Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London
Authors: Wan Y I , Apea V J , Dhairyawan R , Puthucheary Z A , Pearse R M , Orkin C M , Prowle J R 
Published: July 2021

Objectives

To determine if changes in public behaviours, developments in COVID-19 treatments, improved patient care, and directed policy initiatives have altered outcomes for minority ethnic groups in the second pandemic wave.

Design

Prospectively defined observational study using registry data.

Setting

Four acute NHS Hospitals in east London.

Participants

Patients aged ≥16 years with an emergency hospital admission with SARS-CoV-2 infection between 1st September 2020 and 17th February 2021.

Main outcome measures

Primary outcome was 30-day mortality from time of index COVID-19 hospital admission. Secondary endpoints were 90-day mortality and need for ICU admission. Multivariable survival analysis was used to assess associations between ethnicity and mortality accounting for predefined risk factors. Age-standardised rates of hospital admission relative to the local population were compared between ethnic groups.

Results

Of 5533 patients, the ethnic distribution was White (n=1805, 32.6%), Asian/Asian British (n=1983, 35.8%), Black/Black British (n=634, 11.4%), Mixed/Other (n=433, 7.8%), and unknown (n=678, 12.2%). Excluding 678 patients with missing data, 4855 were included in multivariable analysis. Relative to the White population, Asian and Black populations experienced 4.1 times (3.77-4.39) and 2.1 times (1.88-2.33) higher rates of age-standardised hospital admission. After adjustment for various patient risk factors including age, sex, and socioeconomic deprivation, Asian patients were at significantly higher risk of death within 30 days (HR 1.47 [1.24-1.73]). No association with increased risk of death in hospitalised patients was observed for Black or Mixed/Other ethnicity.

Conclusions

Asian and Black ethnic groups continue to experience poor outcomes following COVID-19. Despite higher-than-expected rates of admission, Black and Asian patients experienced similar or greater risk of death in hospital, implying a higher overall risk of COVID-19 associated death in these communities.

Strengths and limitations of this study

This study represents one of the largest descriptors of outcomes in minority ethnic patients with COVID-19 distinguished by the majority ethnically diverse cohort within a catchment area of approximately one million people in the east of London.

Large absolute numbers of patients drawn from a single geographic region and treated within the same hospital system minimize many of the geographic biases present within other studies including the impact of variation in transmission risk.

Our analyses are strengthened by adherence to a prespecified analysis plan, inclusion of a detailed baseline, comorbidity, and COVID-19 risk factors in multivariable modelling, and sensitivity tests using different measures of comorbidity.

However as with all observational studies, not all potential contributing risk factors could be assessed, including other measures of baseline health status such as nutritional or lifestyle influences as well as contextual factors such as household composition and occupation.

We were not able to include suspected but not proven COVID-19 cases or community cases not requiring hospital admission or the effect of the differing viral strains in the first and second wave.