Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland

Sarah Amele; Eliud Kibuchi; Ronan McCabe; Anna Pearce; Paul Henery; Kirsten Hainey; Adeniyi Fagbamigbe; Amanj Kurdi; Colin McCowan; Colin R Simpson; Chris Dibben; Duncan Buchanan; Evangelia Demou; Fatima Almaghrabi; Gina Anghelescu; Harry Taylor; Holly Tibble; Igor Rudan; James Nazroo; Laia Bécares; Luke Daines; Patricia Irizar; Sandra Jayacodi; Serena Pattaro; Aziz Sheikh; Srinivasa Vittal Katikireddi

doi:10.1136/jech-2023-220501

Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland

Sarah Amele
, Eliud Kibuchi^*
, Ronan McCabe
, Anna Pearce
, Paul Henery
, Kirsten Hainey
, Adeniyi Fagbamigbe
, Amanj Kurdi
, Colin McCowan
, Colin R Simpson
, Chris Dibben
, Duncan Buchanan
, Evangelia Demou
, Fatima Almaghrabi
, Gina Anghelescu
, Harry Taylor
, Holly Tibble
, Igor Rudan
, James Nazroo
, Laia Bécares

Luke Daines, Patricia Irizar, Sandra Jayacodi, Serena Pattaro, Aziz Sheikh, Srinivasa Vittal Katikireddi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	641-648
Number of pages	8
Journal	Journal of Epidemiology and Community Health
Volume	77
Issue number	10
Early online date	31 Jul 2023
DOIs	https://doi.org/10.1136/jech-2023-220501
Publication status	Published - Oct 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
SARS-CoV-2
Ethnicity
Race
Ethnic inequalities

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Amele, S., Kibuchi, E., McCabe, R., Pearce, A., Henery, P., Hainey, K., Fagbamigbe, A., Kurdi, A., McCowan, C., Simpson, C. R., Dibben, C., Buchanan, D., Demou, E., Almaghrabi, F., Anghelescu, G., Taylor, H., Tibble, H., Rudan, I., Nazroo, J., ... Katikireddi, S. V. (2023). Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland. Journal of Epidemiology and Community Health, 77(10), 641-648. https://doi.org/10.1136/jech-2023-220501

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title = "Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland",

abstract = "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.",

keywords = "COVID-19, SARS-CoV-2, Ethnicity, Race, Ethnic inequalities",

author = "Sarah Amele and Eliud Kibuchi and Ronan McCabe and Anna Pearce and Paul Henery and Kirsten Hainey and Adeniyi Fagbamigbe and Amanj Kurdi and Colin McCowan and Simpson, \{Colin R\} and Chris Dibben and Duncan Buchanan and Evangelia Demou and Fatima Almaghrabi and Gina Anghelescu and Harry Taylor and Holly Tibble and Igor Rudan and James Nazroo and Laia B{\'e}cares and Luke Daines and Patricia Irizar and Sandra Jayacodi and Serena Pattaro and Aziz Sheikh and Katikireddi, \{Srinivasa Vittal\}",

note = "Funding: Economics and Social Research Council (ESRC) ES/W000849/1, Medical Research Council (MRC) MC\_UU\_00022/2, Scottish Government Chief Scientist Office SPHSU17.",

year = "2023",

month = oct,

doi = "10.1136/jech-2023-220501",

language = "English",

volume = "77",

pages = "641--648",

journal = "Journal of Epidemiology and Community Health",

issn = "0143-005X",

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Amele, S, Kibuchi, E, McCabe, R, Pearce, A, Henery, P, Hainey, K, Fagbamigbe, A, Kurdi, A, McCowan, C, Simpson, CR, Dibben, C, Buchanan, D, Demou, E, Almaghrabi, F, Anghelescu, G, Taylor, H, Tibble, H, Rudan, I, Nazroo, J, Bécares, L, Daines, L, Irizar, P, Jayacodi, S, Pattaro, S, Sheikh, A & Katikireddi, SV 2023, 'Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland', Journal of Epidemiology and Community Health, vol. 77, no. 10, pp. 641-648. https://doi.org/10.1136/jech-2023-220501

Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland. / Amele, Sarah; Kibuchi, Eliud; McCabe, Ronan et al.
In: Journal of Epidemiology and Community Health, Vol. 77, No. 10, 10.2023, p. 641-648.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths

T2 - analysis of two 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

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: Economics and Social Research Council (ESRC) ES/W000849/1, Medical Research Council (MRC) MC_UU_00022/2, Scottish Government Chief Scientist Office SPHSU17.

PY - 2023/10

Y1 - 2023/10

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 - COVID-19

KW - SARS-CoV-2

KW - Ethnicity

KW - Race

KW - Ethnic inequalities

U2 - 10.1136/jech-2023-220501

DO - 10.1136/jech-2023-220501

M3 - Article

SN - 0143-005X

VL - 77

SP - 641

EP - 648

JO - Journal of Epidemiology and Community Health

JF - Journal of Epidemiology and Community Health

IS - 10

ER -

Amele S, Kibuchi E, McCabe R, Pearce A, Henery P, Hainey K et al. Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland. Journal of Epidemiology and Community Health. 2023 Oct;77(10):641-648. Epub 2023 Jul 31. doi: 10.1136/jech-2023-220501

Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of two years of a record linked national cohort study in Scotland

Abstract

UN SDGs

Keywords

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