People of black, Asian and minority ethnic (BAME) backgrounds are more likely to die from the Coronavirus Disease 2019, or Covid-19, a new study finds. In the largest Covid-19 study conducted by any country to date, researchers analysed health records of over 17.4 million UK adults to identify factors that increase the risk of Covid-19 death.
Covid-19 is the disease caused by the coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). On 11 March 2020, the World Health Organisation declared Covid-19 as a pandemic after outbreaks in 114 countries killing thousands. As of 9 May 2020, over 4 million people worldwide have contracted Covid-19 with over 275 thousand casualties. So far, Covid-19 has killed at least 31,587 people in the UK, the second-largest tally in the world.
9 in 10 UK Covid-19 deaths occur in people aged over 60 years. Furthermore, men seem to be at a higher risk to Covid-19 with 60% deaths. Data show that Covid-19 disproportionately affects ethnic minority groups, but it’s not clear why. Therefore, researchers established death risks by linking GP records to patients who are hospitalised from Covid-19. The OpenSAFELY analytic platform enabled the linkage between hospital and GP data.
The analysis explores Covid-19 risk in the general population rather than just those infected with SARS-CoV-2. The study tracked over 17.4 million active adult patients from 1 February 2020 until their death, or the study end date of 25 April 2020. Scientists considered several potential factors that can exacerbate Covid-19 risks, including age, sex, body mass index, smoking, existing conditions (asthma, diabetes, heart diseases, liver disease, etc.)
At the time of this study, of the over 17.4 million adults monitored, there were 6,683 deaths from Covid-19 in hospitals. The preprint study shows that the risk of Covid-19 death increases exponentially with age (see Figure 1), with over 90 percent death occurring in over 60s. As such, death risk for over 80 year-olds is 12-fold higher than those in their 50s.
The study also found that men are more likely to die from Covid-19, and other factors that increased risks were obesity, uncontrolled diabetes, severe asthma and various other pre-existing conditions. Poorer people, as defined by deprivation, also face increasing threats from Covid-19.
All non-white ethnic* are also at a higher risk of Covid-19 death than white people (see Figure 2). This is consistent with previous observations that one-third of patients admitted to critical care units are non-white. Alarm bells started ringing when the first ten UK doctors to die from Covid-19 were identified as being from BAME backgrounds.
*The National Health Service ethnic category code is listed here.
Ethnic minorities are more likely to be poorer than white people and live in extended families, which increases the risk of virus transfer between family members that live together. UK minority groups also face increasing inequality, often living in inadequate housing. Additionally, BAME groups are more likely to work in low-paid essential jobs, which makes social distancing more challenging. Previously, researchers predicted that increased risk of Covid-19 to minority groups could be due to these socioeconomic, cultural or lifestyle factors.
Worryingly, the recent analysis indicates that socioeconomic factors or existing health conditions are only a small part of the Covid-19 risk from BAME people. Even after adjusting for several risk factors, ethnic minorities are 1.62–1.71 times more likely to die from Covid-19 in comparison to white people. The risk factors that scientists considered include sex, age, deprivation, obesity, and other existing illnesses.
Professor Liam Smeeth, Professor of Clinical Epidemiology at LSHTM, NHS doctor and co-lead on the study, said in a press release: “We need highly accurate data on which patients are most at risk in order to manage the pandemic and improve patient care. The answers provided by this analysis are of crucial importance to countries around the world. For example, it is very concerning to see that the higher risks faced by people from BAME backgrounds are not attributable to identifiable underlying health conditions.”
If socioeconomic and disease factors cannot explain why black and Asian people face increasing death risk from Covid-19, it implies that other social factors are increasing this risk, which requires further investigation. Scientists suggest that a good starting point would be to investigate the link between jobs and living conditions to see if these factors influence Covid-19 death risks amongst BAME groups.
This study is published in medRxiv and hasn’t undergone peer review. Read the full preprint study here: https://doi.org/10.1101/2020.05.06.20092999
All code for data management and analysis for the study is available here: https://github.com/ebmdatalab/opensafely-risk-factors-research. All clinical and medicines codelists are openly available for inspection and reuse at https://codelists.opensafely.org/.
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