Black and Asian patients have increased risk of severe COVID-19 at different stages of the disease
Patients of Black ethnicity have an increased risk of requiring hospital admission for COVID-19, while patients of Asian ethnicity have an increased risk of dying in hospital from COVID-19, NIHR researchers have found.
People from minority ethnic groups are at greater risk of becoming very sick with COVID-19 than the white population in the UK according to the Office of National Statistics. In particular, Black men and women are nearly twice as likely as white people to die from COVID-19.
Researchers at King’s College London, with support from the NIHR Guy’s and St Thomas’ Biomedical Research Centre and the British Heart Foundation, have examined the relationship between ethnic background and how people are affected by COVID-19.
The results of the study published in EClinicalMedicine confirm that minority ethnic patients bear a higher burden of the disease than white patients and also that Black patients and Asian patients are more severely affected at different stages of the disease.
The study analysed data from 1,827 adult patients admitted to King’s College Hospital, south-east London, with a primary diagnosis of COVID-19 between 1 March and 2 June 2020.
Researchers analysed mortality in this group, and also compared a subset of 872 admitted patients from inner south-east London with 3,488 matched controls residing in the same region to determine how ethnic background is associated with the need for hospitalisation for severe disease. Of these 872 admitted patients, 48.1% were Black, 33.7% white, 12.6% mixed ethnicity and 5.6% were Asian ethnicity.
The analysis showed that Black and mixed ethnicity patients had a three-fold higher risk of requiring hospital admission once infected with COVID-19 compared to white inner-city residents of the same region. This was only partly explained by comorbidities and deprivation, because after adjusting for these factors Black patients still had a 2.2 to 2.7-fold higher admission risk. However, in-hospital survival for these patients was not significantly different from white patients.
By contrast, Asian patients did not have a higher risk of requiring hospital admission with COVID-19 than white patients, but their in-hospital death rate and need for intensive care unit admission was higher than the other groups.
The researchers observed that the minority ethnic patients were 10-15 years younger than white patients and had a higher prevalence of comorbidities, especially diabetes.
The study suggests that while comorbidities and socioeconomic factors contribute to the impact of COVID-19 on minority communities, there may be an important role for other factors such as biological factors which affect different subgroups in different ways.
Professor Ajay Shah, BHF Professor of Cardiology at King’s College London and Consultant Cardiologist at King’s College Hospital, said: “The finding that Black versus Asian patients are affected in quite different ways, and that significant risk persists even after adjustment for deprivation and long-term health conditions, is striking. It 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 may be how to prevent mild infection progressing to severe whereas for Asian patients it may be how to treat life-threatening complications.”
Professor Chris Whitty, Chief Medical Officer for England and Head of the NIHR, said: "The evidence is now clear that people from Black and minority ethnic groups are more severely affected by COVID-19. This NIHR-supported research shows how different groups are affected, providing important information to help healthcare professionals offer the best possible treatment to minority ethnic patients."
The researchers advise that the results of this study are likely to be applicable across the whole of London and similar UK cities, but more research is needed to translate to multi-ethnic populations in other countries.