Ethnic disparities in hospitalisation for COVID-19 in England: The role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study

Brain Behav Immun. 2020 Aug;88:44-49. doi: 10.1016/j.bbi.2020.05.074. Epub 2020 Jun 1.

Abstract

Background: Differentials in COVID-19 hospitalisations and mortality according to ethnicity have been reported but their origin is uncertain. We examined the role of socioeconomic, mental health, and pro-inflammatory factors in a community-based sample.

Methods: We used data on 340,966 men and women (mean age 56.2 years) from the UK Biobank study, a prospective cohort study with linkage to hospitalisation for COVID-19. Logistic regression models were used to estimate associations between ethnicity and hospitalisation for COVID-19.

Results: There were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of COVID-19 infection (odds ratio; 95% confidence interval: 4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the 'other' non-white group (1.84; 1.13, 2.99). After controlling for potential explanatory factors which included neighbourhood deprivation, household crowding, smoking, body size, inflammation, glycated haemoglobin, and mental illness, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31).

Conclusions: There were clear ethnic differences in risk of COVID-19 hospitalisation and these do not appear to be fully explained by measured factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage.

Keywords: COVID-19; Ethnicity; Inflammatory factors.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Asian Continental Ancestry Group / statistics & numerical data*
  • Betacoronavirus
  • Body Mass Index
  • C-Reactive Protein / immunology
  • COVID-19
  • Cohort Studies
  • Comorbidity
  • Coronavirus Infections / ethnology*
  • Coronavirus Infections / immunology
  • Coronavirus Infections / therapy
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • England / epidemiology
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Forced Expiratory Volume
  • Glycated Hemoglobin A / metabolism
  • Health Status
  • Healthcare Disparities / ethnology*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inflammation
  • Male
  • Mental Health
  • Middle Aged
  • Pandemics
  • Patient Health Questionnaire
  • Pneumonia, Viral / ethnology*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / therapy
  • SARS-CoV-2
  • Socioeconomic Factors

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • C-Reactive Protein