Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities

Katikireddi, S. V. , Lal, S., Carrol, E. D., Niedzwiedz, C. L. , Khunti, K., Dundas, R. , Diderichsen, F. and Barr, B. (2021) Unequal impact of the COVID-19 crisis on minority ethnic groups: a framework for understanding and addressing inequalities. Journal of Epidemiology and Community Health, 75(10), pp. 970-974. (doi: 10.1136/jech-2020-216061) (PMID:33883198)

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Minority ethnic groups have been disproportionately affected by the COVID-19 pandemic. While the exact reasons for this remain unclear, they are likely due to a complex interplay of factors rather than a single cause. Reducing these inequalities requires a greater understanding of the causes. Research to date, however, has been hampered by a lack of theoretical understanding of the meaning of “ethnicity” (or race) and the potential pathways leading to inequalities. In particular, quantitative analyses have often adjusted away the pathways through which inequalities actually arise (i.e. mediators for the effect of interest), leading to the effects of social processes, and particularly structural racism, becoming hidden. In this paper, we describe a framework for understanding the pathways that have generated ethnic (and racial) inequalities in COVID-19. We suggest that differences in health outcomes due to the pandemic could arise through six pathways: 1) differential exposure to the virus; 2) differential vulnerability to infection/disease; 3) differential health consequences of the disease; 4) differential social consequences of the disease; 5) differential effectiveness of pandemic control measures; and 6) differential adverse consequences of control measures. Current research provides only a partial understanding of some of these pathways. Future research and action will require a clearer understanding of the multiple dimensions of ethnicity and an appreciation of the complex interplay of social and biological pathways through which ethnic inequalities arise. Our framework highlights the gaps in the current evidence and pathways that need further investigation in research that aims to address these inequalities.

Item Type:Articles
Keywords:Ethnicity, health inequalities, COVID-19, social epidemiology.
Glasgow Author(s) Enlighten ID:Dundas, Professor Ruth and Katikireddi, Professor Vittal and Niedzwiedz, Dr Claire
Authors: Katikireddi, S. V., Lal, S., Carrol, E. D., Niedzwiedz, C. L., Khunti, K., Dundas, R., Diderichsen, F., and Barr, B.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of Epidemiology and Community Health
Publisher:BMJ Publishing Group
ISSN (Online):1470-2738
Published Online:21 April 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Journal of Epidemiology and Community Health 75(10): 970-974
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
Inequalities in healthMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
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
302182A machine learning approach to understanding comorbidity between mental and physical health conditionsClaire NiedzwiedzMedical Research Council (MRC)MR/R024774/1HW - Public Health