How does risk vary for Black and Asian patients with COVID-19?

New research suggests that people of Black, mixed, and Asian ethnicity are more at risk of COVID-19, but these risks vary as the disease progresses.

A new study finds that COVID-19 risks for people of Black, mixed, or Asian ethnicity vary over the course of the disease.

The research also suggests that even after accounting for socioeconomic status and other comorbidities, these populations are more at risk of contracting COVID-19.

For the authors of the research, which appears in the journal EClinicalMedicine, this suggests that other yet-to-be-identified factors associated with ethnicity are likely to be at play.

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COVID-19 and ethnicity

As the COVID-19 pandemic progresses, both anecdotal evidence and emerging studies are making clear how the disease disproportionately affects people from different ethnic backgrounds.

However, the reasons for this, precisely what form these effects take, and how different ethnic groups are affected are yet to be fully understood.

For example, a person’s ethnicity may make them more likely to 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 may increase risk due to associated illnesses, socioeconomic status, education, employment, genetic differences, or issues linked to racism that encompasses many of the issues mentioned above.

Furthermore, ethnicity itself is a complicated factor due to the complexities of individual genetic heritage.

As Dr. Winston Morgan, a Reader in Toxicology and Clinical Biochemistry at the University of East London, United Kingdom, argues, “there is as much genetic variation within racialized groups as there is between the whole human population.”

For the researchers, while genetic differences can, at times, be associated with specific ethnicities and linked to particular health issues, how this could work in the context of COVID-19 is far from clear.

Indeed, for Dr. Morgan: “The evidence suggests that the new coronavirus does not discriminate but highlights existing discriminations. The continued prevalence of ideas about race today – despite the lack of any scientific basis – shows how these ideas can mutate to justify the power structures that have ordered our society since the 18th century.”

In this context, better understanding the relationship between adverse COVID-19 outcomes and ethnicity is crucial in reducing these negative outcomes.

Differential effects across ethnicities

To contribute to this task, the authors of the present research developed a study to examine whether people from different ethnic groups are more likely to be admitted to hospital with severe COVID-19 and whether they are more likely to die from the disease. The team also wanted to consider the socioeconomic factors and comorbidities associated with the differences they identified.

The authors carried out two studies. The first — an observational study — looked at the data from 1,827 adults who had confirmed cases of COVID-19 and were admitted to King’s College Hospital in London, UK, between March 1 and June 2, 2020.

The second — a case control study— matched a subset of 872 patients who were inner-city residents by age and location with a control group of 3,488 people taken from a primary care database listing 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 found that Black and mixed ethnicity patients were three times as likely to need hospitalization after contracting COVID-19 than white patients from the same part of London.

When adjusting for other factors, such as known COVID-19 comorbidities and deprivation, the authors still found that Black and mixed ethnicity patients had a 2.2–2.7-fold risk of requiring admission compared to white people.

Once in hospital, the authors found no significant difference in survival rates between Black and mixed ethnicity patients and white patients.

In contrast, the study authors found that people of Asian ethnicities did not have an increased risk of hospitalization with COVID-19. However, they did have an increased rate of admittance to intensive care units and greater death rates as a consequence of the disease.

Reasons for the difference?

The research suggests that ethnicity likely affects people’s COVID-19 outcomes in a manner not yet understood.

This may be due to genetic differences but could result from behavioral differences or aspects of structural racism not accounted for when only considering socioeconomic background.

For Prof. Ajay Shah, senior author and British Heart Foundation Professor of Cardiology at King’s College London, “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,” Prof. Shah adds.

According to Dr. Sonya Babu-Narayan, the Associate Medical Director at the British Heart Foundation who funded the study, “This study provides further evidence that COVID-19 disproportionally affects those whose ethnic background is a minority where they live, as has been seen across the world.”

“Why coronavirus hits people with an ethnic minority background harder, and how to mitigate this, has been complex to address,” she continues.

“People from Black, Asian and other minority ethnic backgrounds more often have heart and circulatory risk factors including high blood pressure and diabetes, and are more exposed to socioeconomic disadvantage, but this study indicates the worse effects of COVID-19 are present even after these are accounted for.”

“Research is now needed to assess how other structural and behavioral factors may contribute, including occupation, access to health messaging and health care, and differences in the patient journey once people reach the hospital. As we see COVID-19 cases rise again in the UK, we must address these disparities with urgency.”

– Dr. Sonya Babu-Narayan

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