Models for mortality require tailoring in the context of the COVID-19 pandemic
Authors: Arielle Lasry, Roberta Horth
Journal: The Lancet (2020)

Amitava Banerjee and colleagues1Banerjee A Pasea L Harris S et al.Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study.Lancet. 2020; 395: 1715-1725Summary Full Text Full Text PDF PubMed Scopus (338) Google Scholar present the estimated prevalence of serious underlying medical conditions indicative of susceptibility to severe COVID-19 and mortality in England. Their results are useful for targeting prevention strategies towards people at a higher risk for severe outcomes, to forecast the demand on health systems, to avert the strain on acute care facilities, and for clinicians and their patients who are at a higher risk for severe disease to optimise control of their underlying conditions and adopt precautions for the prevention of COVID-19. Nonetheless, caution is merited in interpreting these results. The authors assume an identical effect of COVID-19 on mortality, irrespective of the underlying medical conditions, although early data suggest otherwise.2Jordan RE Adab P Cheng KK Covid-19: risk factors for severe disease and death.BMJ. 2020; 368m1198Crossref PubMed Scopus (1107) Google Scholar As data emerge on the death rates by underlying conditions and the effect of multiple conditions, it will be important to re-parameterise mortality projections. Moreover, their model does not account for disparities in the prevalence of underlying medical conditions and mortality risk across sociodemographic groups. Data from several countries show that the COVID-19 pandemic is disproportionally affecting minorities and populations with a low income. Barriers related to employment, income, housing, and access to essential services exist, and might impede the adoption of crucial mitigation strategies, such as physical distancing. Mitigation strategies, though essential for controlling an epidemic and with clear benefits for all populations, might have greater collateral negative consequences for some people than others.3Armitage R Nellums LB Considering inequalities in the school closure response to COVID-19.Lancet Glob Health. 2020; 8e644Summary Full Text Full Text PDF PubMed Scopus (220) Google Scholar A population health perspective that accounts for the broader determinants of health might help to guide clinical and public health decisions to not exacerbate existing health and sociodemographic inequities.4Silverstein M Hsu HE Bell A Addressing social determinants to improve population health: the balance between clinical care and public health.JAMA. 2019; 322: 2379-2380Crossref PubMed Scopus (32) Google Scholar We declare no competing interests. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort studyWe provide policy makers, researchers, and the public a simple model and an online tool for understanding excess mortality over 1 year from the COVID-19 pandemic, based on age, sex, and underlying condition-specific estimates. These results signal the need for sustained stringent suppression measures as well as sustained efforts to target those at highest risk because of underlying conditions with a range of preventive interventions. Countries should assess the overall (direct and indirect) effects of the pandemic on excess mortality. Full-Text PDF Open AccessModels for mortality require tailoring in the context of the COVID-19 pandemic – Authors' replyWe thank Arielle Lasry and Roberta Horth for their comments on our study1 and agree that long-term mortality models, applicable to people with different underlying conditions, have an important ongoing role in the COVID-19 response, and that they require further development to include wider determinants of health. Full-Text PDF