Ethnicity and outcomes in COVID-19 in the United Kingdom: a systematic review and meta-analysis
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Abstract
This systematic review and meta-analysis evaluated the clinical outcomes of COVID-19 disease in the ethnic minorities of the UK in comparison to the White ethnic group. Medline, Embase, Cochrane, MedRxiv, and Prospero were searched for articles published between May 2020 to April 2021. PROSPERO ID: CRD42021248117. Fourteen studies (767177 participants) were included in the review. In the adjusted analysis, the pooled Odds Ratio (OR) for the mortality outcome was higher for the Black (1.83, 95% CI: 1.21-2.76), Asian (1.16, 95% CI: 0.85-1.57), and Mixed and Other (MO) groups (1.12, 95% CI: 1.04-1.20) compared to the White group. The adjusted and unadjusted ORs of intensive care admission were more than double for all ethnicities (OR Black 2.32, 95% CI: 1.73-3.11, Asian 2.34, 95% CI: 1.89-2.90, MO group 2.26, 95% CI: 1.64-3.11). In the adjusted analysis of mechanical ventilation need the ORs were similarly significantly raised (Black group 2.03, 95% CI: 1.80-2.29, Asian group 1.84, 95% CI: 1.20-2.80, MO 2.09, 95% CI: 1.35-3.22). This review confirmed that all ethnic groups in the UK suffered from increased disease severity and mortality with regards to COVID-19. This has urgent public health and policy implications to reduce the health disparities.
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SciScore for 10.1101/2021.11.07.21266027: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Origin 2021b was used to convert graphical data to tabulated form as advised by Cochrane to avoid mistakes in the manual conversion of data [14]. Cochranesuggested: (Cochrane Library, RRID:SCR_013000)The statistical heterogeneity was explored by calculating the I2 statistic using RevMan and by looking at the overlap of the CIs in the forest plots. RevMansuggested: (RevMan, RRID:SCR_003581)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share …
SciScore for 10.1101/2021.11.07.21266027: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Origin 2021b was used to convert graphical data to tabulated form as advised by Cochrane to avoid mistakes in the manual conversion of data [14]. Cochranesuggested: (Cochrane Library, RRID:SCR_013000)The statistical heterogeneity was explored by calculating the I2 statistic using RevMan and by looking at the overlap of the CIs in the forest plots. RevMansuggested: (RevMan, RRID:SCR_003581)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:4.2 Limitations: A broad ethnic classification was used in this review. The Asian group included very diverse subgroups, each of which has now been shown to have different risk profiles. This approach was used to include a wide study base, as there were very few studies that had data on sub-categories, which resulted in an incomplete assessment of the risk faced by these subgroups [5]. The search had to be limited to the UK using search terms like ‘UK’, ‘England’, and so some studies might have been missed due to this strategy. As the research was carried out during the pandemic, there was a large amount of missing data reported which hindered the analysis. This review was limited to adults and so the results could not be generalized to children. The PCR test for COVID-19 has a high false-negative rate, which led to some cases being wrongly classified as non-COVID [23]. However, this was a limitation of the UK testing strategy, rather than of this review. As this review concentrated on UK based studies, the results were less generalizable to other countries as there might be differences in hospitalization policies, testing, ICU facilities, and other factors. It has been noted that many participants’ ethnicities have been put down as ‘Other’, and this may have created erroneous results for the MO group [21]. Again, this is an error of data collection by the original study researchers, rather than of this review. 4.3 Policy implications: These results have urgent implications f...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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