TY - JOUR
T1 - Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths
T2 - analysis of 2 years of a record linked national cohort study in Scotland
AU - Amele, Sarah
AU - Kibuchi, Eliud
AU - McCabe, Ronan
AU - Pearce, Anna
AU - Henery, Paul
AU - Hainey, Kirsten
AU - Fagbamigbe, Adeniyi Francis
AU - Kurdi, Amanj
AU - McCowan, Colin
AU - Simpson, Colin R
AU - Dibben, Chris
AU - Buchanan, Duncan
AU - Demou, Evangelia
AU - Almaghrabi, Fatima
AU - Anghelescu, Gina
AU - Taylor, Harry
AU - Tibble, Holly
AU - Rudan, Igor
AU - Nazroo, James
AU - Bécares, Laia
AU - Daines, Luke
AU - Irizar, Patricia
AU - Jayacodi, Sandra
AU - Pattaro, Serena
AU - Sheikh, Aziz
AU - Katikireddi, Srinivasa Vittal
N1 - Funding Information:
This work was supported by the ESRC (grant number ES/W000849/1). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. SA, EK, RM, AP, KH, ED and SVK are supported by Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). SVK acknowledges funding from a National Records of Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). AP acknowledges funding from Wellcome Trust (205412/Z/16/Z).
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - BACKGROUND: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland.METHODS: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time.FINDINGS: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave.INTERPRETATION: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.
AB - BACKGROUND: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland.METHODS: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time.FINDINGS: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave.INTERPRETATION: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.
KW - Humans
KW - Ethnicity
KW - Cohort Studies
KW - SARS-CoV-2
KW - COVID-19/diagnosis
KW - Minority Groups
KW - Hospitalization
KW - Scotland/epidemiology
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85170438548&partnerID=8YFLogxK
U2 - 10.1136/jech-2023-220501
DO - 10.1136/jech-2023-220501
M3 - Article
C2 - 37524538
SN - 1470-2738
VL - 77
SP - 641
EP - 648
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 10
ER -