Ethnic minorities and COVID-19: examining whether excess risk is mediated through deprivation.

Alex Rowlands,Clare L Gillies,Kamlesh Khunti,Thomas Yates,Melanie J Davies,Francesco Zaccardi,David E Kloecker,Cameron Razieh,Nazrul Islam,Yogini V Chudasama

doi:10.1093/eurpub/ckab041

Abstract

BackgroundPeople from South Asian and black minority ethnic groups are disproportionately affected by the COVID-19 pandemic. It is unknown whether deprivation mediates this excess ethnic risk.MethodsWe used UK Biobank with linked COVID-19 outcomes occurring between 16th March 2020 and 24th August 2020. A four-way decomposition mediation analysis was used to model the extent to which the excess risk of testing positive, severe disease and mortality for COVID-19 in South Asian and black individuals, relative to white individuals, would be eliminated if levels of high material deprivation were reduced within the population.ResultsWe included 15 044 (53.0% women) South Asian and black and 392 786 (55.2% women) white individuals. There were 151 (1.0%) positive tests, 91 (0.6%) severe cases and 31 (0.2%) deaths due to COVID-19 in South Asian and black individuals compared with 1471 (0.4%), 895 (0.2%) and 313 (0.1%), respectively, in white individuals. Compared with white individuals, the relative risk of testing positive for COVID-19, developing severe disease and COVID-19 mortality in South Asian and black individuals were 2.73 (95% CI: 2.26, 3.19), 2.96 (2.31, 3.61) and 4.04 (2.54, 5.55), respectively. A hypothetical intervention moving the 25% most deprived in the population out of deprivation was modelled to eliminate between 40 and 50% of the excess risk of all COVID-19 outcomes in South Asian and black populations, whereas moving the 50% most deprived out of deprivation would eliminate over 80% of the excess risk of COVID-19 outcomes.ConclusionsThe excess risk of COVID-19 outcomes in South Asian and black communities could be substantially reduced with population level policies targeting material deprivation.

Highlights

Coronavirus disease-2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus
A recent analysis of population level data from the UK concluded that the elevated risk of COVID-19 mortality in South Asian and black populations was largely explained by demographic and socio-economic factors closely linked to deprivation [3], with conclusions based on the degree of attenuation with adjustment
These findings only provide estimates of risk when markers of deprivation are held at a fixed value; they do not quantify the degree to which the excess risk in ethnic minority groups could be eliminated by reducing material deprivation using formal mediation analysis frameworks

Summary

Introduction

Coronavirus disease-2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Mounting evidence suggests that people from minority ethnic groups in the United Kingdom (predominantly South Asian and black African or Caribbean populations) and elsewhere are disproportionately affected by COVID-19 with a higher risk of infection, hospitalisation and mortality [1,2,3,4,5]. A recent analysis of population level data from the UK concluded that the elevated risk of COVID-19 mortality in South Asian and black populations was largely explained by demographic and socio-economic factors closely linked to deprivation [3], with conclusions based on the degree of attenuation with adjustment These findings only provide estimates of risk when markers of deprivation are held at a fixed value; they do not quantify the degree to which the excess risk in ethnic minority groups could be eliminated by reducing material deprivation using formal mediation analysis frameworks. It is unknown whether deprivation mediates this excess ethnic risk

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Results

Conclusion