Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

Sze, Shirley; Pan, Daniel; Nevill, Clareece R; Gray, Laura J.; Martin, Christopher; Nazareth, Joshua; Minhas, Jatinder S.; Divall, Pip; Khunti, Kamlesh; Abrams, Keith R.; Nellums, Laura B; Pareek, Manish

doi:10.1016/j.eclinm.2020.100630

Cited by 543 publications

(540 citation statements)

References 88 publications

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“…A study by Adhikari and colleagues [ 9 ] concluded that counties with higher rates of poverty and those with more diverse populations had significantly higher infection and death rates compared to counties with a substantial White population. Next, lower socioeconomic status is intricately linked to larger household sizes, crowding, and therefore more cross-infection [ 10 ]. This emphasized the needed to untangle the differences in immunologic response to SARS-CoV-2 based on race/ethnicity [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Demographic predictors of hospitalization and mortality in US children with COVID-19

Moreira¹,

Chorath

Rajasekaran

et al. 2021

Eur J Pediatr

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Understanding which children are at increased risk for poor outcome with COVID-19 is critical. In this study, we link pediatric population-based data from the US Center for Disease Control and Prevention to COVID-19 hospitalization and in-hospital death. In 27,045 US children with confirmed COVID-19, we demonstrate that African American [OR 2.28 (95% CI: 1.93, 2.70)] or mixed race [OR 2.95 (95% CI: 2.28, 3.82)] and an underlying medical condition [OR 3.55 (95% CI: 3.14, 4.01)] are strong predictors for hospitalization. Death occurred in 39 (0.19%) of 20,096 hospitalized children; children with a prior medical condition had an increased odd for death [OR 8.8 (95% CI: 3.7, 21.1)].Conclusion: Hospitalization and in-hospital death are rare in children diagnosed with COVID-19. However, children at higher risk for these outcomes include those with an underlying medical condition, as well as those of African American descent.

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Section: Discussionmentioning

confidence: 99%

Demographic predictors of hospitalization and mortality in US children with COVID-19

Moreira¹,

Chorath

Rajasekaran

et al. 2021

Eur J Pediatr

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“…In the non-pregnant population, a recent systematic review has demonstrated that Black and Asian ethnic groups are more likely to be infected with SARS-CoV-2 compared to those of White ethnicity [16]. This suggests that the disproportionate impact could be attributable to increased infection in these ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

pregnancy¹,

Vousden

Bunch

et al. 2021

Preprint

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BackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

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“…While some earlier challenges in achieving vaccine uptake in the ultra-orthodox Jewish community have been addressed, uptake was also initially low in Israeli Arab areas and it is taking longer to address that challenge [ 13 ]. Disadvantaged communities in all countries have borne the brunt of the pandemic, with higher rates of infection [ 14 ] and worse outcomes [ 15 ]. They have also suffered most from the economic and social consequences of responses.…”

Section: Lessons For Other Countriesmentioning

confidence: 99%

What can we learn from Israel’s rapid roll out of COVID 19 vaccination?

Rajan

2021

Isr J Health Policy Res

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Israel has led the world in rolling out its COVID-19 vaccination program. This experience provides lessons that others can learn from. It is, however, necessary to consider some national specificities, including the small size of the country, its young population, and the political imperative to drive this program forward. Israel also has a number of other advantages, including a strong public health infrastructure. The lessons that can be learnt include the importance of coordinating delivery mechanisms with the inevitable prioritisation of groups within the population, timely deployment of a skilled cadre of health workers, a recognition that not everyone in the population shares in the benefits of digital connectedness, the need to reach out to disadvantaged groups, based on an understanding of the barriers that they face, and the importance of placing COVID-19 vaccination within a comprehensive response to the pandemic.

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Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

Cited by 543 publications

References 88 publications

Demographic predictors of hospitalization and mortality in US children with COVID-19

Demographic predictors of hospitalization and mortality in US children with COVID-19

The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

What can we learn from Israel’s rapid roll out of COVID 19 vaccination?

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