A study of more than 17 million adults in England adds to a large body of evidence indicating that, compared with White populations, racial minorities have borne a heavier burden of COVID-19 infections, hospitalizations, intensive care unit (ICU) admissions, and deaths.
Led by researchers from the London School of Hygiene & Tropical Medicine and published late last week in The Lancet, the observational study involved the electronic health records of patients registered with primary care practices during the pandemic's first (Feb 1 to Aug 3) and second (Sep 1 to Dec 31) wave in 2020.
Among the 17,288,532 community-dwelling adults representing about 40% of the English population, 62.9% were White, 5.9% were South Asian, 2.0% were Black, 1.0% were mixed race, 1.9% were of "other" race, and 26.3% didn't indicate their race.
During the first pandemic wave, the odds of being tested for COVID-19 were slightly higher in the South Asian group (adjusted hazard ratio [aHR], 1.08), the Black group (aHR, 1.08), and the mixed-ethnicity group (aHR, 1.04), while those of other race had lower odds (aHR, 0.77) compared with the White group.
Similarly, the South Asian group had higher odds of testing positive for coronavirus (aHR, 1.99), as did the Black group (aHR, 1.69), the mixed-ethnicity group (aHR, 1.49), and the other race group (aHR, 1.20). These groups' likelihood of requiring hospitalization for COVID-19 was also higher than those of the White group (South Asian aHR, 1.48; Black aHR, 1.78; mixed ethnicity aHR, 1.63), and other race aHR, 1.54).
Likewise, the racial minority groups were much more likely than the White group to be admitted to the ICU (South Asian aHR, 2.18; Black aHR 3.12; mixed ethnicity aHR, 2.96; other aHR, 3.18) and more likely to die of their infections (South Asian aHR, 1.26; Black aHR, 1.51; mixed ethnicity aHR, 1.41; other aHR, 1.22).
Disparity widens for South Asians in 2nd wave
During the second wave, the risk of hospitalization, ICU admission, and death increased in the South Asian group relative to the White group but lessened for the Black group.
The authors said that social deprivation was the most likely reason for the disparities in all groups except South Asians, who were likely more affected by underlying health conditions and relatively large households sizes, which they said confer disadvantages as well as advantages.
"While multigenerational living may increase risk of exposure and transmission (from children or working age adults to older or vulnerable family members), such households and extended communities also offer valuable informal care networks and facilitate engagement with health and community services," lead author Rohini Mathur, PhD, of the London School of Hygiene & Tropical Medicine, said in a Lancet press release.
The researchers noted that these differences persisted even after adjusting for differences in sociodemographic, clinical, and household characteristics. "Causes are likely to be multifactorial, and delineating the exact mechanisms is crucial," they wrote.
"Tackling ethnic inequalities will require action across many fronts, including reducing structural inequalities, addressing barriers to equitable care, and improving uptake of testing and vaccination."
Boosting vaccine confidence
In a commentary in the same journal, Daniel Morales, MBChB, PhD, of the University of Dundee in Scotland, and Sarah Ali, MBChB, of the Royal Free London National Health Services Foundation Trust, noted that future research on why different racial groups had different COVID-19 outcomes will be critical.
But the biggest challenge now, Morales and Ali said, is ensuring that people in all racial minority groups are vaccinated against COVID-19.
"There are reports of increased hesitancy among minority ethnic groups, including those working in front-line health and social care roles, who are known to face an increased risk of COVID-19," they wrote. "Unless direct measures are taken to increase vaccine confidence, differential vaccine uptake could further exacerbate health inequalities faced by minority ethnic groups compared with White groups."