Black, Asian And Minority Ethnic Groups Research Articles

Foreign-born nurses as COVID-19 survivors in the Nordic region: A descriptive phenomenological study.

In 2020, amid limited COVID-19 vaccination access, many nurses from Black, Asian and Minority Ethnic (BAME) groups in the United States of America and United Kingdom succumbed to the virus. No fatalities among Filipino foreign-born nurses (FBNs) in the BAME groups were recorded in the Nordic region. This study explored the experiences of Filipino FBNs in the Nordic region who, during the initial 2020 pandemic wave, cared for COVID-19 patients, contracted the virus and subsequently recovered. The research employed a descriptive phenomenological methodology to explore the experiences of six Filipino FBNs who had recovered from COVID-19 in various regions of the Nordic countries, including Finland (n = 1), Sweden (n = 1), Denmark (n = 2), Norway (n = 1) and Iceland (n = 1). Data collection occurred through online videoconferencing between September 2020 and February 2021, utilising a semi-structured approach. The data analysis was conducted following Sundler and colleagues' qualitative thematic analysis, which is grounded in descriptive phenomenology. The data analysis yielded three primary themes and twelve sub-themes, which explored the experiences of Filipino FBNs with COVID-19 infection. The study demonstrated that unclear national guidelines impacted nurses' preparedness in caring for COVID-19 patients, contributing to their susceptibility to contracting the virus. The lack of occupational healthcare services for nurses during and after the pandemic affected their work morale in an unfamiliar setting. The study provided valuable insights into the experiences of Filipino FBNs during the COVID-19 pandemic, emphasising the need for clearer guidelines, enhanced training and improved support for healthcare workers. It highlighted the psychological impact of COVID-19, emphasising the importance of mental health support and stigma reduction efforts. The study also emphasised the significance of improving occupational health services to support the well-being and recovery of healthcare workers during and after the pandemic, with implications for developing comprehensive strategies to protect frontline healthcare workers in health crises.

The impact of COVID-19 on the changes in health behaviours among Black, Asian and Minority Ethnic (BAME) communities in the United Kingdom (UK): a scoping review

BackgroundThe COVID-19 pandemic has led to changes in health behaviours, which include eating patterns and nutrition, smoking, alcohol consumption, sleeping patterns, physical activity and sedentary behaviour. There is a dearth of evidence reporting the impact of COVID-19 on the health behaviour of Black, Asian and minority ethnic (BAME) communities. This scoping review synthesises the available evidence on the impact of COVID-19 on the changes in health behaviours among BAME communities in the UK.MethodsFollowing a keyword strategy, 16 electronic databases were searched for articles that met the screening criteria. These articles were then reviewed in full text. Empirical studies that assessed COVID-19 related health behaviour changes among BAME communities in the UK, conducted during the COVID-19 pandemic between July 2020 and August 2021 and published in English language, were set as inclusion criteria. An initial 2160 studies were identified in the selected databases. After removing duplications and screening the title and abstracts of the 2154 studies, only 4 studies were selected to be reviewed as they met the inclusion criteria. The included studies employed different sample sizes which ranged from N = 47 to N = 30,375 and reported several health behaviour changes. Out of the 4 included studies, 3 studies included BAME groups within their sample as a subgroup while one study focused specifically on BAME groups.ResultsThe scoping review found that there were lower levels of physical activity among BAME groups compared to the White ethnic groups. About 41.7% of BAME groups reported drinking less alcohol than usual compared to their white counterparts who were, 34% of whom reported drinking less alcohol. Study participants from BAME backgrounds had the greatest effect of COVID-19 on decisions to purchase healthier food compared to people from white backgrounds whose decisions on purchasing healthier food were least affected. Similar to other ethnic groups the COVID-19 pandemic increased positive hygiene among BAME groups which is important in preventing other diseases and infections..ConclusionCOVID-19 had a significant impact on the health behaviours of BAME groups especially during the lockdowns as they reported changes to behaviour such as low levels of physical activities. Hence, it is important to promote health awareness among BAME groups to encourage healthy living. In addition, programmes such as physical fitness activities that favour BAME groups should be put in place, for example BAME women’s walking groups to encourage people from BAME backgrounds to engage more in physical activities. Furthermore, healthy food programmes such as food parcels can be given to people from BAME backgrounds who are not able to afford healthy food due to the impact of COVID-19. Similar to other ethnic groups, the COVID-19 pandemic has increased positive hygiene among BAME groups which is important in preventing other diseases and infections.

COVID-19 pandemic experiences of students from BAME and White ethnic groups pursuing higher education in the UK: A qualitative comparative exploration.

The new severe acute respiratory syndrome coronavirus 2, SARS-Cov2, more commonly known as COVID-19 continues to be an ongoing cause of one of the most disruptive pandemics worldwide. UK universities comprise students who come from different backgrounds and cultures and the majority returned home or lived alone during the lockdown. This qualitative study aimed to compare the experiences of students from Black, Asian, and Minority Ethnic (BAME) backgrounds and White British students. An in-depth interview was conducted with each of 35 students-18 from BAME and 17 from White backgrounds-in their homes on Zoom or Microsoft between November 2020 and May 2021. Interview transcripts were checked for accuracy and were analysed using N-Vivo coding software for themes. The pre-pandemic and pandemic experiences of students were collected in the form of a data, including perceptions of the COVID-19 virus, the physical environment in which students lived, and the effect on their general wellbeing, social interactions, online learning, teaching, and assessment. Mental health issues were more prevalent among female students compared to males and this was more evident amongst BAME females who had returned to living at home, possibly due to lack of personal space. There was a reduction in personal hygiene in White females. There was an increase in the use of social media, particularly by BAME females. Students mostly disliked online learning and exams. Concerns were also raised about how universities communicated important information to the students. Based on the recommendations of the WHO in relation to COVID-19, universities need to effectively manage the information they provide to students and build trust through risk communication and community engagement. One important area in this regard is addressing access to mental health services. The reasons why BAME females experience more mental health issues should be explored further.

Patient perspectives on elective orthopaedic surgery during the COVID-19 pandemic: a comparison between patients from different ethnic backgrounds.

Suspending elective surgery during the first wave of coronavirus (COVID-19) led to record-breaking numbers of patients on waiting lists. Patients in Black, Asian and minority ethnic (BAME) groups are disproportionately affected by COVID-19. This study compares the perspectives of patients from different ethnic backgrounds on the return to elective surgery. Some 151 patients were sampled from cancelled operating lists at two hospitals. Semi-structured interviews focused on the impact of COVID-19, and views about resuming elective surgery. The Generalized Anxiety Disorder 7-iten Scale (GAD-7) measured anxiety. A visual analogue scale (VAS) measured pain. Data were analysed using exploratory thematic analysis. Fewer BAME patients were pleased about restarting surgery, compared with white patients (47.3% vs 82.6%, p<0.001), and a greater proportion wanted to postpone their operation until after the pandemic (21.8% vs 9.3%, p=0.048). White/white British patients had higher GAD-7 scores (2 (0-21) vs 0 (0-16), p=0.009). Black/Black British patients had significantly higher VAS scores compared with white/white British and Asian/Asian British patients (85 vs 75 vs 70 respectively, p<0.05). The delay in surgery due to the pandemic has had a devastating impact on patients awaiting operations. The variation in pain and anxiety levels between ethnic groups must be addressed when redesigning services to avoid discrepancies in postoperative clinical outcomes. Patients in BAME groups are more likely to postpone their operation, which may lead to further health deterioration, psychosocial and socio-economic consequences, and poorer clinical outcomes following surgery. The thoughts, feelings and concerns of all must be considered when redesigning services to prevent health inequalities between patients from different backgrounds.

What the public in England know about antibiotic use and resistance in 2020: a face-to-face questionnaire survey

ObjectivesTo describe public attitudes and knowledge around antibiotic activity, resistance and use.DesignFace-to-face household 18 question survey using computer-assisted data collection undertaken by Ipsos Market and Opinion Research International.SettingRandomly selected households...

The 'leaky' BAME pipeline in UK dentistry.

Introduction There are growing calls for dentistry to debate, critique and analyse the role and place of racism in the profession. This article supports this debate and considers whether people from Black, Asian and Minority Ethnic (BAME) backgrounds experience barriers to progressing in the profession.Aims To create a BAME 'pipeline' model illustrating how ethnicity shapes the composition of the dental profession in the UK.Material and methods Publicly available datasets from UK higher education agencies and professional dental associations were identified, examined and collated to create a BAME pipeline model.Results Registrants from the BAME category do not share similar experiences within the dental profession compared to white registrants. The experiences of British Asian people appear to be more favourable, vis-à-vis access to dental schools and progression to the General Dental Council register, compared to Black British people and other UK minority ethnic groups. Black British registrants experience blockages at all stages of their career progression, most notably when accessing dental schools, with only 2% commencing dental studies. All BAME groups 'leak' out of the dental pipeline at clinical academia. There are insufficient data to ascertain whether there are additional 'leaks' at the career specialisation stage.Discussion and conclusion The UK BAME dental pipeline is a leaky one and is in need of urgent action and repair.

Developing a toolkit for increasing the participation of black, Asian and minority ethnic communities in health and social care research

BackgroundIt is recognised that Black, Asian and Minority Ethnic (BAME) populations are generally underrepresented in research studies. The key objective of this work was to develop an evidence based, practical toolkit to help researchers maximise recruitment of BAME groups in research.MethodsDevelopment of the toolkit was an iterative process overseen by an expert steering group. Key steps included a detailed literature review, feedback from focus groups (including researchers and BAME community members) and further workshops and communication with participants to review the draft and final versions.ResultsPoor recruitment of BAME populations in research is due to complex reasons, these include factors such as inadequate attention to recruitment strategies and planning, poor engagement with communities and individuals due to issues such as cultural competency of researchers, historical poor experience of participating in research, and lack of links with community networks. Other factors include language issues, relevant expertise in research team and a lack of adequate resources that might be required in recruitment of BAME populations.ConclusionsA toolkit was developed with key sections providing guidance on planning research and ensuring adequate engagement of communities and individuals. Together with sections suggesting how the research team can address training needs and adopt best practice. Researchers highlighted the issue of funding and how best to address BAME recruitment in grant applications, so a section on preparing a grant application was also included. The final toolkit document is practical, and includes examples of best practice and ‘top tips’ for researchers.

Higher education as the pathway to personal and community success for Pakistani and Bangladeshi people: A systematic review

ABSTRACT The United Kingdom’s (UK) goal of a 20% increase in participation of Black, Asian and Minority Ethnic (BAME) groups in higher education (HE) by 2020 has not been met. Pakistani and Bangladeshi students are some of the most underrepresented BAME groups in UK HE institutions. This systematic review included 20 papers that identified barriers and facilitators towards participation in HE separately for Pakistani and Bangladeshi students in the UK. Using thematic analysis, two overarching themes were constructed: (i) the interplay of culturally expected roles on HE participation and (ii) belief that HE is vital for success. This review identified the importance of role models to challenge cultural values that restrict women from participating in HE. Many parents and children viewed HE as a route to personal and community success. The findings support the relevancy of social learning theory in driving change for models of widening participation.

COVID-19 vaccinations among Black Asian and Minority Ethnic (BAME) groups: Learning the lessons from influenza.

BackgroundThe COVID‐19 vaccination roll‐out continues to grow at significant pace around the world. There is, however, growing concern regarding vaccine hesitancy amongst Black, Asian and Minority Ethnic (BAME) populations. Such inequalities have the potential for exposing, an already at‐risk population, further. Whilst the COVID‐19 vaccination programme is in its infancy, influenza programmes have been undertaken for over 50 years, and may provide invaluable insights. In this commentary, we aim to examine the lessons from influenza vaccinations, and how this can help reduce inequalities with COVID‐19 vaccinations.Main TextSeveral factors have been associated with both seasonal and pandemic influenza vaccine hesitancy amongst BAME groups. One of the most prevalent barriers in both types of immunisation programmes is the mistrust of medical organisations. This is often a multi‐faceted issue, with previous negative healthcare discrimination, and historical unethical practices contributing towards this scepticism. This mistrust, however, is predominantly aimed towards healthcare systems, as opposed to individual physicians. In fact, physician endorsement is often a strong driver to vaccination, with Black patients who receive this support 8 times more likely to receive seasonal influenza vaccination. On the other hand, with H1N1 pandemic influenza vaccination, social norms or community influence, was an important determinant. In both seasonal and pandemic immunisation programmes, a significant amount of concern regarding side‐effects, including misinformation, was reported amongst BAME groups.ConclusionsThe use of community‐based approaches, with local advocacy, has the potential to counteract misinformation, and concerns regarding side‐effects. Moreover, using consistent physician endorsement not only in media campaigns but also through messaging would potentially help to address longstanding healthcare mistrust amongst minority ethnic groups. Close attention regarding how the vaccination programme, and the health policies introduced as a consequence, affect BAME communities in order to prevent widening inequalities in the future.

Unravelling the epidemiology and clinical impact of SARS-CoV-2 infection in neonates.

The impact of the SARS-CoV-2 pandemic has transformed the means by which health care is delivered, including perinatal care. Given neonates have unique vulnerabilities to acquiring infections,1 determining optimal practices to prevent and respond to neonatal SARS-CoV-2 infections has been an area of much discussion and debate amongst perinatal healthcare providers. Published information on the clinical characteristics and mode of acquisition for neonatal SARS-CoV-2 infection was scarce earlier in the pandemic, largely limited to case reports. An early cohort study from China revealed higher disease severity in young infants than older children, by criteria which defined severe and critical cases as including early respiratory and in some cases gastrointestinal symptoms, or progression to severe respiratory or systemic illness, respectively.2 Gale et al.'s paper presents data from a peak period of SARS-CoV-2 infection in the United Kingdom (UK) and is an important contribution to our understanding of the incidence, disease severity and transmission modes for neonatal SARS-CoV-2 infection. This study found that COVID-19 disease severe enough to require hospitalisation was rare in neonates, at 5.6 per 10 000 livebirths. While many infections were mild, the study confirms a higher propensity to severe disease in neonates than older children.2, 3 42% of cases were defined as severe, albeit using criteria that may include neonates who, while unwell, would not necessarily require intensive care.2 Data on transmission modes for neonatal SARS-CoV-2 infection have been limited and conflicting. World Health Organisation (WHO) guidelines endorse keeping mother and baby together in cases of maternal SARS-CoV-2 infection.4 However, confusion as to the likelihood of viral transmission may have influenced adherence to these guidelines, with a number of cases where separation of mothers and babies occurred, including in this cohort. This study confirms that vertical transmission is rare and that transmission by close contact is unlikely to occur with maternal SARS-CoV-2 infection, even where a mother with active infection co-rooms with her baby. This finding supports the ongoing implementation of WHO guidelines to keep mothers and babies together, a practice important for bonding, the establishment of feeding, and newborn survival.5 Nosocomial transmission did occur, underscoring a need for stringent infection control procedures for all centres which provide care for patients with SARS-CoV-2 infection. This paper also highlights inequality in disease incidence for SARS-CoV-2 for babies of Black, Asian and Minority Ethnic (BAME) groups, with an incidence three to four-fold that of individuals classified as having white ethnicity. This finding is not isolated to neonates, with a disproportionately high disease incidence amongst individuals of BAME groups amongst pregnant women and wider adult populations.6, 7 This observation is a substantial public health concern that likely speaks to the influence of social determinants of health. Providers of perinatal health care still have much to learn about SARS-CoV-2. Ongoing collection and analysis of comprehensive perinatal epidemiologic data will remain paramount for our capacity to respond this pandemic in a manner that is well-informed, evidence-based and effective in optimising the health and well-being of all mothers and babies affected. None to declare. https://ebneo.org/sars-cov-2-epidemiology

Analysis of laboratory blood parameter results for patients diagnosed with COVID-19, from all ethnic group populations: A single centre study.

IntroductionAlthough factors such as age, sex, diabetes, obesity and changes in certain laboratory investigations are important prognostic factors in COVID‐19 infection, these may not apply to all ethnic/racial groups. We hypothesized differences in routine biochemistry and haematology indices in Caucasian and a combined group of Black, Asian and Minority Ethnic (BAME) patients who tested positive for COVID‐19 who died, compared to survivors.MethodsWe tested our hypothesis in 445 patients (229 Caucasian, 216 BAME) admitted to secondary care with proven COVID‐19 infection, in whom standard routine laboratory indices were collected on admission.ResultsAfter 28 weeks, 190 (42.7%) had died within 28 days of COVID diagnosis (97 Caucasians [42.4%], 93 BAMEs [43.1%], P = .923). A general linear model analysis found the ethnicity interaction with mortality to be significant for fibrinogen, ferritin and HbA1c (after controlling for age). In a multivariate analysis, a neutrophil/lymphocyte ratio > 7.4 and a urea/albumin ratio > 0.28 increased the odds of death for both the Caucasian and the BAME group. Additional factors increasing the odds ratio in the BAME group included age >60 years and being diabetic.ConclusionNeutrophil/lymphocyte ratio and urea/albumin ratio are simple metrics that predict death to aid clinicians in determining the prognosis of COVID‐19 and help provide early intensive intervention to reduce mortality. In the BAME groups, intensive monitoring even at younger age and those with diabetes may also help reduce COVID‐19 associated mortality.

Racial Disparity and the Criminal Justice System

Twelve percent people of London are black. Sounds unfair, but reality, the law enforcement agencies are more likely to proceed against the black men for the crimes committed in any area of London e.g. Stephen Lawrence case. Survey says the BAME (Black, Asian and Minority Ethnic) groups are disproportionately being targeted by the police. The period of their imprisonment is generally longer than the white people stays in the custody. These racial disparities in the criminal justice system raise a question mark on the whole justice procedure. Whenever there are disparities in the system because of racism, it is creating impediment to the whole structure of the justice process. Thus, this article intends to critically explore how racism causes prejudice to a particular group in the criminal justice system of the UK.

A Large London District General Hospital Highlights CLL and Bame As Risk Factors for Severe Disease Amongst Haematology-Oncology Patients

IntroductionThe earliest documented transmission of the coronavirus SARS-CoV-2, causing the disease Covid-19 occurred in the United Kingdom in February 2020. With data from Wuhan and Italy indicating a significant mortality rate in the region of 1-3% and identification of the risks of co-morbidities, hemato-oncology patients were quickly identified as being at a heightened risk from the virus due to baseline and chemotherapy induced immunosuppression. Data has shown that patients with cancer have a significantly higher incidence of severe events following infection with SARS-CoV-19 than those without cancer. Unlike many reported case series, our institution sees an unselected take of all hemato-oncology diagnoses within a large, ethnically-diverse locality and therefore provides an unfiltered snapshot of the impact of SARS-CoV-2 at an all-inclusive, population level.MethodsProspective data collection was carried out on all hemato-oncology patients admitted with a confirmed diagnosis of Covid-19 during March and April 2020 by reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay on a nasopharyngeal aspirate across two sites in one of London's largest District General Hospital Trusts. Our institution has a catchment area of 810 000 heads of population of which 38-46.5% are of black, Asian and minority ethnic (BAME) ethnicity depending on locality.ResultsWe identified a total of 30 hemato-oncology patients admitted with PCR proven SARS-CoV-19. Their baseline characteristics are shown in figure 1. When compared with our cancer registry data (Fig 2A) this highlights a disproportionate representation of BAME patients (57% of cases vs 26% of base population). Lymphoid malignancies and plasma cell dyscrasias (PCD) accounted for 90% of the admissions. CLL and PCD accounted for 30% and 23% respectively (Fig 2C).Co-morbidities were less prevalent than those seen in patient cohorts without hematological malignancy. 70% of patients had </=1 co-morbidity and only 29% had >/= 2 comorbidities (Fig 2B) highlighting that, unlike other non-oncology series, hematological malignancy alone acts as a major risk factor for serious illness. Hypertension and Diabetes were the most common risk factors, seen in 50% and 43% of patients respectively.The most common presenting features were cough (84%), fever (72%) and shortness of breath (80%). 16% had Gastrointestinal symptoms, but only seen in the context of concurrent respiratory symptoms. The vast majority (84%) had radiological changes consistent with a diagnosis of COVID-19.Our cohort had a mortality rate of 47%. Of those that died, 57% were from BAME groups and 43% were White. 71% of those that died had either CLL (6/14 cases) or multiple myeloma (MM) (4/14 cases). CLL appears to be an independent risk factor from age, as two of the patients with CLL that died were amongst the youngest in our cohort (47 years and 59 years). Two patients that died had Myelodysplastic syndrome, one had Diffuse large B cell lymphoma and one had Hodgkin's lymphoma. We found that age and number of co-morbidities were positively associated with death. Of the patients that died, 79% were 70 years of age or over and the majority of survivors were 60 years old or younger (56%). Lymphopenia was a consistent finding at diagnosis (median lymphocyte count 0.8 x 109/l), neutropenia was rare (median neutrophil count 5.9 x 109/l) and C-reactive protein was elevated in all cases (median value 169, range 42-473 mg/l).Of our 4 patients with plasma cell dyscrasias who died, 2 had end stage myeloma (4th line+ of therapy), 1 had primary refractory MM and 1 had plasma cell leukaemia, thus identifying these patients as extremely high risk from the outset.ConclusionIt is of great importance to identify patient and disease specific risk factors conferring poor risk amongst our hemato-oncology patients. With shielding, invariably comes the increased risk of morbidity from social isolation and delayed presentation of non-COVID illness. Our data shows that CLL and BAME patients appear to be at particular risk of severe illness and poor outcomes. In a local ethnically diverse population, our patients are at heightened risk of morbidity and mortality and must be offered all strategies for interventions that may reduce likelihood of becoming infected with COVID 19 and should be considered early for vaccination, convalescent plasma and monoclonal antibodies.DisclosuresNo relevant conflicts of interest to declare.

Decolonizing care of Black, Asian and Minority Ethnic patients in the critical care environment: A practical guide.

The authors comment on how the coronavirus disease-2019 (COVID-19) pandemic has demonstrated how structural racism is transcribed and enacted in the health of Black, Asian and Minority Ethnic (BAME) people Topics covered include ways through which critical and intensive care nurses can decolonize care for BAME patients, the importance for nurses to consider a patient's cultural needs, and how failure to consider culture can lead to a deficit in racially appropriate care

Ethnic variations in referrals to the Leicester memory and dementia assessment service, 2010 to 2017

The incidence of dementia in Black, Asian and minority ethnic (BAME) groups is increasing in the UK, with concern about underdiagnosis and late presentation. By reviewing referrals to memory clinics from Leicester City we examined whether the following differed by ethnicity: the proportion with a diagnosis of dementia, type of dementia and severity at presentation. We examined referrals between 2010 and 2017: all those whose ethnicity was recorded as Black (n = 131) and a random sample of 260 Asian and 259 White British referrals. Severity of dementia was assessed by record review. Odds ratios (ORs) were adjusted for general practice, age, gender and year of referral. A diagnosis of dementia was recorded in 193 (74.5%) White British, 96 (73.3%) Black and 160 (61.5%) Asian referrals. Compared with Asians, White British had twice the adjusted odds of a dementia diagnosis (OR = 1.99 (1.23-3.22). Of those with dementia, Alzheimer's disease was more common in White British (57.0%) than in Asian (43.8%) and Black referrals (51.0%): adjusted OR White British versus Asian 1.76 (1.11-2.77). Of those with dementia, the proportion with moderate/severe disease was highest in White British (66.8%), compared with 61.9% in Asian and 45.8% in Black groups. The adjusted OR for the White versus Black groups was 2.03 (1.10-3.72), with no significant difference between Asian and White British groups. Differences in confirmed dementia suggest general practitioners have a lower threshold for referral for possible dementia in some BAME groups. Unlike other centres, we found no evidence of greater severity at presentation in Asian and Black groups.

Don't blame the BAME: Ethnic and structural inequalities in susceptibilities to COVID-19.

This article has been written from the UK, using British terminology to refer to ethnic minorities where BAME (Black, Asian, minority ethnic groups) is a commonly used and recognized acronym. In the United Kingdom, Asian also generally refers to minorities from South Asian countries including India, Pakistan, Bangladesh, and Sri Lanka. In the United States, Asian more frequently refers to people from Southeast Asian countries like China, Japan, and South Korea. Socially constructed categories used to refer to minoritized groups are variously constructed in different countries; for example, British nomenclature most often refers to ethnicity rather than race.

Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data.

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths)groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, we believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection, reducing occupational risks, reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.

Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, we believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection, reducing occupational risks, reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.

The impact of ethnicity on clinical outcomes in COVID-19: A systematic review.

BackgroundThe relationship between ethnicity and COVID-19 is uncertain. We performed a systematic review to assess whether ethnicity has been reported in patients with COVID-19 and its relation to clinical outcomes.MethodsWe searched EMBASE, MEDLINE, Cochrane Library and PROSPERO for English-language citations on ethnicity and COVID-19 (1st December 2019-15th May 2020). We also reviewed: COVID-19 articles in NEJM, Lancet, BMJ, JAMA, clinical trial protocols, grey literature, surveillance data and preprint articles on COVID-19 in MedRxiv to evaluate if the association between ethnicity and clinical outcomes were reported and what they showed. PROSPERO:180654.FindingsOf 207 articles in the database search, five reported ethnicity; two reported no association between ethnicity and mortality. Of 690 articles identified from medical journals, 12 reported ethnicity; three reported no association between ethnicity and mortality. Of 209 preprints, 34 reported ethnicity – 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported worse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups compared to White groups.InterpretationData on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggest BAME individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance.FundingNIHR

Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths)groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.