Pathways to ethnic inequalities in COVID-19 health outcomes in the United Kingdom: A systematic map

Irizar, Patricia; Kapadia, Dharmi; Amele, Sarah; Bécares, Laia; Divall, Pip; Katikireddi, Srinivasa Vittal; Kibuchi, Eliud; Kneale, Dylan; McCabe, Ronan; Nazroo, James; Nellums, Laura B.; Taylor, Harry; Sze, Shirley; Pan, Daniel; Pareek, Manish

Abstract

Background: Marked ethnic inequalities in COVID-19 infection and its consequences have been documented. The aim of this paper is to identify the range and nature of evidence on potential pathways which lead to ethnic inequalities in COVID-19 related health outcomes in the United Kingdom (UK). Methods: We searched six bibliographic and five grey literature databases from 1st December 2019 to 23rd February 2022 for research on pathways to ethnic inequalities in COVID-19 health outcomes in the UK. Meta-data were extracted and coded, using a framework informed by a logic model. Open Science Framework Registration: DOI 10.17605/OSF.IO/HZRB7. Results: The search returned 10,728 records after excluding duplicates, with 123 included (83% peer-reviewed). Mortality was the most common outcome investigated (N = 79), followed by infection (N = 52). The majority of studies were quantitative (N = 93, 75%), with four qualitative studies (3%), seven academic narrative reviews (6%), nine third sector reports (7%) and five government reports (4%), and four systematic reviews or meta-analyses (3%). There were 78 studies which examined comorbidities as a pathway to mortality, infection, and severe disease. Socioeconomic inequalities (N = 67) were also commonly investigated, with considerable research into neighbourhood infrastructure (N = 38) and occupational risk (N = 28). Few studies examined barriers to healthcare (N = 6) and consequences of infection control measures (N = 10). Only 11% of eligible studies theorised racism to be a driver of inequalities and 10% (typically government/third sector reports and qualitative studies) explored this as a pathway. Conclusion: This systematic map identified knowledge clusters that may be amenable to subsequent systematic reviews, and critical gaps in the evidence-base requiring additional primary research. Most studies do not incorporate or conceptualise racism as the fundamental cause of ethnic inequalities and therefore the contribution to literature and policy is limited.

• Journal Article Type: Article
• Acceptance Date: Jun 20, 2023
• Online Publication Date: Jun 24, 2023
• Publication Date: 2023-07
• Deposit Date: Sep 8, 2023
• Publicly Available Date: Sep 8, 2023
• Journal: Social Science and Medicine
• Print ISSN: 0277-9536
• Electronic ISSN: 1873-5347
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 329
• Article Number: 116044
• DOI: https://doi.org/10.1016/j.socscimed.2023.116044
• Keywords: Ethnicity, Systematic map, COVID-19, Health inequalities, Racism
• Public URL: https://nottingham-repository.worktribe.com/output/22989235
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S027795362300401X?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Pathways to ethnic inequalities in COVID-19 health outcomes in the United Kingdom: A systematic map; Journal Title: Social Science & Medicine; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.socscimed.2023.116044; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier Ltd.