Background: People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19 Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear Methods: We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region For the cohort study, we studied 1827 adults consecutively admitted with COVID-19 The primary exposure variable was self-defined ethnicity Analyses were adjusted for socio-demographic and clinical variables Findings: The 872 cases comprised 48 1% Black, 33 7% White, 12 6% Mixed/Other and 5 6% Asian patients In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3 12 [95% CI 2 63–3 71] and 2 97 [2 30–3 85] respectively) Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2 24 [1 83–2 74] for Black, 2 70 [2 03–3 59] for Mixed/Other) Asian ethnicity was not associated with higher admission risk (adjusted OR 1 01 [0 70–1 46]) In the cohort study of 1827 patients, 455 (28 9%) died over a median (IQR) of 8 (4–16) days Age and male sex, but not Black (adjusted HR 1 06 [0 82–1 37]) or Mixed/Other ethnicity (adjusted HR 0 72 [0 47–1 10]), were associated with in-hospital mortality Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1 71 [1 15–2 56]) Interpretation: Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role The impact of COVID-19 may be different in Asians Funding: British Heart Foundation;the National Institute for Health Research;Health Data Research UK FAU - Zakeri, Rosita
A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. LID - 100574