Ethnicity and risk of death in patients hospitalised for COVID-19 infection in the UK: an observational cohort study in an urban catchment area

Research output: Contribution to journalArticlepeer-review

Authors

  • Suzy Gallier
  • Chris Mainey
  • Peter Nightingale
  • David Mcnulty
  • Hannah Crothers
  • Felicity Evison
  • Katharine Reeves
  • Domenico Pagano
  • Peter J Diggle
  • Simon Ball

Colleges, School and Institutes

External organisations

  • University Hospitals Birmingham NHS Foundation Trust
  • Lancaster University
  • Wellcome Trust Clinical Research Facility; Queen Elizabeth Hospital; Edgbaston Birmingham UK
  • University Hospitals Birmingham
  • Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

Abstract

Background: Studies suggest that certain black and Asian minority ethnic groups experience poorer outcomes from COVID-19, but these studies have not provided insight into potential reasons for this. We hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health-seeking behaviours and community demographics were considered, and that this might reflect a more aggressive disease course in these patients.

Methods: Patients with confirmed SARS-CoV-2 infection requiring admission to University Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham, UK between 10 March 2020 and 17 April 2020 were included. Standardised admission ratio (SAR) and standardised mortality ratio (SMR) were calculated using observed COVID-19 admissions/deaths and 2011 census data. Adjusted HR for mortality was estimated using Cox proportional hazard model adjusting and propensity score matching.

Results: All patients admitted to UHB with COVID-19 during the study period were included (2217 in total). 58% were male, 69.5% were white and the majority (80.2%) had comorbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger and have no comorbidities, but twice the prevalence of diabetes than white patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted and they were more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death, both by Cox regression (HR 1.4, 95% CI 1.2 to 1.8), after adjusting for age, sex, deprivation and comorbidities, and by propensity score matching, matching for the same factors but categorising ethnicity into South Asian or not (HR 1.3, 95% CI 1.0 to 1.6).

Conclusions: Those of South Asian ethnicity appear at risk of worse COVID-19 outcomes. Further studies need to establish the underlying mechanistic pathways.

Bibliographic note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Details

Original languageEnglish
Article numbere000644
Number of pages11
JournalBMJ Open Respiratory Research
Volume7
Issue number1
Publication statusPublished - 1 Sep 2020

Keywords

  • Asian Continental Ancestry Group/statistics & numerical data, Betacoronavirus/isolation & purification, Cohort Studies, Comorbidity, Coronavirus Infections/ethnology, Female, Hospitalization/statistics & numerical data, Humans, Male, Middle Aged, Mortality/ethnology, Outcome Assessment, Health Care, Pandemics, Pneumonia, Viral/ethnology, Proportional Hazards Models, Risk Factors, Severity of Illness Index, United Kingdom/epidemiology