COVID-19 death risk higher for ethnic minorities, report reveals

Coronavirus: Public Health England publishes report into disparities in the risk and outcomes of COVID-19

People from Black, Asian and other ethnic minority groups are at a higher risk of dying from coronavirus, says a report by Public Health England (PHE).

The report, called Disparities in the risk and outcomes of COVID-19, shows age remains the biggest risk factor associated with COVID-19, while being male is another. However, there also has a disproportionate impact on BAME people. 

However, the reasons for the impact of the virus on BAME people remain unclear. The PHE analysis on ethnicity and risk did not consider a person's occupation or obesity, even though both are known risk factors.

PHE reviewed thousands of health records and virus data to look at disparities by:

• age and sex
• geography
• deprivation
• ethnicity
• pre-existing health problems or co-morbidities.

PHE said it not possible to combine all of these factors together to judge an individual's risk because of the way the source data is recorded. However, it reports that the data reveals clear inequalities.

The report findings
The report found:

• People aged 80 or older are 70 times more likely to die than those under 40
• Working-age men diagnosed with COVID-19 are twice as likely to die as women
• The risk of dying with the virus is higher among those living in more deprived parts of the UK
• Certain occupations - security guards, taxi or bus drivers and construction workers and social care staff - are at higher risk
• Virus death rates were highest among people of Black and Asian ethnic groups when compared to white British ethnicity
• People of Chinese, Indian, Pakistani, other Asian, Caribbean and other Black ethnicity had between a 10% and 50% higher risk of death when compared to White British people
• Once age and sex are stripped out, people of Bangladeshi ethnicity have twice the risk of death than people of White British ethnicity

The PHE review confirms that the impact of COVID-19 has replicated existing health inequalities and, in some cases, has increased them.  The largest disparity found was by age. Among people already diagnosed with COVID- 19, people who were 80 or older were seventy times more likely to die than those under 40.

Risk of dying among those diagnosed with COVID-19 was also higher in males than females; higher in those living in the more deprived areas than those living in the least deprived; and higher in those in Black, Asian and Minority Ethnic (BAME) groups than in White ethnic groups.

“These inequalities largely replicate existing inequalities in mortality rates in previous years, except for BAME groups, as mortality was previously higher in White ethnic groups,” states the report. “These analyses take into account age, sex, deprivation, region and ethnicity, but they do not take into account the existence of comorbidities, which are strongly associated with the risk of death from COVID-19 and are likely to explain some of the differences.”

When compared to previous years, PHE found a particularly high increase in all cause deaths among:

• people born outside the UK and Ireland
• workers in a range of caring occupations including social care and nursing auxiliaries and assistants
• people who drive passengers in road vehicles for a living including taxi and minicab drivers and chauffeurs
• security guards and related occupations
• people in care homes.

The analysis did not take into account the existence of comorbidities, which are strongly associated with the risk of death from COVID-19. PHE said this could explain some of these differences.

When this data was analysed, the majority of testing had been offered to those in hospital with a medical need. Confirmed cases therefore represent the population of people with severe disease, rather than all of those who get infected. This is important because disparities between diagnoses rates may reflect differences in the risk of getting the infection, in presenting to hospital with a medical need and in the likelihood of being tested.

PHE said the results of the review need to be widely discussed and considered by all those involved in the national and local response to COVID-19. “However,” the report states, “it is already clear that relevant guidance, certain aspects of recording and reporting of data, and key policies should be adapted to recognise and wherever possible mitigate or reduce the impact of COVID-19 on the population groups that are shown in this review to be more affected by the infection and its adverse outcomes.”

Publication and response
On Monday night, the Department of Health and Social Care denied reports that publication of the report had been delayed due to official concerns of potential civil unrest linked to global anger over the death of African-American George Floyd in the USA.

Health Secretary Matt Hancock told the House of Commons: “Black lives matter, as do those of the poorest areas of our country which have worse health outcomes and we need to make sure all of these considerations are taken into account, and action is taken to level-up the health outcomes of people across this country.”

Speaking at the daily 10 Downing Street coronavirus briefing later in the day, Hancock said more work needed to be done to understand what was driving these disparities. He said: “We are absolutely determined to get to the bottom of this and find ways of closing this gap.”

Hancock said that equalities minister Kemi Badenoch to continue working on the issue alongside PHE.

Prof John Newton, who is the government’s director of health improvement, told the briefing that although the virus was having a worse impact on BAME people, this may not necessarily be due to their ethnicity and could, instead, be related to types of employment. He said: “The report if nothing else emphasises the complexity of what we're seeing, so really we're urging people not to jump to conclusions and institute measures which are not really justified by the data.”

London Mayor Sadiq Khan said: “Lives depend on" finding out why the virus disproportionately impacts black and minority ethnic people, and what actions the government was taking to stop it.