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Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

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People from Black and Asian backgrounds are at substantially greater risk of contracting coronavirus than white people, according to a study published in the journal EClinicalMedicine by the Lancet,

The study highlights the disproportionate impact of the disease on different groups in society and found that black people are twice as likely to become infected with coronavirus as white people, and people from Asian backgrounds are one and a half times as likely, researchers found after analysing 50 studies that reported on the medical records of nearly 19 million Covid patients.

The analysis, is the first comprehensive, systematic review of published research and preliminary papers that delve into the burden of coronavirus on different ethnic groups. About half of the papers have appeared in peer-reviewed journals and the rest are preliminary findings.

Beyond the raised risk of infection, the review suggests people from Asian backgrounds are more likely to be admitted to intensive care and may have a greater risk of death with coronavirus than white people. But the researchers cautioned that none of the studies on intensive care admissions had been peer-reviewed and that the increased risk of death was only borderline statistically significant.

Manish Pareek, an associate clinical professor in infectious diseases at the University of Leicester, said the combined message from the studies was that the disproportionate impact of coronavirus on Black and Asian people was driven by the higher risk of infection in those communities.

The dramatically different rates of infection are believed to be driven by a range of factors, such as greater levels of deprivation, living in larger, multi-generational households, and having more public-facing jobs where working from home is not an option.

The research team screened 1,500 published articles and preprints before focusing their analysis on 50 papers produced in the US and the UK. The studies appeared between 1 December 2019 and 31 August this year. The patients with Covid either had a positive swab for the virus or had clinical signs and symptoms of the infection.

Last month a report from the Office for National Statistics said men from black African backgrounds in England and Wales are nearly three times more likely to die from Covid than white men. Women from black Caribbean backgrounds were nearly twice as likely to die as white women. The ONS study concluded that living arrangements and jobs were the main drivers for the increased death rates, rather than pre-existing health conditions such as heart disease and diabetes.

Abstract

Background
Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19.

Methods
Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654.

Findings
18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67–2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24–1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46–2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22–1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34–2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99–1.50]).

Interpretation
Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.

In South Africa, TimesLIVE reports, researchers led by the University of Cape Town are collecting data on a rare new syndrome that mainly attacks black children infected with COVID-19.

Paediatric specialists from across the country have teamed up to gather data that will provide a better understanding of multi-system inflammatory syndrome in children (MIS-C).

MIS-C is a rare disease which develops a few weeks after the onset of Covid-19. A cluster of children have become critically ill with the syndrome in the Western Cape.

“The majority of our patients are of black, Asian and minority ethnic (BAME) origin, and this has been the trend throughout the world. We don’t know why this is,” said Dr Kate Webb, who is leading the research at UCT.

Children are widely thought to be at low risk of being infected with Covid-19. But the UCT team said the true incidence in children was unknown, possibly because their milder symptoms lead to a low rate of testing.

Webb, a paediatric rheumatologist, said symptoms of MIS-C include fevers, rashes, abdominal pain and problems with the heart and other organs.

She has teamed up with UCT paediatric cardiologist Prof Liesl Zühlke for the research project, which aims to capture data from children with Covid-19 and MIS-C across the country.

 

Full EClinicalMedicine report (Open access)

 

Full TimesLIVE report

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