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

Sarah Amele; Eliud   Kibuchi; Ronan  McCabe; Anna Pearce; Paul Henery; Kirsten Hainey; Adeniyi Francis 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 Becares; 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 2 years of a record linked national cohort study in Scotland

Sarah Amele, Eliud Kibuchi, Ronan McCabe, Anna Pearce, Paul Henery, Kirsten Hainey, Adeniyi Francis 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 BecaresLuke Daines, Patricia Irizar, Sandra Jayacodi, Serena Pattaro, Aziz Sheikh, Srinivasa Vittal Katikireddi

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

6 Citations (Scopus)

13 Downloads (Pure)

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 - 1 Oct 2023

Funding

This work was supported by the ESRC (grant number ES/W000849/1). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. SA, EK, RM, AP, KH, ED and SVK are supported by Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). SVK acknowledges funding from a National Records of Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). AP acknowledges funding from Wellcome Trust (205412/Z/16/Z).

Keywords

Covid-19
SARS CoV-19
ethnicity
race
ethnic inequalities

Access to Document

10.1136/jech-2023-220501Licence: CC BY 4.0

Amele-etal-JECH-2023-Ethnic-inequalities-in-positive-SARS-CoV-2-testsFinal published version, 4.04 MBLicence: CC BY 4.0

Cite this

Amele, S., Kibuchi, E., McCabe, R., Pearce, A., Henery, P., Hainey, K., Fagbamigbe, A. F., 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 2 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

@article{5e5ca97246964ccf9fa899b4c59a6170,

title = "Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths: analysis of 2 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-19, ethnicity, race, ethnic inequalities",

author = "Sarah Amele and Eliud Kibuchi and Ronan McCabe and Anna Pearce and Paul Henery and Kirsten Hainey and Fagbamigbe, \{Adeniyi Francis\} 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 Becares and Luke Daines and Patricia Irizar and Sandra Jayacodi and Serena Pattaro and Aziz Sheikh and Katikireddi, \{Srinivasa Vittal\}",

year = "2023",

month = oct,

day = "1",

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

language = "English",

volume = "77",

pages = "641--648",

journal = "Journal of Epidemiology and Community Health",

issn = "0143-005X",

publisher = "BMJ Publishing Group",

number = "10",

}

Amele, S, Kibuchi, E, McCabe, R, Pearce, A, Henery, P, Hainey, K, Fagbamigbe, AF, Kurdi, A, McCowan, C, Simpson, CR, Dibben, C, Buchanan, D, Demou, E, Almaghrabi, F, Anghelescu, G, Taylor, H, Tibble, H, Rudan, I, Nazroo, J, Becares, 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 2 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 2 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, 01.10.2023, 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 2 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 Francis

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 - Becares, Laia

AU - Daines, Luke

AU - Irizar, Patricia

AU - Jayacodi, Sandra

AU - Pattaro, Serena

AU - Sheikh, Aziz

AU - Katikireddi, Srinivasa Vittal

PY - 2023/10/1

Y1 - 2023/10/1

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-19

KW - ethnicity

KW - race

KW - ethnic inequalities

UR - https://jech.bmj.com/

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 2 years of a record linked national cohort study in Scotland. Journal of Epidemiology and Community Health. 2023 Oct 1;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 2 years of a record linked national cohort study in Scotland

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Cite this