Ethnicity and clinical outcomes in COVID-19: A Systematic Review and Meta-analysis

Abstract

Importance The association of ethnicity with outcomes in patients with COVID-19 is unclear. Objective To determine whether the risk of SARS-CoV-2 infection, COVID-19 intensive care unit (ICU) admission and mortality are associated with ethnicity. Data Sources We searched all English language articles published 1st December 2019 - 30th June 2020 within MEDLINE, EMBASE, PROSPERO and the Cochrane library using indexing terms for COVID-19 and ethnicity, as well as manuscripts awaiting peer review on MedRxiv during the same period. Study Selection Included studies reported original clinical data, disaggregated by ethnicity, on patients with confirmed or suspected COVID-19. We excluded correspondence, area level, modelling and basic science articles. Two independent reviewers screened articles for inclusion. Of 926 identified articles, 35 were included in the meta-analyses. Data Extraction and Synthesis The review was conducted according to PRISMA guidelines. Reviewers independently extracted data using a piloted form on: (1) rates of infection, ICU admission and mortality by ethnicity; and (2) unadjusted and adjusted data comparing ethnic minority and White groups. Data were pooled using random effects models. Main Outcomes and Measures Outcomes were: (1) infection with SARS-CoV-2 confirmed on molecular testing; (2) ICU admission; and (3) mortality in COVID-19 confirmed and suspected cases. Results 13,535,562 patients from 35 studies were included in the meta-analyses. Black, Asian and Hispanic individuals had a greater risk of infection compared to White individuals (Black: pooled adjusted RR: 2.06, 95% CI: 1.59-2.67; Asian: 1.35, 95%CI: 1.15-1.59; Hispanic: 1.77, 95% CI: 1.39-2.25). Black individuals were significantly more likely to be admitted to ICU than White individuals (pooled adjusted RR: 1.61, 95% CI: 1.02-2.55). Risk of mortality was similar across ethnicities among hospitalised patients, but increased among Asian and Mixed ethnic groups in the general population. Conclusions Black, Asian and Hispanic ethnic groups are at increased risk of SARS-CoV-2 infection. Black individuals may be more likely to require ICU admission for COVID-19. There may also be disparities in risk of death from COVID-19 at a population level. Our findings are of critical public health importance and should inform policy on minimising SARS-CoV-2 exposure in ethnic minority groups.

What Can We Learn About Psychological Aging By Studying Covid-19?

“…As noted by others (e.g., Luchetti et al, 2020 ), studies suggesting resilience to loneliness during the pandemic have not included these populations. Moreover, there is evidence that certain minority groups are experiencing worse physical health effects of Covid-19 ( Sze et al, 2020 ), but the work presented in this special section does not yet systematically consider variability in psychological processes across race and ethnicity.…”

Association of demographic and occupational factors with SARS-CoV-2 vaccine uptake in a multi-ethnic UK healthcare workforce: a rapid real-world analysis

“…The COVID-19 pandemic has also disproportionately affected those from ethnic minority groups, with previous work demonstrating an increased risk of SARS-CoV-2 infection and adverse outcome relative to White individuals. 5,11,12 Furthermore, HCWs of minority ethnicity have been shown to be at higher risk of infection than their White colleagues. 9,13 In light of the increased risk of COVID-19 infection and adverse outcome faced by ethnic minority HCWs, concerns have been raised regarding uptake of the SARS-CoV-2 vaccine in this group both in the UK and in US 14, 15 .…”

Frequency and Source of Worries in An International Sample of Pregnant and Postpartum Women During the COVID-19 Pandemic

“…Our data suggest signi cantly higher worry level among populations residing outside Europe, and in some racial and ethnic communities (Asian, Black, Latin/Hispanic, Mixed Race, South Asian and other). Several factors likely contribute to this result including: 1) differences in access and quality of health care among regions (many of the highest-ranking health care systems are found in Europe); 2) the impact being able to access health care can have upon feelings of wellbeing and health and; 3) consistently established differences in COVID-19 outcomes between racial and ethnic groups (35). At the same time, our model found that having access to health insurance, a proxy for accessible health care, was not associated with worry level.…”