Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London

Wan, Y. I.; Apea, V. J.; Dhairyawan, R.; Puthucheary, Z. A.; Pearse, R. M.; Orkin, C. M.; Prowle, J. R.

Objectives To determine if changes in public behaviours, developments in COVID-19 treatments, improved patient care, and directed policy initiatives have altered outcomes for minority ethnic groups in the second pandemic wave. Design Prospectively defined observational study using registry data. Setting Four acute NHS Hospitals in east London. Participants Patients aged [≥]16 years with an emergency hospital admission with SARS-CoV-2 infection between 1st September 2020 and 17th February 2021. Main outcome measures Primary outcome was 30-day mortality from time of index COVID-19 hospital admission. Secondary endpoints were 90-day mortality and need for ICU admission. Multivariable survival analysis was used to assess associations between ethnicity and mortality accounting for predefined risk factors. Age-standardised rates of hospital admission relative to the local population were compared between ethnic groups. Results Of 5533 patients, the ethnic distribution was White (n=1805, 32.6%), Asian/Asian British (n=1983, 35.8%), Black/Black British (n=634, 11.4%), Mixed/Other (n=433, 7.8%), and unknown (n=678, 12.2%). Excluding 678 patients with missing data, 4855 were included in multivariable analysis. Relative to the White population, Asian and Black populations experienced 4.1 times (3.77-4.39) and 2.1 times (1.88-2.33) higher rates of age-standardised hospital admission. After adjustment for various patient risk factors including age, sex, and socioeconomic deprivation, Asian patients were at significantly higher risk of death within 30 days (HR 1.47 [1.24-1.73]). No association with increased risk of death in hospitalised patients was observed for Black or Mixed/Other ethnicity. Conclusions Asian and Black ethnic groups continue to experience poor outcomes following COVID-19. Despite higher-than-expected rates of admission, Black and Asian patients experienced similar or greater risk of death in hospital, implying a higher overall risk of COVID-19 associated death in these communities.