Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out: a retrospective, population-based cohort study

Abstract

Objectives: To assess whether ethnic differences in COVID-19 mortality in England have continued into the third wave and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. Design: Cohort study of 28.8 million adults using data from the Office for National Statistics Public Health Data Asset. Setting: People living in private households or communal establishments in England. Participants: 28,816,020 adults (47% male) aged 30-100 years in 2020 (mean age = 56), who were present at the 2011 Census and alive on 8 December 2020. Main outcome measures: Death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021) of the pandemic. We calculated hazard ratios (HRs) separately for males to females to summarise the association between ethnic group and death involving COVID-19 in each wave, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. Results: Age-adjusted HRs of death involving COVID-19 were higher for most ethnic minority groups than the White British group during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African and Black Caribbean). In both waves, HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. The only groups where fully-adjusted HRs remained elevated were the Bangladeshi group (men: 2.19, 95% CI 1.72 to 2.78; women: 2.12, 95% CI 1.58 to 2.86) and men from the Pakistani group (1.24, 95% CI 1.06 to 1.46). Conclusion: Public health strategies to increase vaccination uptake in ethnic minority groups could reduce disparities in COVID-19 mortality that cannot be accounted for by pre-existing risk factors.

Evaluation of Risk Factors for Postbooster Omicron COVID-19 Deaths in England

“…The association with ethnicity was unclear and differed from previous studies, but this is likely to be due largely to the pronounced differences in vaccination uptake between ethnic groups in previous studies. 4 Limitations of our study were that we only included data for the population living in England who were enumerated in the 2011 Census of England and Wales. The association between the QCovid risk groups and the risk of death were stronger in people who had received a booster and were infected by the Omicron variant compared with evidence from the Alpha and Delta period in doubly vaccinated individuals.…”

Inequalities in SARS-CoV-2 case rates by ethnicity, religion, measures of socioeconomic position, English proficiency, and self-reported disability: cohort study of 39 million people in England during the alpha and delta waves

“…This finding is consistent with the continued increased risk of mortality during the third wave for ethnic minority groups compared with the white British population. 7 38 …”

Vaccine effectiveness for preventing COVID-19 hospital admission during pregnancy: a population-based cohort study in England during the Alpha and Delta waves of the SARS-CoV-2 pandemic

“…We adjusted for sociodemographic factors known from previous studies to be associated with risk of severe COVID-19 outcomes and vaccine uptake. [24, 25, 26, 27, 28] For 91.6% of participants, the following covariates were included from the 2021 Census: age, ethnic group, English language proficiency, country of birth, keyworker status, highest qualification held, disability status, and health status ( Table S1 ). For the remaining 8.4% of participants that could not be linked to the 2021 Census, these variables were based on 2011 Census data.…”