Evidence for ethnic inequalities in mortality related to COVID-19 infections: findings from an ecological analysis of England

Abstract

ObjectivesIn the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.DesignEcological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.SettingLocal authorities in England.ResultsFor every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5·12, 95% CI (4·00 to 6·24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4·42, 95% CI (2·24 to 6·60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people.ConclusionsWe find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.

COVID-19 and Adolescent Mental Health in the United Kingdom

“…Ethnic minority. Owing to notable ethnic inequalities in COVID-19 infection and mortality rates and in the cascading socioeconomic impact of the pandemic in the UK [18,19], we use a dummy variable to distinguish between white British/Irish adolescents (¼0; 84%) and ethnic minority adolescents (¼1; 16%). Small cell sizes prevented us from disaggregating ethnic minority adolescents into more detailed subgroups.…”

Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

“…Addressing racial and ethnic discrimination is vital to global efforts in defeating COVID-19 (Bhala et al 2020). Data from the UK, US and Europe find racial and ethnic minority groups have experienced disproportionately high rates of infection and mortality (Bhala et al 2020; Office for National Statistics 2021; Nazroo and Becares 2020;Valeriani et al 2020). Multiple and inter-related proximal causes of such inequalities have been suggested.…”

“…They are also more likely to be employed as essential workers or less able to work from home, and therefore experience a greater risk of exposure at work or commuting (Office for National Statistics 2021). Underlying these more immediate risk factors is the cumulative impact of structural and institutional racism (Nazroo and Becares 2020).…”

Associations Between Structural and Social Determinants of Health With COVID Infection Rates at a Safety Net Hospital.

“…12 Nazroo et al from United Kingdom reported that rates of COVID-19-related mortality within a local authority increased as the proportion of the population who were of ethnic minority increased. 13 Goodman et al in a cross-sectional United States population demonstrated that men, hypertension and obesity, age 20-39 years were associated with the highest mortality in hospitalized patients. 14 Zhang et al from Wuhan epicenter demonstrated that male sex, a severe COVID-19 condition, expectoration, muscle ache, and decreased albumin were independent risk factors for mortality.…”