Coronavirus (COVID-19) advice for people on the Highest Risk List: evidence review

Annex B - Highest Risk List Mortality and Deaths Data

Footnote ^[10]

14. Since the start of the COVID-19 outbreak, Public Health Scotland (PHS) has been working closely with Scottish Government and health and care colleagues to monitor COVID-19 amongst the population. This section presents analysis based on the latest published PHS figures (as at 21 February 2022) on COVID-19-related deaths for the Highest Risk List in Scotland^[11]. Comparisons are made with mortality rates for the rest of the population. Levels of excess mortality due to COVID-19 within the Highest Risk List cannot be easily established as there is no similar cohort pre-COVID-19 pandemic to compare against.

14.1 As at 21 February 2022, there were 177,475 individuals on the Highest Risk List in Scotland. This equates to around 3.2% of the Scottish population. The table below (Figure 5) shows the number and rate per 100,000 population of individuals on the Highest Risk List by age group and sex. Fifty-one per cent of people on the Highest Risk List are aged 65 and over, and 56% are women.

Figure 3 - Number and rate per 100,000 population of individuals on highest risk list by age group and sex. There are 33 individuals whose age is unknown.

15. COVID-19 deaths in the Highest Risk List

15.1 In January 2022, COVID-related deaths in the Highest Risk List accounted for 25% of all COVID-related deaths in Scotland. This has decreased in the last few months from 39% in June 2021 (although the latest figures may rise as deaths are identified as being in the Highest Risk List).

15.2 The proportion of people on the Highest Risk List dying of COVID-related causes within 28 days after a positive test fell from a high of 19% in January 2021 to 6% by April 2021 (figure 6) and it remained around this level until December 2021^[12] when it dropped further to 2% (the lowest in the time series).

15.3 We do not know if those dying of COVID-related causes were vaccinated, but as of 31 January 2022, 97% of the Highest Risk List had received at least one vaccine dose, 96% had received two doses and 90% had received a booster or a third dose. This fall in COVID-related deaths may support findings from studies such as Kearns et al and McKeigue et al that suggest COVID-19 vaccinations do produce antibodies and offer some protection for people on the Highest Risk List, albeit on a reduced level compared to the general population.

15.4 The number of COVID-related deaths amongst the Highest Risk List in Scotland remains highest for those in the respiratory and clinician identified groups. It is lowest for pregnant with heart disease (where there have been no deaths) and in the transplant group (figure 7).

15.5 A similar pattern is seen for non COVID-related deaths (figure 8), with the exception of the cancer group which has the second highest number of non COVID-related deaths compared to the third highest number of COVID-related deaths.

16. COVID-19 mortality rates in the Highest Risk List

16.1 The Highest Risk List as a whole had a COVID-19 mortality rate 9 times higher than the non-Highest Risk List population in January 2022 (figure 9). This supports annotated bibliography findings that suggest that there remains an increased risk of COVID-19 mortality for the Highest Risk List after vaccination compared to the general population. The COVID-19 mortality ratio has fallen in the last few months from 17 times higher in June 2021 (highest in the time series).

16.2 In January 2022, the cancer, rare diseases and clinician identified groups had the highest relative COVID-related mortality rate at 12 times higher than the non-Highest Risk List population.

16.3 In January 2022, the cancer, clinician identified, and rare diseases groups had the highest COVID-related mortality rate(figure 10). There has been an increase in COVID-related mortality rates in most groups since December 2021(figure 10). As mentioned above, there have been no deaths in the pregnant with heart disease group.

16.4 In comparison, the non COVID-related mortality rates in the Highest Risk List are more diverse, being the highest for the cancer group and lowest for the immunosuppression, transplant and pregnant with heart disease groups (figure 11).

16.5 Non COVID-related mortality is much higher than the COVID-related mortality (figure 12), for the Highest Risk List as a whole as well as for each individual group.