New research suggests that people of Black, mixed-race, and Asian ethnicity are at higher risk of contracting COVID-19, but these risks vary as the disease progresses.
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A new study reveals that the risks of contracting COVID-19 for people of Black, mixed, or Asian ethnicity vary throughout the course of the disease.
The research also suggests that, even taking into account socioeconomic status and other comorbidities, these populations have a higher risk of contracting COVID-19.
According to the authors of the research, which appears in the journal EClinicalMedicine , this suggests that other, as yet unidentified, factors related to ethnicity are likely to play a role.
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As the COVID-19 pandemic progresses, both anecdotal evidence and emerging studies are making it clear how the disease disproportionately affects people of different ethnic backgrounds.
However, the reasons for this, the precise form these effects take, and how different ethnic groups are affected are not yet fully understood.
For example, a person’s ethnicity may increase the likelihood that they will be exposed to the virus, contract it, develop a severe case of COVID-19, or all three.
There may also be different reasons for these increased risks. Ethnicity can increase the risk due to associated diseases, socioeconomic status, education, employment, genetic differences, or problems linked to racism, which encompasses many of the issues mentioned above.
Furthermore, ethnicity itself is a complicating factor due to the complexity of individual genetic inheritance.
As Dr. Winston Morgan, professor of toxicology and clinical biochemistry at the University of East London, UK, argues, “there is as much genetic variation within racialized groups as among the entire human population.”
For researchers, while genetic differences can sometimes be associated with specific ethnicities and linked to particular health problems, it is not at all clear how this might work in the context of COVID-19.
Indeed, according to Dr. Morgan: “The evidence suggests that the new coronavirus does not discriminate, but rather exposes existing discrimination. The persistence of ideas about race today—despite the lack of scientific basis—demonstrates how these ideas can mutate to justify the power structures that have governed our society since the 18th century.”
In this context, a better understanding of the relationship between adverse COVID-19 outcomes and ethnicity is crucial to reducing these negative outcomes.
To contribute to this task, the authors of this research conducted a study to examine whether people from different ethnic groups are more likely to be hospitalized with severe COVID-19 and whether they are more likely to die from the disease. The team also wanted to consider socioeconomic factors and comorbidities associated with the identified differences.
The authors conducted two studies. The first, an observational study, analyzed data from 1,827 adults with confirmed cases of COVID-19 who were admitted to King’s College Hospital in London, UK, between March 1 and June 2, 2020.
The second study, a case-control study, compared a subset of 872 patients residing in marginal urban areas, based on their age and location, with a control group of 3488 people drawn from a primary care database that included people from the local area; four controls for each of the patients in the subset.
Of the 872 patients, 48.1% were black, 33.7% were white, 12.6% were of mixed ethnicity, and 5.6% were Asian.The team discovered that black and mixed-race patients were three times more likely to require hospitalization after contracting COVID-19 than white patients in the same area of London.
After adjusting the data to account for other factors, such as known COVID-19 comorbidities and socioeconomic deprivation, the authors still found that Black and mixed-race patients were 2.2 to 2.7 times more likely to need hospitalization compared to white people.
Once in the hospital, the authors found no significant differences in survival rates between black and mixed-ethnicity patients and white patients.
In contrast, the study authors found that people of Asian descent did not have a higher risk of hospitalization for COVID-19. However, they did show a higher rate of admission to intensive care units and higher mortality rates from the disease.
The research suggests that ethnicity likely influences the evolution of COVID-19 in ways that are not yet understood.
This may be due to genetic differences, but it could also be a consequence of behavioral differences or aspects of structural racism that are not taken into account when considering only socioeconomic background.
According to Professor Ajay Shah, lead author and British Heart Foundation Chair of Cardiology at King’s College London, “it is surprising to find that black and Asian patients are affected in very different ways, and that the significant risk persists even after adjusting for deprivation and long-term health conditions.”
“This strongly suggests that other factors, possibly biological, are important and that we may need different treatment strategies for different ethnic groups. For Black patients, the issue might be how to prevent a mild infection from progressing to a severe one, while for Asian patients, it might be how to treat life-threatening complications,” adds Professor Shah.According to Dr. Sonya Babu-Narayan, Associate Medical Director of the British Heart Foundation, which funded the study, “This study provides further evidence that COVID-19 disproportionately affects people from minority ethnic backgrounds where they live, as has been observed around the world.”
“It has been complex to address why the coronavirus affects people from ethnic minorities more severely and how to mitigate this effect,” he continues.
“People of Black, Asian and other ethnic minority backgrounds more frequently have heart and circulatory risk factors, such as hypertension and diabetes, and are more exposed to socioeconomic disadvantages, but this study indicates that the worst effects of COVID-19 persist even after taking these factors into account.
It is now necessary to investigate how other structural and behavioral factors may contribute, including occupation, access to health information and care, and differences in patient experience once they arrive at the hospital. Given the renewed surge in COVID-19 cases in the UK, we must address these inequalities urgently.
– Dra. Sonya Babu-Narayan
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