Inequalities in SARS-CoV-2 case rates by ethnicity, religion, measures of socioeconomic position, English proficiency, and self-reported disability: cohort study of 39 million people in England during the alpha and delta waves
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Abstract
To examine sociodemographic inequalities in people with SARS-CoV-2 during the second (alpha) and third (delta) waves of the covid-19 pandemic.
Design
Retrospective, population based cohort study.
Setting
Resident population of England.
Participants
39 006 194 people aged 10 years and older who were enumerated in the 2011 census, registered with the NHS, and alive on 1 September 2020.
Main outcome measures
Age standardised SARS-CoV-2 case rates (ie, the number of people who received a positive test result per 100 000 person weeks at risk) during the second wave (1 September 2020 to 22 May 2021) or third wave (23 May to 10 December 2021) of the pandemic. Age standardised rates were calculated by sociodemographic characteristics and adjusted rate ratios were estimated using generalised linear regression models with a Poisson distribution (models were adjusted for covariates including sex, age, geographical variables, and sociodemographic characteristics).
Results
During the study period, 5 767 584 people (14.8% of the study population) tested positive for SARS-CoV-2. In the second wave, the fully adjusted relative risks of having a positive test were highest for the Bangladeshi and Pakistani ethnic groups compared with the white British group, with rate ratios of 1.75 (95% confidence interval 1.73 to 1.77) and 1.69 (1.68 to 1.70), respectively. Muslim and Sikh religious groups had fully adjusted rate ratios of 1.51 (1.50 to 1.51) and 1.64 (1.63 to 1.66), respectively, compared with the Christian group. Greater area deprivation, disadvantaged socioeconomic position, living in a care home, and low English language proficiency were also associated with higher relative risk of having a positive test. However, the inequalities among groups varied over time. Being Christian, white British, without a disability, and from a more advantaged socioeconomic position were associated with increased relative risk of testing positive during the third wave.
Conclusion
Research is urgently needed to understand the large sociodemographic inequalities in SARS-CoV-2 case rates in order to inform policy interventions in future waves or pandemics.
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SciScore for 10.1101/2022.03.02.22271762: (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
No key resources detected.
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:Strengths and limitations: The primary strength of the study is using nationwide linked population-level data that combines a diverse set of demographic and socio-economic factors from the 2011 Census with timely data on national SARS-CoV-2 testing. Unlike …
SciScore for 10.1101/2022.03.02.22271762: (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
No key resources detected.
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:Strengths and limitations: The primary strength of the study is using nationwide linked population-level data that combines a diverse set of demographic and socio-economic factors from the 2011 Census with timely data on national SARS-CoV-2 testing. Unlike studies based solely on electronic health records, our study is based on self-identified ethnicity, limiting the potential for exposure misclassification bias. We also have information on a wide range of socio-demographic factors not typically available in electronic health records, such as religion, main language and educational attainment. Another strength is the size of the dataset, comprising 78.4% of people aged 10 years and over living in England in 2020. Therefore, this study is sufficiently powered to detect small differences in the odds of testing positive for SARS-CoV-2 by detailed characteristics after adjusting for confounding factors and interactions with age. An important limitation is that the PHDA only contains information on people who were enumerated at the 2011 Census. It therefore excludes people living in England in 2011 but who did not participate in the 2011 Census (estimated to be approximately 5% of the population at the time); respondents who could not be linked to the 2011 to 2013 NHS Patient Registers (5.4% of Census respondents); people who have immigrated since 2011; children younger than 10-years-old in 2021; and people not registered with a GP surgery or who had opted out of GDPPR. A further ...
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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