Ethnicity, household composition and COVID-19 mortality: a national linked data study

Nafilyan, V. et al. (2021) Ethnicity, household composition and COVID-19 mortality: a national linked data study. Journal of the Royal Society of Medicine, 114(4), pp. 182-211. (doi: 10.1177/0141076821999973) (PMID:33759630) (PMCID:PMC7994923)

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Objective To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. Design Causal mediation analysis. Setting Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). Participants Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). Main outcome measures Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. Results Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. Conclusion Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.

Item Type:Articles
Additional Information:This research was funded by the Office for National Statistics. VN is also funded by Health Data Research UK (HDRUK). HDR-UK is an initiative funded by the UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal
Authors: Nafilyan, V., Islam, N., Ayoubkhani, D., Gilles, C., Katikireddi, V., Mathur, R., Summerfield, A., Tingay, K., Asaria, M., John, A., Goldblatt, P., Banerjee, A., Glickman, M., and Khunti, K.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of the Royal Society of Medicine
Publisher:SAGE Publications
ISSN (Online):1758-1095
Published Online:24 March 2021
Copyright Holders:Copyright © 2021 The Royal Society of Medicine
First Published:First published in Journal of the Royal Society of Medicine 114(4): 182-211
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health