The risk of COVID hospital admission and COVID mortality during the first COVID 19 wave with a special emphasis on Ethnic Minorities: an observational study of a single, deprived, multi ethnic UK health economy
Authors: Singh Baldev M , Bateman James , Viswanath Ananth , Klaire Vijay , Mahmud Sultan , Nevill Alan M , Dunmore Simon J 
Published: November 2020

Objectives

To address the generalisability of COVID-19’s outcomes to the well-defined but diverse communities of a single City area.

Design

An observational study of COVID-19 outcomes using quality-assured and integrated data from a single UK hospital contextualised to its feeder population and its associated factors (comorbidities, ethnicity, age, deprivation).

Setting/Participants

Single city hospital with a feeder population of 228,632 adults in Wolverhampton’s city area.

Main Outcome Measures

Hospital admissions and mortality.

Results

5558 patients admitted, 686 died (556 in hospital); 930 were COVID-19 admissions (CA),of which 270 were hospital COVID deaths, 47 non-COVID deaths, 36 deaths post-discharge; 4628 non-COVID-19 admissions (NCA), 239 in-hospital deaths (2 COVID), 94 deaths post-discharge. 223,074 adults not admitted, 407 died. Age, gender, multi-morbidity and Black ethnicity (OR 2.1 [95% CI 1.5-3.2] p<0.001, absolute excess risk of <1/1,000) were associated with COVID-19 admission and mortality. The South Asian cohort had lower CA and NCA, lower mortality (CA (0.5 [0.3-0.8], p<0.01), NCA (0.4 [0.3-0.6] p<0.001), community deaths (0.5 [0.3-0.7] p<0.001). Despite many common risk factors for CA and NCA, ethnic groups had different admission rates, and within-groups differing association of risk factors. Deprivation impacted only in White ethnicity, in the oldest age bracket and in a lesser (not most) deprived quintile.

Conclusions

Wolverhampton’s results, reflecting high ethnic diversity and deprivation, are similar to other studies for Black ethnicity, age and comorbidity risk in COVID-19 but strikingly different in South Asians and for deprivation. Sequentially considering population and then hospital based NCA and CA outcomes, we present a complete single health-economy picture. Risk factors may differ within ethnic groups; our data may be more representative of communities with high BAME populations, highlighting the need for locally focussed public health strategies. We emphasise the need for a more comprehensible and nuanced conveyance of risk.

Strengths and limitations of this study

The rapidly developing COVID-19 pandemic has led to numerous studies (published, preprints and national public health reports) of its health impacts in relation to ethnicity, co-morbidities and other factors; few studies, however, have attempted to evaluate infection patient data in terms of morbidity and mortality in context of the feeder population and most are limited by incompleteness of data and inability to account for regional variations in factors such as ethnicity and deprivation

Our observational study used a high quality and complete dataset from the local population and the hospital serving it to examine the association of purported risk factors with severity and mortality and the results reveal the importance of evaluating such risks in the local, and not just national, population setting taking into account the local variations in patient backgrounds

We found an increased risk of COVID-19 mortality for Black ethnicity (OR 2.1) but a decreased risk (OR 0.5) for South Asians, compared with white ethnicity; Our analysis reveals that a nuanced approach to studying risk factors associated with COVID-19 severity and mortality is important – factoring in regional variation in ethnicity, deprivation etc. specifically linked to the source population

We suggest, based on our findings, that understandably rapid analysis and dissemination of studies of COVID-19 risk needs to be tempered by careful consideration of the real implications; we further urge caution in conveying risk messages to the wider community because of an ethical imperative to ensure such messages do not lead to unnecessary fear and deter individuals, particularly from specific ethnic backgrounds, from seeking needed medical assistance.