Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine rollout: a retrospective, population-based cohort study
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Abstract
Background
Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors.
Methods
We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status.
Results
Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]).
Conclusions
Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.
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SciScore for 10.1101/2022.02.14.22270940: (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 For computational efficiency, we included all individuals who died of any cause during the analysis period and a random sample (selected by simple random sampling without replacement) of those who did not, with sampling rates of 1% for the White British ethnic group and 10% for every other ethnic group; case weights equal to the inverse probability of selection were included in the analysis, following previously published methods [3]. 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 …
SciScore for 10.1101/2022.02.14.22270940: (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 For computational efficiency, we included all individuals who died of any cause during the analysis period and a random sample (selected by simple random sampling without replacement) of those who did not, with sampling rates of 1% for the White British ethnic group and 10% for every other ethnic group; case weights equal to the inverse probability of selection were included in the analysis, following previously published methods [3]. 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 main strength of our study derives from using the ONS Public Health Data Asset, a nationwide large-scale population-wide data source combining the 2011 Census, mortality records, the General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR), Hospital Episode Statistics (HES) and vaccination data from the National Immunisation Management System (NIMS). Unlike studies based only on electronic health records, our study relies on self-identified ethnicity, limiting the potential for exposure misclassification bias. The PHDA also contains both detailed socio-demographic characteristics, such as household composition, housing quality, and occupational exposure, and extensive information on pre-pandemic health based on primary care and hospital records. To our knowledge, our study is the first to use nationally representative population-based linked data to examine the association between ethnicity and COVID-19 mortality in the third wave of the pandemic and explore the role of differences in vaccination uptake as a potential additional explanatory factor for the differences in COVID-19 mortality. The main limitation is that most socio-demographic characteristics included in our models reflect the situations of individuals as they were in 2011, not necessarily those at the start of the COVID-19 pandemic. To mitigate this, we excluded people aged less than 30 years old, whose circumstances are the most likely to have cha...
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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