Ethnicity profiles of COVID-19 admissions and outcomes

Abstract

Tang and his colleagues compared hospitalised, community and staff Coronavirus disease 2019 (COVID-19) infection rates during the early phase of the evolving COVID-19 epidemic [1] , but an emerging factor is the ethnicity of individuals. In this letter, we report our investigation into the potential associations between ethnicity and COVID-19. Despite only 15% of the UK population being from black and ethnic minority (BAME) backgrounds [2] , recent data has identified that 34% of patients admitted to intensive care (ITU) with COVID-19 belong to BAME groups [3] . The potential difference in outcomes associated with ethnicity for patients with COVID-19 has caused concern within the scientific community, with many calling for further research [ 4 , 5 ].Consequently, we analysed routinely collected data from adult patients at Sheffield Teaching Hospitals (STH) between 01/03/20 and 25/04/20. Ethnicities were categorised into BAME (including Black, Asian-subcontinent, mixed and any other non-White background), White and Not Known. A total of 3018 patients were tested for COVID-19, of whom 1493 were female and 1499 male (26 gender-unknown). Median age for BAME patients was 54 years and for White patients was 71 years.Overall data showed that of the 3018 patients tested, 806(26 • 7%) were positive for COVID-19, including 95 from a BAME and 631 from a White background ( Table 1 ). BAME patients were significantly more likely to test positive than the White cohort (X 2 (1, n = 726) = 4 • 9561, p = • 026). Whilst there was an almost equal gender split in terms of population tested, men were significantly more likely to test positive than women ((X 2 (1, n = 2922) = 16 • 90,189, p < • 0 0,0 01). BAME men were significantly more likely to test positive compared to both BAME women (X 2 (1, n = 296) = 7 • 2608, p = • 007) and White men (X 2 (1, n = 1349) = 6 • 7514, p = • 009). Furthermore, positive BAME patients were significantly younger than White patients, with a median age of 55 years compared to 77 years (Mann-Whitney U = 15,155, p < • 001 two-tailed).Of positive patients, 755 were admitted to hospital for further treatment or were tested whilst inpatient. There was no significant difference between BAME and White groups in terms of overall admissions (X2(1, n = 726) = 3 • 0032, p = • 083). BAME inpatients were, however, significantly more likely to be admitted to ITU compared to White inpatients (X2(1, n = 695) = 23 • 977, p < • 0 0,0 01). After age adjustment, black (2 • 97, p = • 010) and sub-continental groups (2 • 43, p = • 087) had much higher odds than the white cohort (1) for ITU admission. Whilst men accounted for just over half (450/806

Genetic variants of the human host influencing the coronavirus-associated phenotypes (SARS, MERS and COVID-19): rapid systematic review and field synopsis

“…In a global pandemic, the genetic diversity of populations across the world implies the need for inclusive investigations recruiting participants from the different genealogical and geographical origin. We endorse the recommendations recently invoked [94] and followed in an exploratory study [95], strongly suggesting the implementation of ethnicity forms and the analysis of data disaggregated by attributed ancestry.…”

Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis

“…Two studies reported non-significant difference in unadjusted mortality risk in Black (vs. non-Black) [18,19]. Four studies (three unadjusted, one adjusted analyses) did not find an increase in mortality risk amongst non-White ethnicity [20][21][22][23]. Four studies reported lower mortality risk in Hispanic patients compared to that in non-Hispanic patients; two reported significant unadjusted analysis, and none reported significant ageadjusted analyses [24][25][26][27].…”

“…Seven studies were not suitable for meta-analysis. Five UK-based studies reported over-representation of the BAME communities in ICU cohorts [20,21,46,50,51], with two reporting higher age-adjusted risk for BAME [20,21]. On the other hand, two US studies did not find a significant difference in risk of ICU admission between Black and non-Black study participants [18,19].…”

“…Seven studies were not suitable for meta-analyses. In a descriptive unadjusted analysis, three studies reported no differences between the number of Hispanic and non-Hispanic patients [25], Black and non-Black patients [18] and between White and BAME patients [20]. Despite no significant differences, ethnic minorities were still disproportionately represented in COVID-19 admissions [45,46].…”

The under-representation of BAME patients in the COVID-19 Recovery trial at a major London NHS Trust

“…A recent letter in this journal by Kakkar and colleagues noted how, during the first wave of the coronavirus pandemic, black, Asian and minority ethnic (BAME) inpatients were significantly more likely to be admitted to intensive care compared to white inpatients at Sheffield Teaching Hospitals. 1 This is just one piece of a growing body evidence that illustrates how BAME individuals have been disproportionately affected by the novel coronavirus pandemic, with excess mortality due to COVID-19 in BAME populations in England now a well-established phenomenon. 2 The precise makeup of factors responsible for this disparity remains unknown.…”