Deaths in people from Black, Asian and minority ethnic communities from both COVID-19 and non-COVID causes in the first weeks of the pandemic in London: a hospital case note review

Abstract

ObjectiveTo undertake a case review of deaths in a 6-week period during the COVID-19 pandemic commencing with the first death in the hospital from COVID-19 on 12th of March 2020 and contrast this with the same period in 2019.SettingA large London teaching hospital.ParticipantsThree groups were compared: group 1—COVID-19-associated deaths in the 6-week period (n=243), group 2—non-COVID deaths in the same period (n=136) and group 3—all deaths in a comparison period of the same 6 weeks in 2019 (n=194).Primary and secondary outcome measuresThis was a descriptive analysis of death case series review and as such no primary or secondary outcomes were pre-stipulated.ResultsDeaths in patients from the Black, Asian and minority ethnic (BAME) communities in the pandemic period significantly increased both in the COVID-19 group (OR=2.43, 95% CI=1.60–3.68, p<0.001) and the non-COVID group (OR=1.76, 95% CI=1.09–2.83, p=0.02) during this time period and the increase was independent of differences in comorbidities, sex, age or deprivation. While the absolute number of deaths increased in 2020 compared with 2019, across all three groups the distribution of deaths by age was very similar. Our analyses confirm major risk factors for COVID-19 mortality including male sex, diabetes, having multiple comorbidities and background from the BAME communities.ConclusionsThere was no evidence of COVID-19 deaths occurring disproportionately in the elderly compared with non-COVID deaths in this period in 2020 and 2019. Deaths in the BAME communities were over-represented in both COVID-19 and non-COVID groups, highlighting the need for detailed research in order to fully understand the influence of ethnicity on susceptibility to illness, mortality and health-seeking behaviour during the pandemic.

Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk.

“…All of the studies using retrospective analysis of routinely-collected healthcare record data are however subject to bias from ethnic differences in access to testing and healthcare alongside co-morbidities, reducing the accuracy of ascertainment of ‘true’ rates of infection. Better assessments of population infection rates can be obtained from large-scale prospective epidemiological studies with surveillance serology testing, with UK data from the REACT-2 study [4] using lateral flow immunoassay IgG to SARS-COV-2 finding point seroprevalence rates of 17.3% in people of Black ethnicity, although differentiating biological from socio-economic explanations behind these differences is challenging [ 25 , 26 , 27 ].…”

Efficacy and safety of CT-P59 plus standard of care: a phase 2/3 randomized, double-blind, placebo-controlled trial in outpatients with mild-to-moderate SARS-CoV-2 infection

“…The current study enrolled few black or Hispanic patients, populations that are disproportionately affected by SARS-CoV-2 infection 23,24 . Likewise, there was a relatively small proportion (20-30%) of elderly patients enrolled, another group that is at high risk of complications and death from COVID-19 25 .…”

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“…Due to varying social vulnerability associated with different population demographics, such as age, gender, and race/ethnicity, some population groups are more vulnerable in the threat of COVID-19. A few variables are presented in the previous modeling [24][25][26][27][28][29], albeit population mobility, age, race were significant factors [30][31][32][33][34][35][36]. As a respiratory disease, air pollution indices like PM2.5 and Air Quality Index (AQI) are highly related to COVID-19.…”