Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis

Abstract

IntroductionEarly literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes.MethodsPubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis.Results58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil.ConclusionThe risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic.PROSPERO registration numberCRD42020180085.

The Effect of the COVID-19 Pandemic on the Social Inequalities of Health Care Use in Hungary: A Nationally Representative Cross-Sectional Study

“…Furthermore, a pooled analysis of ethnic vulnerability due to the first wave pandemic lockdown revealed that the hospitalization rate was higher for ethnic minorities in the US and Europe. Hispanics, Asians, and Black African Americans were 2.08, 1.59, and 1.53 times more likely to be hospitalized than Whites, respectively [ 30 ].…”

Healthcare Disparities and Outcomes of Cancer Patients in a Community Setting from a COVID-19 Epicenter

“…The disproportionate burden of morbidity and mortality from COVID in racial and ethnic minorities has been well-documented and should elicit further investigation [ 6 , 7 , 8 , 9 , 27 , 29 , 30 , 43 , 48 ]. According to the New York State Department of Health, approximately 34% and 28% of COVID fatalities are Hispanic or Black, despite comprising 29% and 22% of the population, respectively [ 49 ].…”

“…A recent European registry analysis (On COVID) of 2634 patients with cancer diagnosed with COVID, also showed that mortality has improved in subsequent waves of the pandemic, which is reassuring and temporal trends in COVID outcomes should continue to be evaluated [26]. The disproportionate burden of morbidity and mortality from COVID in racial and ethnic minorities has been well-documented and should elicit further investigation [6][7][8][9]27,29,30,43,48]. According to the New York State Department of Health, approximately 34% and 28% of COVID fatalities are Hispanic or Black, despite comprising 29% and 22% of the population, respectively [49].…”

Effect of the COVID-19 Pandemic on Cost-Related Prescription Nonredemption, Health care Seeking and Hospitalization in Hungary: A Nationally Representative Cross-Sectional Study

“…A pooled analysis of ethnic vulnerability due to the first wave pandemic lockdown revealed that the hospitalization rate was higher for ethnic minorities in the US and Europe. Hispanics, Asians and Black African-Americans were 2.08, 1.59 and 1.53 times more likely to be hospitalized than Whites [34].…”