AbstractObjectivesTo determine if specific ethnic groups are at higher risk of mortality from COVID19 infection.DesignRetrospective cohort studySettingUniversity Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham, UKParticipantsPatients with confirmed SARS-CoV-2 infection requiring admission to UHB between 10th March 2020 and 17th April 2020ExposureEthnicityMain outcome measuresStandardised Admission Ratio (SAR) and Standardised Mortality Ratio (SMR) for each ethnicity was calculated using observed sex-specific age distributions of COVID-19 admissions/deaths and 2011 census data for Birmingham/Solihull. Hazard Ratio (aHR) for mortality was estimated for each ethnic group with white population as reference group, using Cox proportional hazards model adjusting for age, sex, social deprivation and co-morbidities, and propensity score matching.Results2217 patients admitted to UHB with a proven diagnosis of COVID-19 were included. 58.2% were male, 69.5% White and the majority (80.2%) had co-morbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger (median age 61 years vs.77 years), have no co-morbidities (27.8% vs. 16.6%) but a higher prevalence of diabetes mellitus (48.0% vs 28.2%) than White patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted. South Asian patients were also more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death; both by Cox regression (Hazard Ratio 1.66 (95%CI 1.32 – 2.10)) after adjusting for age, sex, deprivation and comorbidities and by propensity score matching, (Hazard ratio 1.68 (1.33–2.13), using the same factors but categorising ethnicity into South Asian or not.ConclusionsCurrent evidence suggests those of South Asian ethnicity may be at risk of worse COVID-19 outcomes, further studies need to establish the underlying mechanistic pathways.Research in contextEvidence beforePublished studies of the evolving COVID-19 pandemic have suggested risk factors for the most severe manifestations of the disease, including increasing age, male sex and co-morbidities, especially hypertension, cardiovascular disease and diabetes. There have been observations suggesting poorer outcomes for patients of some ethnicities, and understanding this has become a global priority.Added valueAlthough still an emerging picture, initial data from our multi-ethnic cohort suggests there are more admissions from South Asian patients than would be expected based on our population, these patients are admitted with a worse severity of COVID19 related respiratory compromise without a significant delay in presentation and experience a higher level of mortality even when differences in age, sex, deprivation and key comorbidities were taken into account. This was consistently shown using different statistical methods.ImplicationsSouth Asian ethnicity may form another ‘at risk’ population from COVID-19. However, further studies are needed to better understand the underlying reasons, in particular any modifiable factors to improve outcomes as well as to refine our understanding and communication around non-modifiable risk factors.
Comparing Characteristics of Endometrial Cancer in Women of South Asian and White Ethnicity in England
