Ethnicity, household composition and COVID-19 mortality: a national linked data study.

Vahé Nafilyan,Peter Goldblatt,Daniel Ayoubkhani,Karen Tingay,Rohini Mathur,Miqdad Asaria,Annabel Summerfield,Myer Glickman,Srinivasa Vittal Katikireddi,Ann John,Clare Gilles,Amitava Banerjee,Kamlesh Khunti,Nazrul Islam

doi:10.1177/0141076821999973

Abstract

ObjectiveTo estimate the proportion of ethnic inequalities explained by living in a multi-generational household.DesignCausal mediation analysis.SettingRetrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020).ParticipantsAdults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568).Main outcome measuresHazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health.ResultsLiving in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups.Conclusion Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.

Highlights

People of ethnic minority background in the UK and the USA have been disproportionately affected by COVID-191–5 compared to the White population, Black and South Asian groups
We investigated how the propensity to live in a multi-generation household varies across ethnic groups, and whether this heterogeneity contributes to the raised risk of COVID-19 mortality among ethnic minority groups compared to the White population
We focus on elderly adults only, we find that almost all ethnic minority groups were at higher risk of COVID-19 deaths compared to the White population, and that the differences were attenuated once we adjusted for a range of geographical factors, sociodemographic characteristics and co-morbidities

Summary

Introduction

People of ethnic minority background in the UK and the USA have been disproportionately affected by COVID-191–5 compared to the White population, Black and South Asian groups. Household composition varies substantially between ethnic groups, with some ethnic minority populations more likely to live in large, multigenerational households.[9] While living in multi-generational households is associated with increased social capital,[10] which could have beneficial health effects,[11] it may increase the risk of potential viral transmission.[12,13] For older people, who are at greater risk of experiencing severe complications if infected, residing with younger people may represent an increase in exposure to infection, which could lead to an increased risk of hospitalisation and mortality from COVID-19. To the best of our knowledge, no study has yet examined whether the difference in household composition partly explains the elevated risk of COVID-19 mortality in ethnic minority groups

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Discussion

Conclusion