Racial and ethnic determinants of Covid-19 risk

Lo, C.-H.; Nguyen, L. H.; Drew, D. A.; Graham, M. S.; Warner, E. T.; Joshi, A. D.; Astley, C. M.; Guo, C.-G.; Ma, W.; Mehta, R. S.; Kwon, S.; Song, M.; Davies, R.; Capdevila, J.; Lee, K. A.; Lochlainn, M. N.; Varsavsky, T.; Sudre, C. H.; Wolf, J.; Cozier, Y. C.; Rosenberg, L.; Wilkens, L. R.; Haiman, C. A.; Marchand, L. L.; Palmer, J. R.; Spector, T. D.; Ourselin, S.; Steves, C. J.; Chan, A. T.; Consortium, COPE

Background Racial and ethnic minorities have disproportionately high hospitalization rates and mortality related to the novel coronavirus disease 2019 (Covid-19). There are comparatively scant data on race and ethnicity as determinants of infection risk. Methods We used a smartphone application (beginning March 24, 2020 in the United Kingdom [U.K.] and March 29, 2020 in the United States [U.S.]) to recruit 2,414,601 participants who reported their race/ethnicity through May 25, 2020 and employed logistic regression to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for a positive Covid-19 test among racial and ethnic groups. Results We documented 8,858 self-reported cases of Covid-19 among 2,259,841 non-Hispanic white; 79 among 9,615 Hispanic; 186 among 18,176 Black; 598 among 63,316 Asian; and 347 among 63,653 other racial minority participants. Compared with non-Hispanic white participants, the risk for a positive Covid-19 test was increased across racial minorities (aORs ranging from 1.24 to 3.51). After adjustment for socioeconomic indices and Covid-19 exposure risk factors, the associations (aOR [95% CI]) were attenuated but remained significant for Hispanic (1.58 [1.24-2.02]) and Black participants (2.56 [1.93-3.39]) in the U.S. and South Asian (1.52 [1.38-1.67]) and Middle Eastern participants (1.56 [1.25-1.95]) in the U.K. A higher risk of Covid-19 and seeking or receiving treatment was also observed for several racial/ethnic minority subgroups. Conclusions Our results demonstrate an increase in Covid-19 risk among racial and ethnic minorities not completely explained by other risk factors for Covid-19, comorbidities, and sociodemographic characteristics. Further research investigating these disparities are needed to inform public health measures.