Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank

Abstract

Preliminary reports suggest that the Coronavirus Disease 2019 (COVID− 19) pandemic has led to disproportionate morbidity and mortality among historically disadvantaged populations. We investigate the racial and socioeconomic associations of COVID− 19 hospitalization among 418,794 participants of the UK Biobank, of whom 549 (0.13%) had been hospitalized. Both Black participants (odds ratio 3.7; 95%CI 2.5–5.3) and Asian participants (odds ratio 2.2; 95%CI 1.5–3.2) were at substantially increased risk as compared to White participants. We further observed a striking gradient in COVID− 19 hospitalization rates according to the Townsend Deprivation Index − a composite measure of socioeconomic deprivation − and household income. Adjusting for socioeconomic factors and cardiorespiratory comorbidities led to only modest attenuation of the increased risk in Black participants, adjusted odds ratio 2.4 (95%CI 1.5–3.7). These observations confirm and extend earlier preliminary and lay press reports of higher morbidity in non-White individuals in the context of a large population of participants in a national biobank. The extent to which this increased risk relates to variation in pre-existing comorbidities, differences in testing or hospitalization patterns, or additional disparities in social determinants of health warrants further study.

Racial/Ethnic Disparities in Hospital Admissions from COVID-19 and Determining the Impact of Neighborhood Deprivation and Primary Language

“…Both U.K. studies assessed COVID-19 patients and found that Black andAsian patients were at an increased odds of hospitalization. Similar to our findings, after controlling for areas of deprivation and comorbidities, the risk for racial and ethnic minority patients persisted (21,22).…”

“…median income, number of dependents, % with complete plumbing) , and employment status. ADI (20) and other indices (21)(22)(23) have been used to estimate the effects of these socioeconomic variables in aggregate on outcomes, including in COVID-19.…”

The association of treatment with hydroxychloroquine and hospital mortality in COVID-19 patients

“…Finally, two more RCTs have reported no association between HCQ and virological clearance [39] or prevention of disease in individuals exposed to it [40]. A number of factors could explain the difference between our results and the ones observed in these studies [32][33][34][35][36][37][38][39][40] including the following: the clinical-epidemiological design of our work; [30] the involvement of all patients admitted with COVID-19, regardless their past medical history, the time between onset of symptoms and the start of treatment, the duration of admission, and the need for oxygen; the different statistical approach; and the observation in our work of patients from private hospitals, who are likely to have a high socioeconomic status [41]. The safety of the HCQ has been questioned, as it could negatively impact the immune response to the virus, or cause abnormalities in the ECG [33,42,43].…”

COVID-19 no Nordeste brasileiro: sucessos e limitações nas respostas dos governos dos estados

“…This study focusing on the states of the Northeast region, one of the poorest regions of the country, but heterogeneous in some socioeconomic and demographic indicators, allows to verify the variations in the magnitude of the epidemic and explore the effectiveness of the social distance measures implemented in a socioeconomic and political context unfavorable. The interaction between poverty, unemployment, education level, race, and gender and has been documented as determinants of COVID-19 28,29 . People with low incomes are more exposed to infectious diseases, including SARS-CoV-2, due to the lack of access to basic sanitation and treated water, the lack of access to education and health services, the use of public transport, subject to crowding and the difficulty of self-isolating, living in precarious housing and/or with an excessive number of residents, or also because they are more often unemployed or engaged in informal jobs.…”