Ethnicity and Risk of Death in Patients Hospitalised for COVID-19 Infection: An Observational Cohort Study in an Urban Catchment Area

Abstract

Background: Studies during the COVID-19 pandemic have suggested patient characteristics with increased risk of death. Most studies have not included populations which reflect an urban UK demographic but emerging case reports have suggested poorer outcomes in certain ethnic groups. It was hypothesised that people from South Asian ethnic groups would be more susceptible to severe manifestations of COVID-19. Methods: Patients with confirmed SARS-CoV-2 infection by positive polymerase chain reaction testing and requiring admission to University Hospitals Birmingham NHS Foundation Trust in Birmingham UK between 10th March 2020 and 17th April 2020 were included. Demographics, ethnicity, baseline co-morbidities, social deprivation index and outcome (death within the censor date) were assessed and Cox regression analysis conducted. Using observed sex-specific age distributions of COVID-19 admissions/deaths and 2011 census data for Birmingham/Solihull, expected numbers of admissions and deaths were estimated and ratios of observed to expected numbers calculated, providing standardised admission ratios (SAR) and standardised mortality ratios (SMR). Results: 2217 patients admitted to UHB with a proven diagnosis of COVID-19 were included. 58.2% were male, 69.5% White and the majority (80.2%) had co-morbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger (median age 61 vs.77), have no co-morbidities (27.8% vs. 16.6%) but a higher prevalence of diabetes mellitus (48.1% vs 28.2%) than White patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted. These patients were more likely to present with severe disease. South Asian ethnicity was associated with an increased risk of death (Hazard Ratio 1.67 (95%CI 1.34 – 2.10)) after adjusting for age, sex, deprivation and comorbidities. Interpretation: Current evidence suggests those of South Asian ethnicity may be at risk of worse COVID019 outcomes, further studies needs to establish the underlying mechanistic pathways. Funding Statement: HDRUK Hub PIONEER Declaration of Interests: S Gallier, C Mainey, P Nightingale, D McNulty, A Kolesnyk, M Ahmed, H Crothers, F Evison, A Liaqat, L Irshad, M. Harris, T Nabavi, P Cockwell, D Pagano, report no conflicts of interest. S Ballreports funding support from the HDFR-UK, K Reeves reports funding support from the NIHR, E Sapey reports funding support from the MRC, Wellcome Trust, NIHR and British Lung Foundation. K. Nirantharakumar reports funding from MRC, Wellcome Trust, NIHR, Vifor and AstraZeneca. A.K Dennistonreports funding from HDR-UK, Wellcome Trust and Fight for Sight. Ethics Approval Statement: This retrospective cohort study, using prospectively collected data was conducted as part of DECOVID, an HRA and London - City & East Research Ethics Committee approved research database (Ethics number 20/HRA/1689).