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, supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre. The findings are published in EClinical Medicine by The Lancet today (Thursday 12 November 2020).
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 However, all studies investigating ITU admission that were included in the meta-analysis had not yet been peer-reviewed, and the risk of death was only of borderline statistical significance.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 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.
Dr Shirley Sze, NIHR Academic Clinical Lecturer and Specialist Registrar in Cardiology at the University of Leicester, and a lead author of the paper, said: “The clear evidence of increased risk of infection amongst ethnic minority groups is of urgent public health importance – we must work to minimise exposure to the virus in these at-risk groups by facilitating their timely access to healthcare resources and target the social and structural disparities that contribute to health inequalities.”
Dr Daniel Pan, Specialist Registrar in Infectious Diseases at the University Hospitals of Leicester NHS Trust and an NIHR Clinical Academic Fellow at the University of Leicester is a lead author of the paper. He said: “Future papers must try to adjust for the risk of infection when looking at the risk of ITU admission and death in COVID-19 patients, in order for us to accurately assess the impact of ethnicity on an individual’s risk of death once they are infected”.
The paper, ‘Ethnicity and clinical outcomes in COVID-19: A Systematic Review and Meta-analysis’ is published in EClinical Medicine by The Lancet on 12 November 2020.