Factors associated with COVID-19-related death using OpenSAFELY
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Abstract
Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide 1. 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.
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There is a preponderance of evidence demonstrating that the COVID-19 epidemic has disproportionately affected lower income sub-city units, and the Americas is no exception.
“There is now a preponderance of evidence demonstrating that the epidemic has disproportionately affected lower income sub-city units, and the Americas is no exception [17–22].”
From Social epidemiology of urban COVID-19 inequalities in Latin America and Canada (2024) · cites this paper as [22]
The Results (p. 431) report a higher risk of COVID-19-related death with greater deprivation, and the Policy implications section describes increased risk among people living in more-deprived areas. The study uses records from England; it does not establish an effect on lower-income sub-city units or provide evidence about the Americas. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSocial inequalities in COVID-19 deaths were evident during the early pandemic period across the world.
“Social inequalities in COVID-19 deaths were evident during the early pandemic period across the world(2-8).”
From Social inequalities in COVID-19 death by area-level income in 11.2 million people in Ontario, Canada: patterns over time and the mediating role of vaccination. (2026) · cites this paper as [4]
The Results (p. 431) report higher COVID-19-related death risk among Black and minority ethnic groups and a gradient of increasing risk with deprivation. The study uses patient records from England, so it supports social inequalities during the early pandemic there, but not the claim that they were evident across the world. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAge is the major clinical risk factor for severe, critical, and fatal COVID-19.
“Age is the major clinical risk factor for severe, critical, and fatal COVID-19”
From COVID-19 and the human innate immune system (2021) · cites this paper as Williamson et al., 2020
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- Authors
- Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., Inglesby, P., Cockburn, J., McDonald, H. I., MacKenna, B., Tomlinson, L., Douglas, I. J., Rentsch, C. T., Mathur, R., Wong, A. Y. S., Grieve, R., Harrison, D., Forbes, H., Schultze, A., Croker, R., Parry, J., Hester, F., Harper, S., Perera, R., Evans, S. J. W., Smeeth, L., & Goldacre, B.
- Affiliations
- University of Oxford (GB)
- London School of Hygiene & Tropical Medicine (GB)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Goldacre, Ben
- ORCID
- Williamson, Elizabeth J.
- Walker, Alex J.
- Bhaskaran, Krishnan
- Bacon, Seb
- Bates, Chris
- Morton, Caroline E.
- Curtis, Helen J.
- 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
- Schultze, Anna
- Croker, Richard
- Hester, Frank
- Perera, Rafael
- Evans, Stephen J. W.
- Smeeth, Liam
- Goldacre, Ben
- Venue
- Nature
- Published
- 2020-07-08
- Volume
- 584
- Issue
- 7821
- Pages
- 430-436
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC7611074
- OpenAlex
- W3047144258
- Cited by
- 6,674
- References
- 33
- Citations by year
- 2026: 176 · 2025: 303 · 2024: 698 · 2023: 904 · 2022: 1505 · 2021: 2173 · 2020: 908 · 2019: 2
- FWCI
- 179.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nature (publishedVersion)
- medRxiv (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- PubMed Central (acceptedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Funders
- London School of Hygiene and Tropical Medicine
- Wellcome Trust (107731/Z/15/Z, 201375/Z/16/Z, 201375, 107731)
- UK Research and Innovation
- National Institute for Health Research Health Protection Research Unit
- National Institute for Health and Care Research
- British Heart Foundation (FS/19/19/34175)
- Department of Health and Social Care
- Royal Society
- Diabetes UK
- Public Health England
- Medical Research Council (MR/S003940/1)
- NIHR Oxford Biomedical Research Centre
- National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames Valley
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, COVID-19 mortality, risk factors, OpenSAFELY, primary care electronic health records, sex differences, age, socioeconomic deprivation, diabetes mellitus, severe asthma, ethnicity, NHS England, cohort studies
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Aging, Asthma, Diabetes Mellitus, Female, Humans, Hypertension, Male, Middle Aged, Pneumonia, Viral, Sex Characteristics, Smoking, State Medicine, Cohort Studies, Proportional Hazards Models, Age Distribution, Coronavirus Infections, Risk Assessment, Black People, Asian People, Young Adult, Pandemics
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