According to a recent retrospective analysis of 17 million people, minority ethnic groups in general, and South Asians in particular, had a higher risk of testing positive for SARS-CoV-2 and COVID-19-related hospitalizations, intensive care unit (ICU) admissions, and deaths during the second wave of the pandemic in the UK compared to the first.
The research, led by the London School of Hygiene & Tropical Medicine (LSHTM), accounted for a large number of explanatory variables such as household size, social influences, and health conditions across all ethnic groups and at various stages of COVID-19, from testing to mortality, and was published in the medical journal Lancet on Friday.
“South Asian groups remained at higher risk of testing positive, with relative risks of hospitalization, ICU admission, and death in the second wave being higher than in the first wave,” the study finds.
It found that, compared to the first wave last year, the relative risk of testing positive, hospitalization, ICU admission, and death for all minority ethnic communities was lower in the pandemic second wave earlier this year, with the exception of South Asian groups, which include Indians, Pakistanis, and Bangladeshis.
“While most minority ethnic groups improved in the second wave compared to the first, it’s worrying to see that the gap among South Asian groups widened,” said LSHTM’s Dr. Rohini Mathur, the study’s lead author.
“This emphasizes the critical need for successful preventive strategies that are tailored to the needs of the UK’s ethnically diverse population,” she said.
The social disadvantage was the main possible explanatory factor for inequalities among all minority ethnic groups except South Asians after accounting for age and sex. Health factors such as BMI, blood pressure, and underlying health conditions played the largest role in explaining excess risks for all outcomes in South Asian communities. Only in South Asian communities was household size a significant explanatory factor for the difference in COVID-19 mortality.
“While multigenerational living can increase the risk of exposure and transmission (from children or working-age adults to older or vulnerable family members), such households and extended families often provide important informal care networks and promote interaction with health and community services,” according to Dr. Mathur.
“Given new evidence that minority ethnic groups are less likely to receive the COVID-19 vaccine, co-designing culturally competent and non-stigmatizing communication strategies with these populations is becoming more relevant.”
The research team analyzed partially anonymized electronic health data obtained by general practitioners (GPs) covering 40% of England on behalf of NHS England using the new stable OpenSAFELY data analytics platform. For the first and second waves of the pandemic, these GP records were connected to other national coronavirus-related data sets, such as research, hospital data, and mortality records. Participants’ ethnicity was self-reported in GP records and was divided into five census categories (white, South Asian, Black, other, mixed) and 16 sub-groups.
“Factors that also raise the likelihood of bad COVID-19 results, such as living in disadvantaged neighborhoods, working in front-line occupations, and having poorer access to healthcare, are disproportionately affecting minority ethnic groups in the UK,” says Dr. Mathur.
“Our research shows that even after controlling for all of these causes, minority ethnic groups in England have a higher risk of testing positive, hospitalization, ICU admission, and death than white people.”
“In order to enhance COVID-19 outcomes, we must address the broader disadvantage and systemic racism that these populations face, as well as improve access to treatment and reduce transmission,” she said.
The authors point out that the research has some limitations, such as the inability to capture all possible explanatory variables, such as occupation, health-related behaviors, and bias or structural discrimination encounters.
They advocate for more complete ethnicity documentation of health data in order to promote high-quality research into resolving health inequality for COVID-19 and beyond. Scientists from a group of universities, including LSHTM and the University of Oxford, as well as the National Institute of Health Research, collaborated on the report, which is believed to be the largest of its kind in the world.