1. Participants identifying as South Asian or Black were more likely to test positive for COVID-19 infection, be hospitalized for COVID-related symptoms, and be admitted to the intensive care unit compared with the White population.
2. In the second wave, the relative rates of COVID-related hospitalization, ICU admission, and death were further increased in the South Asian population compared to the White population.
Evidence Rating Level: 2 (Good)
Study Rundown: Since the start of the pandemic, COVID-19 has been noted to disproportionately affect minority ethnic groups versus White groups in the UK. To further understand these differences, this study analyzed electronic health record data of over seventeen million people, accounting for nearly a third of the population of England. Five high-level ethnicities were used as the primary exposure: White, South Asian, Black, other (including Chinese), and mixed. After adjusting for confounding factors, the study found that South Asian, Black and mixed ethnicity groups were more likely to be tested and to test positive compared to the White group, with South Asians having the greatest risk. During the first wave, minority ethnic groups were up to three-times more likely to be admitted to intensive care unit (ICU) and more likely to die of COVID-19 than the White group. After age-sex adjustment, the biggest factor affecting risk of testing positive in all minority ethnic groups, except South Asian, was shown to be social deprivation. For South Asians, the biggest variable on mortality was household size and deprivation, and clinical characteristics on testing positive and during hospitalization. During the much larger second wave, in contrast to wave one, all minority ethnic groups were less likely to be tested than the White group. Compared to the first wave, the outcomes in the Black group were attenuated, with a lower chance of testing positive than the White group and no difference in risk of death. This was the opposite for the South Asian group, which remained at a high risk of testing positive, being admitted to the ICU, and dying from COVID-related complications. While this study provided analysis on a wealth of data, it was unfortunately limited by a lack of social and occupational history and potentially incorrect household size data. Nonetheless, these results help shed light on disproportionately affected communities, which will inform future public health actions.
In-Depth [retrospective cohort]: In this retrospective cohort study, primary care health records were collected on the OpenSAFELY platform, which contains data for 40% of the United Kingdom’s population. 17 288 532 people over the age of 18 were included in the study, with 62.9% of these people being of White ethnicity, 5.9% South Asian, 2.0% Black, 1.9% other, 1.0% mixed, and 26.3% unknown. The study periods were defined as the first wave from Feb 1 to Aug 3, 2020 and the second wave from Sep 1 to Dec 31, 2020. Results were adjusted serially to look at the effect of explanatory factors, such as age, sex, comorbidities, house size, and deprivation. In the first wave, the South Asian (HR 1.08 [95% CI 1.07-1.09]), Black (1.08 [1.06-1.09]), and mixed ethnicity (1.04 [1.02-1.05]) were more likely to be tested for COVID-19 compared to the White group. This difference was not seen in the second wave. South Asian (1.99 [1.94-2.04]), Black (1.69 [1.62-1.77]), and mixed ethnicity (1.49 [1.39-1.59]) groups were also more likely to test positive than the White group. Black and mixed ethnic groups were more likely to be hospitalized (1.78 [1.67-1.90] and 1.63 [1.45-1.83], respectively), admitted to the ICU (3.12 [2.65-3.67] and 2.96 [2.26-3.87], respectively), and die from COVID-related complications (1.51 [1.31-1.71] and 1.41 [1.11-1.81], respectively), compared to White group. In all minority groups, hospitalization, ICU admission rates and death rates were higher than the White group. In the second wave, the South Asian group maintained a higher risk of testing positive (1.32 [1.31-1.33]) compared to White group, while this risk was attenuated in the Black group (0.85 [0.84-0.97]). Risk of ICU admission and COVID-related death were also attenuated in the Black group (ICU 1.67 [1.37-2.05], death 0.92 [0.73-1.16]) and increased in the South Asian group (ICU 2.68 [2.39-3.01]), death 1.87 [1.68-2.07]).
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