16 ms·
Factors associated with Covid-19 deaths in records of 17M adult NHS patients
- gandalfian 6y agohttps://www.economist.com/science-and-technology/2020/05/14/the-pandemic-has-spawned-a-new-way-to-study-medical-recordshttps://twitter.com/bengoldacre?lang=en https://www.economist.com/science-and-technology/2020/05/14/... https://t.co/j1n12eyz7Y?amp=1 https://t.co/j1n12eyz7Y?amp=1 Datamining 17 million NHS records to find Coronavirus factors.
- gandalfian 6y agoSorry my links seem to have gone wrong try https://outline.com/YNRSgm https://outline.com/YNRSgm
- verdverm 6y agoGiven "AI's" inability to understand time and temporal relations, and given the incredible amount of hidden dynamics and game theory in economics, just going to go ahead and facepalm
- gandalfian 6y agoSorry, what are you saying? This is Epidemiologyists doing statistical analysis of a vast data set. Where does the ai come in?
- legerdemain 6y agoNotably, this research is being publicized by Ben Goldacre of Bad Science (among other accomplishments). Goldacre also gets last author on the non-alphabetized list of authors on the preprint, suggesting his primary involvement.
- gandalfian 6y agoYes he is an Epidemiologist by profession and I think it is his team that came up with the way to access medical data. I tried to get it in the title but it seems to have been edited out.
- chiefalchemist 6y agoI wasn't familiar and looked him up. This might save others the effort. https://duckduckgo.com/?q=Ben+Goldacre+of+Bad+Science&t=fpas&ia=web https://duckduckgo.com/?q=Ben+Goldacre+of+Bad+Science&t=fpas...
- chiefalchemist 6y agoDown voted for helping others. HN...you've lost your mind. Your sense of community is an embarrassment.
- notRobot 6y agoA copy-paste of the bio from Wikipedia would be more helpful than a DDG search link.
- chiefalchemist 6y agoFor you perhaps. But I didn't see value in imposing my will on others. In fact, I looked at a few of the articles in that DDG SERP.
- MontagFTB 6y agoFrom the paper: > The overall cumulative incidence of COVID-19 hospital death at 80 days from the study start date was <0.01% in those aged 18-39 years, rising to 0.35% and 0.17% in men and women respectively aged ≥80 years, with a trend by age. How do those rates compare to the seasonal flu in the UK?
- hristov 6y agoIt 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. This study did not do this. This is probably because this would require that all patients are tested for covid as they visit their doctor and this was obviously not happening.
- MontagFTB 6y agoThanks for the clarification. I got the gist from the paper that testing in this cohort was higher than it apparently was.
- LoSboccacc 6y agoalso people with conditions vaccinate at a higher rate against the seasonal flu, further shifting the ratio
- eloff 6y agoAlso 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.
- jdminhbg 6y ago85k coronavirus deaths haven't inundated hospitals in the US either, except in the absolute epicenter in NYC, and even then not to the point originally feared. It's very easy to imagine 50k flu deaths geographically spread evenly not overwhelming US hospitals, especially given that they'd be spread over something like 3x the current coronavirus epidemic timespan. I'm very skeptical of the sudden "oh those flu deaths aren't real" narrative.
- akeck 6y agoWhat is "Deprivation" in this context?
- hristov 6y agoI was wondering about that too. After some research it seems to be something like poverty. I.e., being deprived of decent living conditions, education opportunities employment opportunities, etc. In the paper they used this index which measures deprivation by living location in the UK: https://en.wikipedia.org/wiki/Multiple_deprivation_index https://en.wikipedia.org/wiki/Multiple_deprivation_index
- loeg 6y agoPoor. Many negative health outcomes correlate with poverty / deprivation.
- noneeeed 6y agoI think this may be a British English specific thing, but we use the word "deprivation" fairly interchangeably with "poverty".
- easytiger 6y agoAnd how are they determining it from patient records?
- new_realist 6y agoIt’s not surprising that historically plague-ridden Europeans would be less susceptible to a new blight then other ethnicities. Disease resistance has been selected for.
- peteretep 6y agoAsia got all the same plagues as Europe
- dredmorbius 6y agoThe two regions often responded very dissimilarly. nKyle Harper'sbThe Fate of Rome looks at this in depth. TL:DR; civilisation's patterns (cities, trade, travel) co-evolve diseases. Populations tend to evolve resistance to local endemic disease, but are susceptible to novel agents, including foreign infections. Rome infected China and vice versa.
- DoreenMichele 6y agoThat's not how evolution works. Cystic fibrosis is a predominantly Caucasian genetic disorder because one copy of the gene helps protect against certain historical plagues in Europe without being too debilitating. But two copies kill you gruesomely at a young age. And it kills you primarily by making you more prone to infection. Kind of like how Sickle Cell works. It helps protect against malaria, but two copies of the gene are bad news.
- bad_user 6y agoThese factors aren't causal. In western countries at least, an obvious confounded for those of asian or black ethnic descent is _poverty_ and thus access to healthcare, malnutrition, sleep deprivation, poor education and everything else that goes with poverty.
- Ozzie_osman 6y agoWhat is a hazard ratio? Ie if the hazard ratio is 1.25 (for severe asthma), what does that mean concretely?
- phunge 6y agoA 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.
- logjammin 6y agoI'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.
- mmazing 6y agoFull paper - https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v...
- lettergram 6y agoI 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
- forgot_again 6y agoWhat 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.
- loeg 6y agoIt means poor. It's unclear to me (only skimmed the figures) if the various ethnic/racial hazard factors correct for poverty (deprivation) or not.
- pacificmint 6y agoThey took that into consideration: > People from Asian and black groups are at markedly increased risk of in-hospital death from COVID-19, and contrary to some prior speculation this is only partially attributable to pre-existing clinical risk factors or deprivation;
- loeg 6y agoI noted that. However, "partially attributable" doesn't suggest to me one way or the other whether or not they corrected for that impact in figure 3. Or maybe I'm misreading the sentence.
- JPKab 6y agoDeprivation 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.
- _bxg1 6y ago> Deprivation was also found to be a major risk factor What does this mean? Sleep deprivation?
- JPKab 6y agoBritish term for poverty.
- baron816 6y agoGoddamn British people. Why can’t they just speak English.
- deleted 6y ago[deleted]
- krallja 6y agoIt’s BrE for poverty / inequality
- tialaramex 6y agoIndices of Multiple Deprivation use a bunch of factors to measure how much it sucks to live somewhere. Other people are saying "poverty" but that's only part of the problem. https://en.wikipedia.org/wiki/Multiple_deprivation_index https://en.wikipedia.org/wiki/Multiple_deprivation_index For example suppose you are very poor but you live where I grew up in Metroland. Lack of money sucks pretty badly, but in Metroland other deprivation factors are mostly low. There are jobs in Metroland. The schools are pretty good. There's a hospital, and a nearby doctor with a friendly manner (remember Britain has universal healthcare, but universal does not mean universally excellent). You can't afford private rent here, but local government can find you somewhere to live, and not in six months but maybe six days. The local crime isn't too bad. Vandals, maybe the odd burglary you suspect a neighbour is on the game (prostitution), but you don't fear for your life. The surrounding space is nice, there's a play park, rolling hills, fresh air if you like that sort of thing. So in Metroland even the poor aren't very deprived. In contrast, in some deprived Northern cities in particular, even the middle class suffer pretty badly, and will strive to get out.
- mindviews 6y agoHere's a link to the paper: https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf 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 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561 [2] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484 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 < 0 mm Hg), and (4) critical – respiratory failure requiring intensive case monitoring." I want to see a dozen more studies like [1] and [2] to see if this holds up to replication with larger populations.
- melvinroest 6y ago"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." Wait, only 13.3% (1.1 + 12.2) of all the active cases in total were vitamin D insufficient or worse? I thought the majority of people had insufficient vitamin D. This data doesn't fully make sense to me. How come that so few people with a vitamin D insufficiency were active cases? I get that most of them died. But I don't get that so few, less than 15 percent, got to become an active case. Edit: ah, it's an Indonesian study. Nevermind, I wouldn't know the numbers from there.
- netsharc 6y agoObligatory, "Fucking Twitter thread" complaint. I dread reading - Bullet point - After bullet point - In the form of a tweet per bullet point - Trying to skip the bullshit - And find the conclusion (I'll stop now) ...and having the anxiety to be disappointed that I'll read so much bullshit and end up with nothing. Yes, in the end he links to the abstract which has the (unfortunately harder to parse) meat, but also yes, the Twitter thread disappoints, because he ends up tooting his own horn that they were the first, "this [study is] extremely important" and how he needs a sandwich... and seemingly that's where the thread ends? (TBH, thank god for that).
- Kliment 6y agoI fully agree with you, and therefore: a) the thread, in readable form https://threadreaderapp.com/thread/1258372975004389379.html https://threadreaderapp.com/thread/1258372975004389379.html b) the full publication https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v...
- TedDoesntTalk 6y agothreadreaderapp,com is great. Thank you for introducing me to it.
- dredmorbius 6y agoProTip: DDG bang !thread <twitter url> So: !thread https://twitter.com/bengoldacre/status/1258372975004389379 ...at https://duckduckgo.com https://duckduckgo.com, or in your navbar (if DDG is your default search engine) goes straight there.
- CathedralBorrow 6y agoI don't think this kind of comment is obligatory, really.
- supernova87a 6y agoThe title / headline is overstating it a little. The sample only contains 5,683 people who died of the virus. The 17M is the sample of hospital patients in general. I don't know if this is on purpose, but it makes the study sound artificially more significant. Every study could claim the "17M" figure by this practice.
- ckastner 6y agoAs far as I understand it, they are comparing the statistics of the 5,683 sample to the 17M in order to determine whether anything stands out. If Covid-19 deaths had no associated factors, then we shouldn't see much of a difference between the two. However, we are seeing differences, for example with diabetes.
- supernova87a 6y agoYes that's true, but the 17M figure isn't the interesting / groundbreaking thing. At least it shouldn't be made out to be as if that's the significant thing. 17M just provides the baseline of "normal". Tons more data isn't needed to get that right. 170M wouldn't make a difference. I bet 1.7M wouldn't make a big difference either. What we really need to know right now is how the Covid deaths behave. All that this offers is the 5,683 sample, but the title inflates it to emphasize the 17M. We need the 5,683 sample to be merged with other samples to reach 56,830, etc. That is the significant thing.
- ckastner 6y agoI have to admit, the title does sound misleading in this regard, and (to me) even more so the tweets advertising the paper as per the submission.
- sebbo 6y agoYou misunderstand. The only reason the study has enough power to make statements about the relative risk of, say, obesity independently of age, sex, and ethnicity is because there are 17 million patients to use as "controls".
- smt88 6y agoIt seems like a lot of people are interpreting this data as causal. I've already had people tell me they were surprised to learn that smoking protects against Covid! Here's a fantastic explanation of why you should not let your brain tell you that you're learning about things that cause Covid complications and death: https://twitter.com/EpiEllie/status/1258607277357006849 https://twitter.com/EpiEllie/status/1258607277357006849
- tom_mellior 6y agoThe thread is good, but a possible link with nicotine has been observed before. This might just be the unlikely case where smoking does indirectly confer some health benefit.
- phogster 6y agoMaybe because it could cause you to go outside, increasing exposure to the sun.
- tonyedgecombe 6y agoOr kill you before you get to a vulnerable age.
- m463 6y agoit might work like a mask if you always inhale through a filter and an inferno. It might even purify your second-hand smoke. but yes, you have a very real point. I remember reading about some drug that seemed to give people heart attacks, but it actually cured what it was supposed to and heart attacks were the next statistically likely thing to get you.
- andor 6y agoIn this specific case, going outside would help reduce exposure to aerosolized saliva. Imagine people at a bar. The smokers would stand outside in the cold, smoking, while the non-smokers inside are warmer but at higher risk of catching an infection.
- chvid 6y agoJudging from the chart at p. 11 age is really the dominant factor. Moving the "hazard ratio" from 0.25 (<50) to 10+ (>80). Completely dwarfing other factors such as sex, obesity, and various health problems (that the study has categorised).
- 0-_-0 6y agoInteresting that being an ex-smoker increases the risk, but being a current smoker decreases it. Seems like there is some short term benefit to smoking that outweighs its long term negative health effects.
- supernova87a 6y agoMaybe people who are ex-smokers have had serious lung issues, quit smoking, and are more susceptible. While people smoking have not yet progressed to that stage.
- StringyBob 6y agoMaybe being forced to go outside in the sunshine for a cigarette break!
- Nextgrid 6y agoCould it be a measurement error or that smokers who would’ve died because of covid already did die of something else or get a different condition before, essentially making it survivor bias?
- 0-_-0 6y agoThe survivor bias argument doesn't work for the other health problems listed so I don't think it would work for smoking
- goblin89 6y agoAs someone who relatively freshly started smoking 1.5 years ago, I find it insidious. After stopping for a day or two, I actually feel better as tension goes away and I sleep a lot. Shortly, however, I start randomly getting sneezes, runny nose, and slight ill-like feeling in my head. Part of what makes me start again is the desire to avoid spooking others with those flu-like symptoms in the middle of an epidemic, since I live in a densely populated area. I don’t have a clear idea of what mechanism is at work here, my hypothesis is that the withdrawal somehow suppresses my immune system. Unfortunately, as far as I can tell, nicotine patches aren’t as good (or useful at all) at reducing the respiratory symptoms in short term. I suppose it’s not purely nicotine withdrawal that’s causing this.
- fortran77 6y agoThe whole paper is here: https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v... Obesity, of course, is a major factor. It's hard to pull apart Type II Diabetes and breathing disorders from it, too, so a realistic assessment of disorders that would be mitigated if the patient lost weight might show it as the absolute major contributor. Even Vitamin D deficiency is linked to obesity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705328/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705328/
- maxcan 6y ago> being male (hazard ratio 1.99.. It’s an interesting counter factual to imagine how differently the media would be covering the situation if the genders were reversed and women had about twice the chance of dying from COVID-19..
- Igelau 6y agoI'm surprised they even mentioned this, considering how often my wife has told me to shut up about my "man cold"
- deleted 6y ago[deleted]