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 Bécares; 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

J Epidemiol Community Health. 2023 Oct;77(10):641-648. doi: 10.1136/jech-2023-220501. Epub 2023 Jul 31.

Authors

Sarah Amele^#¹, Eliud Kibuchi^#², Ronan McCabe¹, Anna Pearce¹, Paul Henery³, Kirsten Hainey¹, Adeniyi Francis Fagbamigbe^{4

5}, Amanj Kurdi^{6

7}, Colin McCowan⁸, Colin R Simpson^{9

10}, Chris Dibben¹¹, Duncan Buchanan¹², Evangelia Demou¹, Fatima Almaghrabi⁹, Gina Anghelescu¹³, Harry Taylor¹⁴, Holly Tibble⁹, Igor Rudan⁹, James Nazroo¹⁵, Laia Bécares¹⁴, Luke Daines⁹, Patricia Irizar¹⁵, Sandra Jayacodi¹⁶, Serena Pattaro¹³, Aziz Sheikh⁹, Srinivasa Vittal Katikireddi¹

Affiliations

¹ MRC/CSO Social and Public Health Science Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
² MRC/CSO Social and Public Health Science Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK Eliud.Kibuchi@glasgow.ac.uk.
³ Public Health Scotland, Glasgow Office, Glasgow, UK.
⁴ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁵ Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria.
⁶ Strathclyde Institute of Pharmacy & Biomedical Sciences (SIPBS), Faculty of Science, University of Strathclyde, Glasgow, UK.
⁷ Department of Pharmacology,College of Pharmacy, Hawler Medical University, Erbil, Kurdistan, Iraq.
⁸ School of Medicine, University of St Andrews, St Andrews, Fife, UK.
⁹ Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
¹⁰ School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
¹¹ Centre for Research on Environment, Society and Health, School of GeoSciences, Institute of Geography, University of Edinburgh, Edinburgh, UK.
¹² Research Data Scotland, Edinburgh, UK.
¹³ Scottish Centre for Administrative Data Research (SCADR), University of Glasgow, Glasgow, UK.
¹⁴ Department of Global Health and Social Medicine, King's College London, London, UK.
¹⁵ Department of Sociology, School of Social Sciences, The University of Manchester, Manchester, UK.
¹⁶ Patient and Public Involvement (PPI) Representative, Non affiliated, Glasgow, UK.

^# Contributed equally.

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; epidemiology; ethnic groups; health inequalities; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / diagnosis
Cohort Studies
Ethnicity*
Hospitalization
Humans
Minority Groups
Prognosis
SARS-CoV-2
Scotland / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding