People of Black and Asian ethnicity up to twice as likely to be infected with COVID-19 as those of White ethnicity

People of Black ethnicity are twice as likely to be infected with COVID-19 compared to those of White ethnicity, according to researchers at the Universities of Leicester and Nottingham.

The findings, published today in EClinical Medicine, show that people from Asian backgrounds are also 1.5 times more likely to become infected with the virus compared to White individuals.

In the first meta-analysis of the effect of ethnicity on clinical outcomes in patients with COVID-19, which screened over 1500 articles, the research team pooled data from more than 18 million people who had taken part in 50 studies in the United Kingdom and United States of America. All the studies included in the analysis were published between 1 December 2019 and 31 August 2020 in peer-reviewed journals or as pre-prints waiting for peer-review.

All the patients included in the study who had COVID-19 were defined as such by a positive nasal swab test or clinical signs and symptoms of the virus, along with radiology and laboratory tests.

Researchers also found those of Asian ethnicities to be at higher risk of admission to an intensive therapy unit (ITU) and death. However, all studies investigating ITU admission that were included in the meta-analysis had not yet been peer-reviewed, and the risk of death was only of borderline statistical significance. This is in contrast to the strong evidence of increased risk of infection in Black and Asian ethnic groups.

Dr Laura B Nellums, Assistant Professor in Global Health in the Division of Epidemiology and Public Health at the University of Nottingham and joint senior author of the paper, said: “There is increasing evidence of ethnic disparities in COVID-19, with poorer outcomes among ethnic minority groups in the wider community as well as those working in healthcare settings. However, there has not been a robust synthesis of emerging data to understand which groups may be disproportionately affected, or the inequities driving poorer outcomes in ethnic minority communities.”

Dr Laura B Nellums

“This systematic review and meta-synthesis represents the first comprehensive examination of all available evidence on ethnicity and COVID-19, encompassing more than 18 million individuals. The findings highlight the higher risk of infection among individuals from Black and Asian ethnicities, which is likely driven by social and structural inequities. The research also underscores the significant gaps that still exist in the meaningful collection and reporting of data on ethnicity. There is an urgent need in research, policy, and practice, not only to reduce the risk of COVID-19 infection and consequently poor outcomes in individuals from ethnic minority backgrounds, but also to address the wider social, economic, and systemic inequities driving disparities in access to care and health outcomes in these communities.”

Dr Manish Pareek, Associate Clinical Professor in Infectious Diseases at the University of Leicester, Consultant in Infectious Diseases at the University Hospitals of Leicester NHS Trust and a senior author on the paper, said: “Our findings suggest that the disproportionate impact of COVID-19 on Black and Asian communities is mainly attributable to increased risk of infection in these communities.

“Many explanations exist as to why there may be an elevated level of COVID-19 infection in ethnic minority groups, including: the greater likelihood of living in larger household sizes comprised of multiple generations; having lower socioeconomic status, which may increase the likelihood of living in overcrowded households; and being employed in frontline roles where working from home is not an option.

The research is supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre.

Dr Nellums receives funding from the Academy of Medical Sciences (SBF0051047), the Medical Research Council/Economic and Social Research Council/Arts and Humanities Research Council (MR/T046732/1), and UKRI/MRC (MR/V027549/1).

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