Ethnic variation in outcome of people hospitalised during the first COVID-19 epidemic wave in Wales (UK): an analysis of national surveillance data using Onomap, a name-based ethnicity classification tool

  1. Daniel Rh Thomas
  2. Oghogho Orife
  3. Amy Plimmer
  4. Christopher Williams
  5. George Karani
  6. Meirion R Evans
  7. Paul Longley
  8. Janusz Janiec
  9. Roiyah Saltus
  10. Ananda Giri Shankar

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Abstract

To identify ethnic differences in proportion positive for SARS-CoV-2, and proportion hospitalised, proportion admitted to intensive care and proportion died in hospital with COVID-19 during the first epidemic wave in Wales.

Design

Descriptive analysis of 76 503 SARS-CoV-2 tests carried out in Wales to 31 May 2020. Cohort study of 4046 individuals hospitalised with confirmed COVID-19 between 1 March and 31 May. In both analyses, ethnicity was assigned using a name-based classifier.

Setting

Wales (UK).

Primary and secondary outcomes

Admission to an intensive care unit following hospitalisation with a positive SARS-CoV-2 PCR test. Death within 28 days of a positive SARS-CoV-2 PCR test.

Results

Using a name-based ethnicity classifier, we found a higher proportion of black, Asian and ethnic minority people tested for SARS-CoV-2 by PCR tested positive, compared with those classified as white. Hospitalised black, Asian and minority ethnic cases were younger (median age 53 compared with 76 years; p<0.01) and more likely to be admitted to intensive care. Bangladeshi (adjusted OR (aOR): 9.80, 95% CI 1.21 to 79.40) and ‘white – other than British or Irish’ (aOR: 1.99, 95% CI 1.15 to 3.44) ethnic groups were most likely to be admitted to intensive care unit. In Wales, older age (aOR for over 70 years: 10.29, 95% CI 6.78 to 15.64) and male gender (aOR: 1.38, 95% CI 1.19 to 1.59), but not ethnicity, were associated with death in hospitalised patients.

Conclusions

This study adds to the growing evidence that ethnic minorities are disproportionately affected by COVID-19. During the first COVID-19 epidemic wave in Wales, although ethnic minority populations were less likely to be tested and less likely to be hospitalised, those that did attend hospital were younger and more likely to be admitted to intensive care. Primary, secondary and tertiary COVID-19 prevention should target ethnic minority communities in Wales.

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  1. Version published to 10.1136/bmjopen-2020-048335
  2. ScreenIT

    SciScore for 10.1101/2020.06.22.20136036: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot 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:
    However, Onomap has limitations, and all findings should be interpreted in light of these. We previously validated the tool using data containing self-reported or healthcare professional-reported ethnicity (Supplementary Table 1). Onomap performs well for most ethnicities, but has a low sensitivity for Black or Black British individuals. Risks identified for Black and Black British groups are therefore likely to be underestimated. Kandt and Longley have published a comparison of Onomap with 2011 Census data.18 There is an urgent need for all European countries carrying out Covid-19 surveillance to report trends by ethnicity, in order to inform local infection prevention and control policy and practice. Ethnic variation should also be considered in the design of interventions, and in crisis communication. In Wales, an occupational risk assessment tool has been developed with the aim of reducing risk of infection in those most vulnerable to severe infection.19 This tool, developed initially for the health care sector, is for all ethnicities, but includes a weighting to account for the emerging evidence of increased risk in BAME individuals.

    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.

    About SciScore

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  3. Version published to 10.1101/2020.06.22.20136036v1 on medRxiv