Deaths involving COVID-19 by self-reported disability status during the first two waves of the COVID-19 pandemic in England: a retrospective, population-based cohort study

Abstract

Background People with learning disabilities are at substantially increased risk of COVID-19 mortality, but evidence on risks of COVID-19 mortality for disabled people more generally is limited. We aimed to use population-level data to estimate the association between self-reported disability and death involving COVID-19 during the first two waves of the COVID-19 pandemic in England. MethodsWe conducted a retrospective, population-based cohort study of adults aged 30-100 years living in private households or communal establishments in England, using data from the Office for National Statistics Public Health Data Asset. Participants were present at the 2011 Census and alive on Jan 24, 2020. Participants reported being limited a lot in their daily activities, limited a little, or not limited at all, in response to a question from the 2011 Census. The outcome was death involving COVID-19, occurring between Jan 24, 2020, and Feb 28, 2021. We used Cox proportional hazards regression to calculate hazard ratios (HRs) for the association between disability and death involving COVID-19, sequentially adjusting for age, residence type (private household, care home, or other communal establishment), geographical characteristics (local authority district and population density), sociodemographic characteristics (ethnicity, highest qualification, Index of Multiple Deprivation decile, household characteristics [National Statistics Socio-economic Classification of the household reference person, tenure of household, household size, family status, household composition, and key worker in household], key worker type, individual and household exposure to disease, and individual and household proximity to others), and health status (pre-existing health conditions, body-mass index, and number of admissions to hospital and days spent in hospital over the previous 3 years). Findings 29 293 845 adults were included in the study (13 806 623 [47%] men, 15 487 222 [53%] women), of whom 3 038 772 (10%) reported being limited a little and 2 011 576 (7%) reported being limited a lot. During follow-up, 105 213 people died from causes involving COVID-19 in England, 61 416 (58%) of whom were disabled. Age-adjusted analyses showed higher mortality involving COVID-19 among disabled people who were limited a lot (HR 3•05 [95% CI 2•98-3•11] for men; 3•48 [3•41-3•56] for women) and disabled people who were limited a little (HR 1•88 [1•84-1•92] for men; 2•03 [1•98-2•08] for women) than among non-disabled people. Adjustment for residence type, geography, sociodemographics, and health conditions reduced but did not eliminate the associations between disability and death involving COVID-19 (HR 1•35 [1•32-1•38] for men who were limited a lot; 1•21 [1•18-1•23] for men who were limited a little; 1•55 [1•51-1•59] for women who were limited a lot; and 1•28 [1•25-1•31] for women who were limited a little).Interpretation Given the association between disability and mortality involving COVID-19, verification of these findings and consideration of recommendations...

Disparities in SARS-CoV-2 case rates by ethnicity, religion, measures of socio-economic position, English proficiency, and self-reported disability: cohort study of 39 million people in England during the Alpha and Delta waves

“…Between 1 September 2020 and 10 December 2021, 5,767,584 people (14.8% of the study population) living in England aged ≥10 years had tested positive for SARS-CoV-2, of which 46,484 (0.8%; 0.1% of the total study population) had an infection episode in both the second and third waves of the pandemic During the second wave, the largest differences in rates of testing positive for SARS-CoV-2 were observed for ethnicity; rates were highest in the Bangladeshi and Pakistani ethnic groups at 382. 4 and 373.8 per 100,000 person-weeks, respectively, and in the Chinese ethnic group, with 90.8 cases per 100,000 person-weeks. During the third wave, however, the White British ethnic group had the highest rate at 359.7 cases per 100,000 person-weeks (Table 2).…”

“…Whilst the COVID-19 pandemic has affected all areas of the UK, some groups have been disproportionally affected. Rates of COVID-19 related hospitalisation and death have been higher among the elderly, people with pre-existing health conditions or disability [3] [4] [5], ethnic minority groups [6] [7] [8], some religious groups [9], people with low socio-economic status [10], and those living in care homes [11], large households [12], and deprived areas [13] [14] [15].…”

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19

“…People with disabilities experience inequities in health access and outcomes, and these are potentially magnified with respect to coronavirus disease 2019 (COVID-19) (Shakespeare, Ndagire & Seketi 2021a ). Estimates from the UK show that at least 58% of deaths related to COVID-19 between January 2020 and February 2021 were amongst people with disabilities, although they only made up 17% of the population (Bosworth et al 2021 ). The increased risk of people with disabilities to COVID-19 mortality appears to occur for a combination of reasons, including higher risk of contracting the disease (e.g.…”

Legal restrictions and mitigation strategies amongst a disabled population during COVID-19

“…People with disabilities (PwD) are disproportionately vulnerable to disasters; this includes but is not limited to negative mental health sequalae ( Stough, 2009 ; Stough and Kelman, 2018 ). A UK study during COVID-19 found that PwD are at greater risk of severe outcomes and death than the general population ( Bosworth et al, 2021 ). The global pandemic has disproportionately affected PwD, in terms of not just access to healthcare, but also to support services and networks, the ability to remain physically active, and their loneliness and mental health ( Czeisler et al, 2021 ; Jesus et al, 2021 ; Okoro et al, 2021 ; Wang et al, 2022 ).…”