Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank

J Public Health (Oxf). 2020 Aug 18;42(3):451-460. doi: 10.1093/pubmed/fdaa095.


Background: We examined whether the greater severity of coronavirus disease 2019 (COVID-19) amongst men and Black, Asian and Minority Ethnic (BAME) individuals is explained by cardiometabolic, socio-economic or behavioural factors.

Methods: We studied 4510 UK Biobank participants tested for COVID-19 (positive, n = 1326). Multivariate logistic regression models including age, sex and ethnicity were used to test whether addition of (1) cardiometabolic factors [diabetes, hypertension, high cholesterol, prior myocardial infarction, smoking and body mass index (BMI)]; (2) 25(OH)-vitamin D; (3) poor diet; (4) Townsend deprivation score; (5) housing (home type, overcrowding) or (6) behavioural factors (sociability, risk taking) attenuated sex/ethnicity associations with COVID-19 status.

Results: There was over-representation of men and BAME ethnicities in the COVID-19 positive group. BAME individuals had, on average, poorer cardiometabolic profile, lower 25(OH)-vitamin D, greater material deprivation, and were more likely to live in larger households and in flats/apartments. Male sex, BAME ethnicity, higher BMI, higher Townsend deprivation score and household overcrowding were independently associated with significantly greater odds of COVID-19. The pattern of association was consistent for men and women; cardiometabolic, socio-demographic and behavioural factors did not attenuate sex/ethnicity associations.

Conclusions: In this study, sex and ethnicity differential pattern of COVID-19 was not adequately explained by variations in cardiometabolic factors, 25(OH)-vitamin D levels or socio-economic factors. Factors which underlie ethnic differences in COVID-19 may not be easily captured, and so investigation of alternative biological and genetic susceptibilities as well as more comprehensive assessment of the complex economic, social and behavioural differences should be prioritised.

Keywords: communicable diseases; epidemiology; public health.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asian People* / statistics & numerical data
  • Betacoronavirus
  • Black People*
  • Body Mass Index
  • COVID-19
  • Cardiovascular Diseases / epidemiology
  • Coronavirus Infections* / epidemiology
  • Ethnicity* / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Metabolic Diseases / epidemiology
  • Middle Aged
  • Minority Groups* / statistics & numerical data
  • Pandemics
  • Pneumonia, Viral* / epidemiology
  • Population Surveillance*
  • SARS-CoV-2
  • Socioeconomic Factors
  • United Kingdom / epidemiology
  • White People* / statistics & numerical data