Early in the current pandemic, data appeared to suggest that Black and Asian individuals might be at a higher risk of COVID-19 morbidity and mortality.
However, what is less clear is whether the associations between increased mortality and Black and Asian individuals is related to a greater vulnerability to infection with the virus or more severe disease.
A team of researchers from the Department of Cardiovascular Sciences, University of Leicester, searched all major databases (including non-peer reviewed publications on MedRxiv) published between December 2019 and end of August 2020) for studies that contained original clinical data on COVID-19 infection, intensive care unit (ITU) admission or mortality broken down by ethnicity. The outcomes studied were infection with COVID-19, ITU admission and death and patients with COVID-19 were defined by those having had a positive PCR nasopharyngeal/throat swab test.
A total of 50 studies with 18,728,893 patients were included in the analysis. Overall, 42 of which came from the US and the remaining 8 from the UK. The analysis revealed that compared with those from a white ethnicity, Black individuals had a two-fold higher risk of infection with COVID-19 (relative risk, RR = 2.02, 95% CI 1.67 – 2.44) as did Asian (RR = 1.50, 95% CI 1.24 – 1.83) and Hispanics (RR = 1.77, 95% CI 1.39 – 2.25). Similarly, there was a greater risk of ITU admission for both Black (RR = 1.28) and Asian (RR = 1.97) individuals even after adjustment for age, sex and co-morbidities. Interestingly, there was no statistically significant increased risk of death for those from BAME communities but there was a trend but only for Asians (RR = 1.22, 95% CI 0.99 – 1.63). In discussing their findings, the authors noted that the increased risk of death among those from an Asian ethnicity was probably due to the higher risk of infection.
Although there appeared to be no specific physiological reason to account for the findings, the authors speculated that social factors such as larger household size, employment in essential services (and thus less chance to work from home) may have been important contributory factors.
Reference Sze S et al. Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2020. https://doi.org/10.1016/j.eclinm.2020.100630