Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Abstract

Background There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19). Methods We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509. Findings Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18–1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33–1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02–1.34), South Asian (OR, 1.39; 95% CI, 1.30–1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18–1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively. Interpretation Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.

Self-reported COVID-19 vaccine hesitancy and uptake among participants from different racial and ethnic groups in the United States and United Kingdom

“…Deep-rooted and ongoing mistrust of the medical system among people of color 25 and a lack of diverse representation in clinical trials 26 , 27 may play a role in explaining this hesitancy. Moreover, racial and ethnic minorities who have already borne the disproportionate brunt of the pandemic 28 , 29 may have been taking a more cautious approach to new vaccines. Our data did not reveal differences in self-reports of localized injection-site reactions by race or ethnicity.…”

“…Non-Hispanic categories were defined as each respective race not of Hispanic or Latino ancestry. Responses were then aggregated in a manner consistent with prior analyses 29 . We excluded individuals who selected “Prefer not to say” as their response or did not answer these questions.…”

Knowledge barriers in a national symptomatic-COVID-19 testing programme

“…Digital surveys include selected populations not necessarily representative of the wider population. Such platforms have well-documented biases in demographic age, sex, and socioeconomic factors which we adjusted for in our analyses [18,32]. In addition, digital surveys may not be generalizable, as they may be enriched for health-conscious internet-connected participants, and thus underestimate disparities in at-risk demographic groups.…”

Magnifying the importance of collecting race, ethnicity, industry, and occupation data during the COVID-19 pandemic

“…It is evident that members of certain minority racial and ethnic groups with lower education and income levels are more likely to work in occupations where social isolation is not possible [ 22 ]. Socioeconomic status, usually derived based on the income level, plays a vital role in health outcomes as those with relatively low socioeconomic status may be more likely to hold a minimum wage job or work in unsafe conditions that put them at higher risk of being infected with COVID-19 [ 23 ].…”