Ethnic disparities in COVID-19 outcomes: a multinational cohort study of 20 million individuals from England and Canada

BMC Public Health

Research

Karl Everett¹  Baiju R. Shah¹  Francesco Zaccardi²  Kamlesh Khunti²  Julia Hippisley-Cox³  Pui San Tan³  Martina Patone³  Defne Saatci³  Ash Kieran Clift⁴  Carol Coupland⁵  Hajira Dambha-Miller⁶  Simon J. Griffin⁷ 

[1] Department of Medicine, University of Toronto; Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada;Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, England;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England;Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, England;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England;Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, England;Primary Care Research Centre, University of Southampton, Southampton, England;Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England;MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England;

关键词: Ethnicity;    COVID-19;    Mortality;    Hospitalisation;    UK;    Canada;    Inequalities;   

DOI  :  10.1186/s12889-023-15223-8

 received in 2022-03-10, accepted in 2023-02-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHeterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outcomes.MethodsWe identified adults aged 18 to 99 years in the QResearch primary care (England) and Ontario (Canada) healthcare administrative population-based datasets (start of follow-up: 24th and 25th Jan 2020 in England and Canada, respectively; end of follow-up: 31st Oct and 30th Sept 2020, respectively). We harmonised the definitions and the design of two cohorts to investigate associations between ethnicity and COVID-19-related death, hospitalisation, and intensive care (ICU) admission, adjusted for confounders, and combined the estimates obtained from survival analyses. We calculated the ‘percentage of excess risk mediated’ by these risk factors in the QResearch cohort.ResultsThere were 9.83 million adults in the QResearch cohort (11,597 deaths; 21,917 hospitalisations; 2932 ICU admissions) and 10.27 million adults in the Ontario cohort (951 deaths; 5132 hospitalisations; 1191 ICU admissions). Compared to the general population, pooled random-effects estimates showed that South Asian ethnicity was associated with an increased risk of COVID-19 death (hazard ratio: 1.63, 95% CI: 1.09-2.44), hospitalisation (1.53; 1.32-1.76), and ICU admission (1.67; 1.23-2.28). Associations with ethnic groups were consistent across levels of deprivation. In QResearch, sociodemographic, lifestyle, and clinical factors accounted for 42.9% (South Asian) and 39.4% (Black) of the excess risk of COVID-19 death.ConclusionInternational population-level analyses demonstrate clear ethnic inequalities in COVID-19 risks. Policymakers should be cognisant of the increased risks in some ethnic populations and design equitable health policy as the pandemic continues.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 3