Covid second wave ‘hit Asians hardest’
CULTURALLY SENSITIVE POLICIES CAN IMPROVE HEALTH OUTCOMES AMONG ETHNIC GROUPS, ACADEMICS SAY
MINORITY ethnic groups in general and south Asians, in particular, had a higher risk of testing positive for SARSCoV-2 and of Covid-19 related hospitalisations, intensive care (ICU) admissions and deaths during the second wave of the pandemic in the UK compared to the first, according to a new study of 17 million people.
The research, led by the London School of Hygiene & Tropical Medicine (LSHTM) and published in the medical journal Lancet last Friday (30), accounted for household size, social factors and health conditions across all ethnic groups and at different stages of Covid-19, from testing to mortality.
“South Asian groups remained at higher risk for testing positive, with relative risks for hospitalisation, ICU admission, and death greater in magnitude in the second wave compared to the first wave,” the study found.
It also showed that compared with the first wave last year, the relative risk for testing positive, hospitalisation, ICU admission, and death were smaller in the second wave earlier this year for all minority ethnic communities compared to white people, with the exception of south Asian groups – covering Indians, Pakistanis and Bangladeshis.
“Despite the improvements seen in most minority ethnic groups in the second wave compared to the first, it’s concerning to see the disparity widened among south Asian groups,” said Dr Rohini Mathur
from LSHTM and the study’s lead author. “This highlights an urgent need to find effective prevention measures that fit with the needs of the UK’s ethnically diverse population.”
After accounting for age and sex, social deprivation was the biggest potential explanatory factor for disparities in all minority ethnic groups except those who were south Asian.
In this group, factors such as BMI, blood pressure, and underlying health conditions played the biggest role in explaining excess risks for all outcomes. Household size was an important explanatory factor for the disparity for Covid mortality in south Asian groups only.
Dr Mathur said: “While multi-generation living may increase risk of exposure and transmission (from children or working-age adults to older or vulnerable family members), such households and communities also offer valuable informal care networks and facilitate engagement with health and community services.
“In light of emerging evidence that minority ethnic groups are less likely to take up the Covid-19 vaccine, co-designing culturally competent and non-stigmatising engagement strategies with these communities is increasingly important.”
On behalf of NHS England, the research team used the new secure OpenSAFELY data analytics platform to study partially anonymised electronic health data collected by GPs covering 40 per cent of England.
These GP records were linked to other national coronavirus-related data sets for the first and second waves of the pandemic – including testing, hospital data and mortality records. Ethnicity was selfreported by participants in GP records and grouped into five census categories (white, south Asian, back, other, mixed) and then a further 16 sub-groups.
“Minority ethnic groups in the UK are disproportionately affected by factors that also increase the risk for poor Covid-19 outcomes, such as living in deprived areas, working in front-line jobs, and having poorer access to healthcare,”
Dr Mathur said. “Our study indicates that even after accounting for many of these factors, the risk for testing positive, hospitalisation, ICU admission and death was still higher in minority ethnic groups compared with white people in England.
“To improve Covid outcomes, we urgently need to tackle the wider disadvantage and structural racism faced by these communities, as well as improving access to care and reducing transmission.”
The authors cautioned that there were some limitations to the study, including an inability to capture all potential explanatory variables, including occupation, health-related behaviours, and experiences of racism or structural discrimination. They called for improving the completeness of ethnicity recording in health data to further support the conduct of high-quality research into addressing health inequalities for Covid-19 and beyond.
The study, believed to be the largest of its type, was funded by the UK’s Medical Research Council and conducted by scientists from a group of universities including LSHTM and the University of Oxford, along with the National Institute of Health Research.