The risk of death from the coronavirus disease (Covid-19) is higher for men, old people, and people with greater deprivation, according to the largest analysis to date on the topic, published in the journal Nature on Thursday. Consistent with previous work, the study from the UK found men had a 1.59-fold higher risk of Covid-19-related death than women, and age was a major risk factor.

People 80 years and older had a 20-fold-increased risk of death compared to 50–59-year-old people, found the OpenSAFELY study, which analysed pseudonymised health data of close to 17.3 million UK adults to identify the clinical risk factors for Covid-19-related deaths.

It also confirmed increased risk of death with various pre-existing medical conditions such as diabetes, obesity and asthma.

Black and South Asian people, and those of mixed ethnicity, were 1.62–1.88 times more likely to die of Covid-19 than white people, but contrary to earlier speculation, the increased risk was only partially attributable to pre-existing clinical risk factors and deprivation, or lack of basic necessities.

“Men having higher risk has been noted in many countries including India as they have higher comorbidities, are more likely to smoke, and have high levels of Ace-2 receptors in the testes. South Asians, especially women, have lower vitamin D levels as do black populations,” said Dr K Srinath Reddy, president, Public Health Foundation of India.

Angiotensin-converting enzyme 2 (Ace-2) is the cellular entry receptor used by the new coronavirus Sars-CoV-2 to enter human cells and cause infection. The virus’s crown-like spike protein binds Ace-2 -CoV-2 to invade the air sacs in the lungs, leading to respiratory distress.

Data from several countries has consistently shown men carry up to three times higher risk of death from Covid-19 than women. Men accounted for close to two-thirds (64%) of deaths in China as compared to women, with Italy, Spain, South Korea, France, Germany and India revealing a similar gender gap in death rates.

The OpenSAFELY study found pre-existing medical conditions such as obesity, diabetes, severe asthma, and respiratory, chronic heart, liver, neurological and autoimmune diseases raised risk of Covid-19-related death.

Data from 1.7 million Covid-19 cases and 103,700 deaths in the US from January 22 through May 30 showed people with chronic disease like heart disease and diabetes are 12 times more likely to die and six times more likely to be hospitalised than healthy patients, according to the US Centers for Disease Control and Prevention (CDC). One in five (19.5%) of patients with underlying diseases died compared to 1.6% of those who were healthy, said the CDC in June.

Data from 17,299 hospitalised patients in India showed hypertension was the most common pre-existing condition, followed by diabetes, liver disease, heart disease, asthma and chronic renal disease, according to Integrated Disease Surveillance Programme data.

People 60 years and older account for 53% of Covid19 deaths in India, according to data from the ministry of health and family welfare. “The chances of severe illness and death increase with age, particularly with people with underlying health conditions. Older age, hypertension, diabetes, heart disease, immuno-suppression, and chronic kidney disease are some of the leading causes that lead to complications and increased risk of death. Obesity is an established risk factor, which is common in an urban private tertiary care hospital such as ours,” said Dr Yatin Mehta, chairman of anaesthesiology and critical care, Medanta -The Medicity , Gurugram.

The UK’s OpenSAFELY study also found the most deprived people in the cohort were 1.8 times more likely than the least deprived to die with Covid-19 while clinical factors made only a small contribution to this risk, suggesting that social factors have a role. “The social gradient for comorbidities has reversed in a while ago in the UK, while it has only partially reversed in India,” said Dr Reddy.

“We need highly accurate data on which patients are most at risk in order to manage the pandemic and improve patient care. The answers provided by this OpenSAFELY analysis are of crucial importance to countries around the world. For example, it is very concerning to see that the higher risks faced by people from BME backgrounds are not attributable to identifiable underlying health conditions,” said study co-lead Liam Smeeth, professor of clinical epidemiology at the London School of Hygiene & Tropical Medicine (LSHTM), in a statement.

The study was led by academics at LSHTM and the University of Oxford, working on behalf of the UK’s National Health Service (NHS) and in partnership with NHSX, a UK government unit driving digital transformation of health and social care. The research team developed OpenSAFELY, a secure analytics environment running across detailed pseudonymized data for 40% of all NHS patients in England. Among the electronic health records of 17,278,392 adults, there were 10,926 deaths in and out of hospital that were linked to Covid-19.