A guide to what factors put you at risk from coronavirus – British Heart Foundation

29 May 2020

From high blood pressure to whether youre male or female, all kinds of factors affect your risk from coronavirus. Sarah Brealey and Naomi Herz explain what this means and what you can do about it.

With the death toll from coronavirus continuing to rise, but some restrictions being eased, its normal to wonder how much you are at risk.

We are still learning about the factors that affect your risk from coronavirus and some questions still dont have answers.

What we do know is that everyone is different, and your own level of risk is affected by many different interacting factors including age and existing health conditions. Risk is measured by looking at death rates in large groups of people it doesnt mean that everyone in high risk groups will live or die. In some cases the difference in risk may be relatively small.

Even if you are in a group considered at high risk, that doesnt tell us everything about your own individual risk and it certainly doesnt mean that you will die from coronavirus.

These are some of the factors that can affect level of risk (click on the one you're interested in to jump straight to it, or scroll down to read the full article):

Conclusion: Living with risk

We know that as you get older, your risk of death increases both your overall risk of death (separate from coronavirus) and your risk of dying from coronavirus. Many studies from the UK and internationally have found that being older increases your risk of dying from Covid-19. This could be because youre more likely to have existing health conditions as you get older (which themselves raise your risk of dying from coronavirus). It could also be because the immune system doesnt work as well once you get older. In England and Wales, almost all deaths involving Covid-19 occur in people over 45.

You cant change your age, but you can reduce your risk of catching coronavirus by strictly social distancing (staying two metres away from anyone not in your household), as well as frequent and thorough handwashing.

Men are more likely to die from coronavirus than women. This has been the case across the world and in all age groups.

There are many possible reasons for this difference between men and women, and the explanation is likely to be a combination of all of them. They include:

The evidence showing men are more likely to die from coronavirus comes from many sources, including an Office of National Statistics analysisof deaths in England and Wales, which found that the coronavirus death rate was nearly twice as high in men of working age compared to women.

Source: BHF analysis of ONS weekly death data

Another large study (not yet reviewed by other scientists) also found that men were twice as likely to die in hospital from Covid-19 - a pattern which was seen at all ages and with or without other health conditions. This information came from a platform called OpenSAFELY developed by scientists including Liam Smeeth, who is a BHF Trustee and Professor of Clinical Epidemiology at the London School of Hygiene & Tropical Medicine. The platform allows analysis of over 17 million existing NHS electronic health records to look for patterns in patients who die from Covid-19 in English hospitals.

Men and women alike can reduce their risk of catching coronavirus by social distancing (staying two metres away from other people not from their household), as well as frequent and thorough handwashing. If youre unwell, call NHS 111 or visit 111.nhs.uk or contact your GP. Follow the advice about managing any health conditions you have, and if you smoke, stop.

There's lots of evidence that having an existing long-term health condition raises your risk from Covid-19. Heart disease is one of the most common health conditions among those who die from Covid-19. Of the Covid-19 deaths examined in a British Heart Foundation analysis of ONS data in March and April, ischaemic heart disease was the second most common main pre-existing health condition in deaths involving Covid-19 overall, present with 10% of Covid-19 deaths, and was the most common main pre-existing condition in males under 70. Ischaemic heart disease includes coronary heart diseasesuch as heart attacks, angina, or anyone who has had a heart bypassor stentprocedure.

A recent studyof 20,133 UK patients in hospital with Covid-19 found that their most common conditions were chronic heart disease (31%), uncomplicated diabetes(21%), chronic lung disease (not asthma) (18%) and chronic kidney disease (16%). Other early reports from China and Italy have similarly found links to an increased risk of dying with Covid for people who have chronic lung disease (not asthma), heart disease and brain disease.

NHS England data also shows that 12% of people who died in-hospital with Covid-19 had ischaemic heart disease.

In April, the most frequently recorded underlying cause of death after Covid-19 was dementia, which includes vascular dementiaand Alzheimers. Cerebrovascular conditions, which involve problems with the blood supply to the brain, such as stroke, was listed as the fifth most common underlying cause of death. Patterns in leading causes of death were the same in both England and Wales. We dont yet have a clear picture of how having had a stroke is linked to your risk from coronavirus, although more evidence is emerging.

People with dementia and Alzheimers disease had significantly more deaths reported compared to the 5-year average in both England and Wales. NHS England data also shows 19% of people who died in-hospital with Covid-19 had dementiathe second largest pre-existing condition following diabetes.

NHS England data shows that diabeteswas the most common condition among people who died in-hospital with Covid-19 (27% of deaths), although this also reflects the fact that diabetes is a common condition.

The OpenSAFELY collaborative found that having uncontrolled diabetes was linked with twice the risk of dying with Covid-19.

A recent study (not yet reviewed by other scientists) of over three million people with diagnosed Type 1 and Type 2 diabetes in England found that the risk of Covid-19 death when you have diabetes increases in line with the level of hyperglycaemia (high blood sugar). We can also see that since the start of April, the weekly rate of deaths in people with diabetes has been twice what it was before the coronavirus outbreak.

Keeping your diabetes under control could help to manage your risk. Take any medication youre prescribed, eat a healthy balanced diet, take regular exercise, and check your blood sugar levels regularly if your doctor has recommended you do that.

Being obeseis already linked to a large number of health problems, including heart and circulatory diseases. But regardless of whether or not you have other health issues, it seems that obesity increases your risk of dying from coronavirus.

We dont fully understand why this is. Part of the reason may be that people who are obese are more likely to have other conditions such as diabetes and heart disease, which increase your risk of dying from Covid-19. But being obese does seem to have an additional damaging effect of its own. This could be because people who are very overweight are more likely to have breathing difficulties, for example because their lungs can contain less air and the muscles that support breathing are weaker. This can make them more likely to develop pneumonia, which is one of the serious complications of Covid-19 infection. Because the heart relies on the lungs to supply oxygen to the blood, breathing difficulties also mean the heart is under extra strain.

Around 27% of adults in the UK are obese (defined as having a BMI over 30). Its less clear how much being overweight (a BMI of 25-30) affects your level of risk from coronavirus, although any increase in risk is likely to be smaller. More than a third (35%) of adults in the UK are overweight.

Figures covering England, Wales and Northern Ireland from the Intensive Care National Audit Research Centre suggestthat at least two thirds of people who have fallen seriously ill with coronavirus were overweight or obese.

A recent study (not yet reviewed by other scientists) of 16,749 UK patients in hospital with Covid-19 found that obesity was linked to a higher risk of dying (around a 37% increase in risk of death). That study took into account factors such as age, sex and other health issues. The OpenSAFELY collaborative also found increasing risk of death in relation to how obese people were.

Early figures, this time from Shenzhen in China, found that being overweight was associated with an 86% higher, and obesity with a 142% higher, risk of developing severe pneumonia among patients with Covid-19, compared with patients of normal weight. This was only based on 383 patients, although it did make allowances for other factors that could have affected the results.

Theres never been a better time to start losing weight, and anything you can do to reduce your weight is likely to help manage your risk. Aside from coronavirus, losing weight if youre overweight will help reduce your risk of heart problems, of many cancers, and will reduce strain on your joints so you can feel better and do more of the things you want to do.

If youre trying to lose weight, do it in a heart-healthy way that you can stick to. Crash diets dont last, and you need a healthy balanced diet in order to keep your immune system working properly, which will help you fight off Covid-19 and other infections.

The evidence on how much high blood pressureincreases your risk from Covid-19 is mixed. The data available only looks at people who have had a diagnosis of high blood pressure not everyone with high blood pressure has been diagnosed, and some people with a diagnosis hypertension may have had their blood pressure lowered by medication, but thats what the statistics are able to reflect. The picture is complicated because, like many of the risk factors, its hard to separate from other factors such as age and having other health conditions. As more information becomes available, the picture may become clearer. But there does seem to be a link between high blood pressure and severe illness or death from coronavirus.

Figures based on intensive care admissions in Italy, the US, Sweden and Spain suggests that hypertension made it more likely that someone would be admitted to intensive care with coronavirus. However, these figures dont take into account other health problems that patients in the study may have had. It may be that people with high blood pressure were more likely to also have other health problems and that this affects the results.

Another studythat examined 44,600 patients using data from the Chinese Center for Disease Control and Prevention found that hypertension increased the risk of death. But from this information we cannot work out whether the link would still exist once the effect of peoples age and sex have been factored in.

A studyof 1150 Covid-19 adults admitted to two New York City hospitals found that hypertension increased the risk of death, but after adjusting for other risk factors this was no longer statistically significant.

Figures from the Office of National Statistics found that hypertension was a common pre-existing condition among men under 60 whose death was related to coronavirus. These were deaths where hypertension as well as Covid-19 were listed on the death certificate, so it seems likely that in these cases, hypertension was a contributing factor.

But it is difficult to accurately separate increased blood pressure from the increase in risk from coronavirus that comes in age, as your risk of blood pressure also rises with age.

There are lots of things you can do to improve your blood pressure. Which of these things would help you?

There's lots of evidence that people of black, Asian and minority ethnic origin are more likely to become seriously ill or die from coronavirus. Whats harder to understand is how much this is because of factors such as deprivation, other health conditions, the type of work you do, and where you live. It seems unlikely that theres a simple genetic explanation for the increase in risk. There certainly isnt concrete evidence for a genetic factor that could be causing the differences in rates of severe illness or death.

The relationship between your ethnic background and Covid-19 is not yet fully understood, and your risk of catching or dying from Covid-19 is affected by many different factors. Although there are some issues that affect more people of ethnic minority backgrounds, they do not affect every individual and we should be wary of making generalisations.

The Government has launched an inquiry to try to understand the impact of factors that affect your risk from Covid-19, including ethnicity, gender and obesity and including a focus on levels of risk among NHS staff. The British Heart Foundation has welcomed this inquiry. We are also supporting the NIHR-UKRI call for research on Covid-19 and ethnicity; it is vital that more research is done to understand this trend and to find out what we can do to protect everyone.

The type of work you do seems to be linked to your risk of dying from Covid-19. This partly because different types of job come with different levels of contact with other people, and therefore risk of becoming infected. Certain roles may also be more or less likely to be provided with PPE (personal protective equipment).

Analysis by the Office for National Statistics (ONS) found that being a care worker is linked to a higher risk of death from Covid-19 illness but being as a doctor or nurse isnt. However, these findings were not adjusted for ethnic background, socio-economic class or where you live.

Whilst NHS staff are more likely to come into contact with coronavirus, an ONS analysis found that they are not at higher risk of death related to Covid-19, after adjusting for age or sex. But it remains that NHS staff from ethnic minorities have been dying disproportionately.

We know socio-economic class can have an impact on almost every aspect of your health. The differences in between different occupations may be related to the risk of exposure to coronavirus, but thats not necessarily the whole picture. Overall, men working in low-skilled or caring, leisure and other service occupations had the highest rates of death involving Covid-19, and managers, directors, senior staff and professional occupations had the lowest rates. This strongly suggests that socio-economic factors such as deprivation are also playing a role in these differences.

You may not be able to change your job, but if youre concerned, its a good idea to speak to your employer about your worries. You may be able to work from home, move to a different role, or temporarily stop working.

From early March to mid-April (when deaths were at a peak in the UK), London had the highest age-standardised death rate involving Covid-19 in England and Wales. In both England and Wales, the rate of deaths involving Covid-19 was nearly double in the most deprived areas compared with the least deprived areas.

In recent weeks (ending 15 May), the largest number of deaths involving Covid-19 as well as the largest proportion of Covid-19 deaths (31%) were in the North West. This was the first time since mid-March that London did not have the highest proportion of deaths involving Covid-19 in England and Wales.

Smoking makes it more likely that you will catch Covid-19 and more likely that you will get seriously ill or die from it.

Thats partly because smokers touch their face and mouth more, meaning that they can become infected more easily. And smoking damages your lungs, making you more vulnerable to severe illness from respiratory diseases including Covid-19.

Some misleading headlines have suggested that tobacco or smoking may reduce your risk from coronavirus, or could help to treat it. It is true that some studies have found that smokers have a lower death risk, but that is likely to be more to do with the way the results were analysed and different factors were adjusted for which can never be a completely perfect and reliable process. Even if smoking did have a small protective effect against Covid-19, this would still be hugely outweighed by the well-known harm smoking that smoking cause to your health.

Many people in the UK are already quitting smoking in order to reduce their risk of catching coronavirus. Aside from coronavirus, we know that within days of stopping smoking your breathing becomes easier, and within weeks your circulation will start to improve. If you need a time to quit, make it now.

If you are feeling anxious or worried about the effect of Covid-19 on your day-to-day life, you are not alonemany people in the UK are feeling the same way.

As this outbreak continues to unfold, the evidence will grow and scientists will begin to better understand more about how Covid-19 virus works, how it affects our bodies and how to treat it. In the meantime, our priority should be managing both our mental and physical health.

Everyones individual risk is different, and it is important to remember that an increased risk is not a death sentence. Almost everything we do in life comes with some level of risk its a part of life.

When youre trying to decide what to do, for yourself or a loved one, you might want to consider your (or their) state of health, not just which of these risk factors you or they may have.

As many of us think about going back to work, or starting to use public transport again, remember that you can reduce your risk of catching coronavirus by strictly social distancing (staying two metres away from anyone not in your household), as well as frequent and thorough handwashing.

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A guide to what factors put you at risk from coronavirus - British Heart Foundation