Investigating the association between ethnicity and health outcomes in SARS-CoV-2 in a London secondary care population

PLoS One. 2020 Oct 28;15(10):e0240960. doi: 10.1371/journal.pone.0240960. eCollection 2020.

Abstract

Background: Black, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2.

Methods and findings: We conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 -April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70-63.73 versus 69.3 years, 95% CI 67.17-71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90-72.90 versus, 77.40 years, 95% CI 76.1-78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22-3.25, p<0.006).

Conclusions: BAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Asian People / statistics & numerical data
  • Betacoronavirus*
  • Black People / statistics & numerical data
  • COVID-19
  • Child
  • Child, Preschool
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / ethnology*
  • Coronavirus Infections / therapy
  • Ethnicity / statistics & numerical data*
  • Female
  • Hospital Mortality
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • London / epidemiology
  • Male
  • Middle Aged
  • Minority Groups / statistics & numerical data
  • Pandemics*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / ethnology*
  • Pneumonia, Viral / therapy
  • Retrospective Studies
  • SARS-CoV-2
  • Secondary Care / ethnology
  • Secondary Care / statistics & numerical data
  • Socioeconomic Factors
  • Survival Analysis
  • Treatment Outcome
  • Young Adult

Grants and funding

The authors received no specific funding for this work. However, EC is supported by Economic and Social Science Research Council (ESRC) and the National Institute for Health Research, UK Department of Health [HPRU–2012–10047] in partnership with Public Health England. LSPM acknowledges support from the National Institute of Health Research (NIHR) Imperial Biomedical Research Centre (BRC) and the National Institute for Health Research Health Protection Research Unit (HPRU) in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the UK Department of Health.