Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study

Abstract

ObjectiveTo describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers.SettingFive acute National Health Service Hospitals in east London.DesignProspectively defined observational study using registry data.Participants1737 patients aged 16 years or over admitted to hospital with confirmed COVID-19 infection between 1 January and 13 May 2020.Main outcome measuresThe primary outcome was 30-day mortality from time of first hospital admission with COVID-19 diagnosis during or prior to admission. Secondary outcomes were 90-day mortality, intensive care unit (ICU) admission, ICU and hospital length of stay and type and duration of organ support. Multivariable survival analyses were adjusted for potential confounders.Results1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) black and 707 (40%) white backgrounds. Compared with white patients, those from minority ethnic backgrounds were younger, with differing comorbidity profiles and less frailty. Asian and black patients were more likely to be admitted to ICU and to receive invasive ventilation (OR 1.54, (95% CI 1.06 to 2.23); p=0.023 and OR 1.80 (95% CI 1.20 to 2.71); p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 (95% CI 1.19 to 1.86); p<0.001) and black (HR 1.30 (95% CI 1.02 to 1.65); p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk factor-adjusted analyses accounting for major comorbidities, obesity, smoking, frailty and ABO blood group.ConclusionsPatients from Asian and black backgrounds had higher mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. Higher rates of invasive ventilation indicate greater acute disease severity. Our analyses suggest that patients of Asian and black backgrounds suffered disproportionate rates of premature death from COVID-19.

A retrospective cohort study of risk factors and outcomes in older patients admitted to an inner-city geriatric unit in London during first peak of COVID-19 pandemic

“…Our study showed a high prevalence of patients from Black, Asian and minority ethnic (BAME) backgrounds, reflecting the local general population. However, unlike the previously published studies on BAME patients [13,19], we were not able to demonstrate any significant differences in outcomes according to ethnicity in our cohort.…”

“…This study was performed as a sub-population analysis within the ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London (ethical) study [13], involving analysis of routinely collected patient data by members of the usual care team and approved by NHS England Health Research Authority (IRAS Project ID 283,512).…”

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

“…The study design in seven studies was prospective cohort studies [8,12,[17][18][19][20]22], while the others were all retrospective cohort studies [11,13,15,16,21,[23][24][25]. There were a variety of countries, ranging from the U.S. to European countries, with 2 in the USA [11,24], five in the UK [8,13,15,19,22], 1 in Turkey [18],1 in France [16], 1 in Switzerland [23], 2 in Spain [21,25], 2 in Sweden [12,20], and 1 in the UK and Italy [17]. Of these, 13 study settings were in the hospital [8, 11-13, 15-20, 22, 23, 25] and two were in a nursing home [21,24].…”

“…The largest sample size was in Turkey [18], with 18,234 patients, and the smallest was in France [16], with 94 patients. Among all of the included studies, 11 studies used the clinical frailty scale (CFS) as an assessment tool for frailty [8,12,13,15,17,[19][20][21][22][23]25], one used the hospital frailty risk score [18], one used the frailty index [24], one used the palliative performance scale [11] and one used the frail nondisabled questionnaire [16]. Detailed information of adjustment variables for each study was shown in Supplemental Table 1.…”

“…Three small and underpowered studies showed no association [14][15][16]. Given recent articles exploring this association between frailty and mortality [17][18][19][20][21][22][23], we believe that there is an urgent need to summarize the evidence of this important issue. The objective of our study is to systematically review and quantify the results of the associations between frailty and mortality, which could provide evidencebased suggestions for clinicians.…”