Estimating the risk of post-COVID condition (PCC) in deprived communities, migrants and ethnic minorities in England: Findings from Virus Watch - a prospective community cohort study

Background

Deprived communities, migrant and ethnic minorities were disproportionately affected by COVID-19 and may, therefore, be at a higher risk of post-COVID condition (PCC). This analysis, using data from the Virus Watch study, investigates how deprivation, migration status, and ethnic minority status influence PCC risk in both the full cohort (all regardless of infection status) and those with a confirmed COVID-19 infection.

Methods

A subset of participants from Virus Watch, a prospective community cohort study in England, were included. We used logistic regression to compare the predicted probability of developing PCC in both full and infected cohorts among different deprivation levels, migration and ethnic minority status categories by sex-at-birth during pre-Omicron and Omicron periods, adjusting for socio-demographic covariates.

Results

During the pre-Omicron period, PCC probability increased with deprivation levels, especially in females (most deprived: 7.8%, 95% CI 4.6-11.0%; least deprived: 3.5%, 2.5-4.5%). Migrant and ethnic minority males had a higher likelihood of PCC than their respective counterparts, particularly in the full cohort for migrants (6.3%, 1.8-10.8%) and the previously infected cohort for ethnic minorities (38.8%, 21.2-56.4%). However, these disparities were less pronounced in females. In the Omicron period, these differential probabilities were also less evident.

Conclusion

Our findings suggest that greater PCC probability among these populations is driven by increased infection risk and post-infection determinants. This underscores the need for policies and interventions to reduce infection risk and affordable and easily available healthcare services for those with PCC.

What is already known on this topic

• Deprived, migrant, and ethnic minority groups experienced disproportionate rates of SARS-CoV-2 infection, hospitalisation and death due to a range of socioeconomic factors.

• Emerging evidence suggests that individuals living in deprived areas may have a higher risk of developing post COVID condition (PCC), while mixed results were reported in research on PCC risk in ethnic minorities.

• There is limited evidence on the association between migration status and PCC.

What this study adds

• During the pre-Omicron period, more deprived populations were associated with increased PCC probability, especially among females. Migrant, ethnic minority and migrant-ethnic minority males also had higher PCC probability compared to their counterparts after accounting for potential confounders.

• In the Omicron period, the disparities in the likelihood of PCC were less pronounced, though migrant-ethnic minority females still had higher PCC probability, especially in those with confirmed infections, suggesting post-infection determinants play a role.

• Our study suggests pre- and post-infection determinants of PCC among these populations.

How this study might affect research, practice or policy

• This study underscores the need to address health inequalities faced by deprived, migrant and ethnic minority populations to reduce their risk of COVID-19 infection and PCC.

• Further research into the intersection of migration, ethnicity, and deprivation, along with other factors such as sex and occupation, is required to guide targeted public health efforts and resource allocation.

• Target policies should address occupational and housing exposure risks, increase vaccine uptake, provide culturally appropriate public health information and ensure equitable access to PCC and primary care services