Irizar, P. et al. (2023) Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine, 57, 101877. (doi: 10.1016/j.eclinm.2023.101877) (PMID:36969795) (PMCID:PMC9986034)
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Abstract
Background: COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods: Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings: 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59–1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59–5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02–1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01–1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation: Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination.
| Item Type: | Articles |
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| Additional Information: | This work was supported by the Economic and Social Research Council (ESRC; grant number ES/W000849/1). LG is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM). DP is supported by an NIHR Doctoral Research Fellowship (NIHR302338). SA and EK are supported by Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). MP is supported by a NIHR Development and Skills Enhancement Award and by the NIHR Leicester Biomedical Research Centre (BRC). SVK acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). LBN is supported by an Academy of Medical Sciences Springboard Award (SBF005/1047). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Katikireddi, Professor Vittal and Kibuchi, Dr Eliud and Amele, Ms Sarah |
| Authors: | Irizar, P., Pan, D., Kapadia, D., Bécares, L., Sze, S., Taylor, H., Amele, S., Kibuchi, E., Divall, P., Gray, L. J., Nellums, L. B., Katikireddi, S. V., and Pareek, M. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | EClinicalMedicine |
| Publisher: | Elsevier |
| ISSN: | 2589-5370 |
| ISSN (Online): | 2589-5370 |
| Published Online: | 06 March 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in EClinicalMedicine 57: 101877 |
| Publisher Policy: | Reproduced under a Creative Commons license |
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