Abstract
Background-Black Asian and Minority Ethnicity (BAME) patients account for 34% of critically ill COVID-19 patients despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand the risk factors among ethnic subgroups. We explored the extent to which social determinants for health including individual Index of Multiple Deprivation (IMD) sub-indices are risk factors for presentation with multilobar pneumonia, Intensive Therapy Unit (ITU) admission and hospitalised outcomes disaggregated by BAME subgroup.Methods-Multi-centre cohort study of hospitalised COVID-19 patients. Results-BAME patients with pneumonia and low CURB65 scores (0-1) had higher mortality than Caucasians (22.6% vs.9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004). Age, sex, cirrhosis, obesity, Charlson Comorbidity (CCI) scores, presentation with multi-lobar pneumonia and ITU admission were independent mortality risk factors. BAME subgroups were more likely to be admitted with higher CCI scores than age, sex and deprivation matched controls and from the highest IMD sub-indices of at least one deprivation form: Indoor Living Environment (LE), Outdoor LE, Adult Skills and Wider Barriers to Housing and Services. Admission from the highest sub-indices of these deprivation forms was associated with multilobar pneumonia on presentation and ITU admission.Conclusions-BAME subgroups exhibit younger age structures resulting in CURB65 underscoring and disproportionate exposure to unscored risk factors:sex, obesity, multimorbidity and deprivation. Household overcrowding deprivation, air pollution deprivation, housing quality deprivation and adult skills deprivation are associated with multi-lobar pneumonia on presentation and ITU admission. Risk tools need to reflect risk factors predominantly affecting BAME subgroups.