A global Covid-19 study has found that a higher infection risk was the leading cause of ethnic health inequalities seen during the Covid-19 pandemic.
Compared with the White majority group, South Asian people were three times more likely to test positive for infection, while Black people were 1.8 times more likely and Mixed and Other ethnic groups were each 1.3 times more likely.
Higher rates of severe illness and death were linked to a greater risk of infection caused by different patterns of employment, income and housing experienced by ethnic minorities.
The study, led by the University of Manchester and published in The Lancet: eClinicalMedicine, analyses data from over 200 million people worldwide and, according to the researchers, is the most comprehensive analysis of ethnic inequalities in Covid-19 health outcomes to date.
During the global pandemic, more people from ethnic minority groups were admitted to hospital, and more died from Covid-19 infections. Previous studies have found that ethnic minority populations were at a higher risk from Covid-19, but it was not clear if this was due to higher infection risk or poorer prognosis once infected, or a combination of both.
The researchers searched for data from five databases which included (MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Library) between 1st December 2019 and 3rd October 2022. They analysed 77 studies reporting original data on infection rates, hospitalisation, intensive care unit (ICU) admission, and mortality. Inequalities were assessed using meta-analyses.
The results showed that the infection rate was the biggest driver of ethnic inequality in Covid-19 health outcomes, with ethnic minority populations more likely to test positive for infection than White populations.
When the researchers looked at studies that only included people who had been infected with Covid-19, the risks of severe illness and death were similar for ethnic minority groups and the White majority group. This suggests the higher risk of infection among ethnic minority groups is the main driver for health outcome inequalities.
The risk of being admitted to hospital for severe Covid-19 was 1.5 times higher for Black people, 1.9 times higher for Indigenous people and 1.3 times higher for Hispanic people than White people. The risk of needing intensive care was also higher: South Asian, East Asian, Indigenous, Hispanic and Black groups all had more than triple the risk than White majority groups.
The researchers suggest that socioeconomic conditions can drive higher infection rates. People from ethnic minority backgrounds were more likely to have public-facing jobs, less able to work from home, less able to self-isolate, more likely to live in overcrowded housing, and less likely to have access to open spaces, which all increase the risk of Covid-19 infection.
The study’s lead author, Dr Patsy Irizar from the University of Manchester, said: ‘The Covid-19 pandemic disproportionately impacted ethnic minority people, with the present findings demonstrating that the health inequalities earlier in the pandemic were largely driven by differences in exposure.’
The researchers hope that the work will be relevant to the UK’s independent public enquiry into the pandemic.
Professor Manish Pareek, Chair in Infectious Diseases at the University of Leicester, added: ‘Going forward, it is critical that policy-makers address health inequalities to improve health outcomes for ethnic minority groups.’