam, Goldacre, Ben
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 20-08-2020; Nature Publishing Group
• Subjects: 631/326/596/4130; 692/308/174; 692/699/255/2514; 692/700/1538; 692/700/478/174; Adolescent; Adult; Age; Age Distribution; Age Factors; Aged; Aged, 80 and over; Aging; Asian People - statistics & numerical data; Asthma; Asthma - epidemiology; Betacoronavirus - pathogenicity; Black People - statistics & numerical data; Blood pressure; Body mass index; Cardiovascular disease; Cohort Studies; Confidence intervals; Coronavirus Infections - mortality; Coronavirus Infections - prevention & control; Coronavirus Infections - virology; Coronaviruses; COVID-19; Data centers; Death; Dementia; Deprivation; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Electronic health records; Electronic medical records; Ethnicity; Female; Health care; Hospitalization; Humanities and Social Sciences; Humans; Hypertension; Hypertension - epidemiology; Kidney diseases; Male; Middle Aged; Minority & ethnic groups; Mortality; multidisciplinary; Obesity; Pandemics - prevention & control; Patients; Pneumonia, Viral - mortality; Pneumonia, Viral - prevention & control; Pneumonia, Viral - virology; Primary care; Proportional Hazards Models; Respiratory diseases; Risk Assessment; SARS-CoV-2; Science; Science (multidisciplinary); Severe acute respiratory syndrome coronavirus 2; Sex Characteristics; Smoking - epidemiology; State Medicine; Viral diseases; Young Adult; United Kingdom > UK; England
• ISSN: 0028-0836; 1476-4687
• DOI: 10.1038/s41586-020-2521-4

Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide
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. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY—a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53–1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29–1.69) and 1.45 (1.32–1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.
OpenSAFELY, a new health analytics platform that includes data from over 17 million adult NHS patients in England, is used to examine factors associated with COVID-19-related death.