Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths : analysis of two years of a record linked national cohort study in Scotland
Abstract
BACKGROUND: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland. METHODS: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals≥16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time. FINDINGS: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave. INTERPRETATION: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.
Citation
Amele , S , Kibuchi , E , McCabe , R , Pearce , A , Henery , P , Hainey , K , Fagbamigbe , A , Kurdi , A , McCowan , C , Simpson , C R , Dibben , C , Buchanan , D , Demou , E , Almaghrabi , F , Anghelescu , G , Taylor , H , Tibble , H , Rudan , I , Nazroo , J , Bécares , L , Daines , L , Irizar , P , Jayacodi , S , Pattaro , S , Sheikh , A & Katikireddi , S V 2023 , ' Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations, and deaths : analysis of two years of a record linked national cohort study in Scotland ' , Journal of Epidemiology and Community Health , vol. 77 , no. 10 , pp. 641-648 . https://doi.org/10.1136/jech-2023-220501
Publication
Journal of Epidemiology and Community Health
Status
Peer reviewed
ISSN
0143-005XType
Journal article
Description
Funding: Economics and Social Research Council (ESRC) ES/W000849/1, Medical Research Council (MRC) MC_UU_00022/2, Scottish Government Chief Scientist Office SPHSU17.Collections
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