Skip to main content

Research Repository

Advanced Search

Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants

Irizar, Patricia; Pan, Daniel; Kapadia, Dharmi; Bécares, Laia; Sze, Shirley; Taylor, Harry; Amele, Sarah; Kibuchi, Eliud; Divall, Pip; Gray, Laura J.; Nellums, Laura B.; Katikireddi, Srinivasa Vittal; Pareek, Manish

Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants Thumbnail


Authors

Patricia Irizar

Daniel Pan

Dharmi Kapadia

Laia Bécares

Shirley Sze

Sarah Amele

Eliud Kibuchi

Pip Divall

Laura J. Gray

Laura B. Nellums

Srinivasa Vittal Katikireddi

Manish Pareek



Abstract

Background: COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods: Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings: 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59–1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59–5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02–1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01–1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation: Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding: ESRC: ES/W000849/1.

Citation

Irizar, P., Pan, D., Kapadia, D., Bécares, L., Sze, S., Taylor, H., …Pareek, M. (2023). Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. eClinicalMedicine, 57, Article 101877. https://doi.org/10.1016/j.eclinm.2023.101877

Journal Article Type Article
Acceptance Date Feb 2, 2023
Online Publication Date Mar 24, 2023
Publication Date 2023-03
Deposit Date Sep 8, 2023
Publicly Available Date Sep 8, 2023
Journal eClinicalMedicine
Electronic ISSN 2589-5370
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 57
Article Number 101877
DOI https://doi.org/10.1016/j.eclinm.2023.101877
Keywords Meta-analysis; Ethnicity; COVID-19; SARS-CoV-2; Systematic review; Prognosis
Public URL https://nottingham-repository.worktribe.com/output/18517456
Publisher URL https://www.sciencedirect.com/science/article/pii/S2589537023000548?via%3Dihub
Additional Information This article is maintained by: Elsevier; Article Title: Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants; Journal Title: eClinicalMedicine; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.eclinm.2023.101877; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier Ltd.

Files





You might also like



Downloadable Citations