The perception that COVID-19 disproportionately affects those in the UK from an ethnic background has been confirmed in an analysis of over 17 million people.
Early in the COVID-19 pandemic there was a high level of suspicion that patients from ethnic minorities were more likely to become infected and suffer worse outcomes. The reasons behind this disparity remain unclear and likely to be a complex interaction of health status, socioeconomic deprivation or household composition. However, while each of these factors has been considered in previous studies, none have addressed their combined effect. This was the aim of a study by a team from the Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine. The authors undertook an observational investigation using the openSAFELY platform, which holds electronic health record data for 24 million people registered with primary care practices in England and is linked to the COVID-19-related hospital admissions database. They wanted to explore whether those from ethnic backgrounds were more likely to test positive for COVID-19 as well as having an increased risk of adverse outcomes including hospitalisation, admission to an intensive care unit (ICU) and death. The openSAFELY database contains information on sociodemographic, clinical and household factors. The authors considered two time periods: the first COVID-19 wave (February to August 2020) and the second wave (September to December 2020). The primary exposure was reported ethnicity and the outcomes of interest were receiving a PCR test for COVID-19, positivity rates and hospital-related statistics, e.g., intensive care unit (ICU) admission and mortality. With the openSAFELY database, it was possible to adjust for demographics, household size, clinical covariates (body mass index, blood pressure, smoking status, diabetes etc) and all analyses were made with reference to those of white ethnicity.
Findings
Data were available for 17,288,532 individuals aged 18 years and over, the majority of whom were of white ethnicity (62.9%). However, the dataset included those of South Asian descent (2%), Black (1.9%), other ethnicity (1.9%) as well as 26.3% of unknown ethnicity. In fully adjusted models, the risk of testing positive for COVID-19 was significantly higher during the first wave for all ethnic minorities: South Asian (relative risk, RR = 1.99, 95% CI 1.94 – 2.04), Black (RR = 1.69), other (RR = 1.20) compared to those of white ethnicity. Similarly, there was an elevated risk for COVID-19-related hospital admission, ICU admission and death for all ethnic minorities. For example, among those of black ethnicity, the relative risk of hospitalisation, ICU admission and death were 1.78, 3.12 and 1.51 respectively. However, during the second wave, although the risk of hospitalisation, ICU admission and death remained significant for each of the ethnic groups, the magnitude of these risks were reduced in comparison to the first wave. In fact, only the risk of death remained significant for those of South Asian ethnicity.
Although the authors could not fully account for their findings, they suggested that household size and deprivations might have been a proxy for viral exposure, especially in cases of multigenerational living. They concluded that ethnic minorities have a disproportionately higher level of poorer COVID-19-related outcomes and called for action to reduce ethnic inequalities.
Citation
Mathur R et al. Ethnic differences in SARS-CoV-2 infection and COVID-19- related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform. Lancet 2021
