DEPRIVATION among society at large is 'driving' Covid-19 disparities among minority ethnic groups - predominantly South Asian and Black African or Caribbean populations - and could be considered the main cause of disproportionate infection rates, hospitalisation and deaths experienced by these populations, according to new analysis from the University of Leicester.
The study, supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC) comes a day after a government-commissioned review concluded race and racism have become less important factors in explaining social disparities in the UK.
Researchers at the University of Leicester used UK Biobank data of 407,830 South Asian, Black and White individuals to model a hypothetical intervention whereby 50 per cent of the general population were lifted out of material deprivation status (the 'grade' of deprivation was measured by the highly regarded Townsend score that is made up of four domains: unemployment, non-car ownership, non-home ownership and household overcrowding).
By moving the 50 per cent most deprived in the general population sample out of material deprivation, over 80 per cent of the extra, 'excess' risk of Covid-19 outcomes for South Asian and Black populations was eliminated.
Even just by moving 25 per cent of the sample out of deprivation, between 40-50 per cent of additional risk to South Asian and Black populations was alleviated.
The striking results of this large, unprecedented analysis dispute several existing studies, some of which maintain that poorer health among ethnic minority populations could be the driving factor for Covid-19 disparities.
Cameron Razieh, Lead author of the analysis and Epidemiologist at the University of Leicester specialises in ethnic minority health conditions. He explains:-
"The method of analysis we used in this study upholds that inequalities in health or health behaviours in people living with high deprivation are, in the most part, the result of the high deprivation itself.
"If we take this as truth, then we can conclude that high levels of deprivation are helping drive Covid-19 ethnic disparities. Reducing deprivation within the whole population could therefore play a pivotal role in reducing ethnic inequalities in Covid-19 outcomes observed in South Asian and Black communities."
Professor Kamlesh Khunti, joint senior author of the study who also works as Director of the UK NIHRApplied Research CollaborationsEast Midlands (ARC EM) said:-
"Material deprivation is a universal underpinning determinant of health inequalities within and between populations.
"Quantifying the extent to which material deprivation reduces risk is important but even more imperative is to now ask how we can reduce social inequality and increase social mobility.
"There is a rapidly closing window to use research evidence such as this to give those most in need a fighting chance to better manage their health."
Joint senior author Tom Yates, Professor of physical activity, sedentary behaviour and health at the University of Leicester added:-
"The data from this study calls for improved assistance to be provided to the poorest communities.
"In what we hope is the final stretch of this pandemic we must now pull together - backed by research - to ensure that for those most at risk of Covid-19 outcomes, there is still light at the end of this very long tunnel.
"History may judge harshly if we do not get this right despite the evidence elucidated."
The full analysis of 'Ethnic minorities and COVID-19: Examining whether excess risk is mediated through deprivation' is available in pdf form, published in theEuropean Journal of Public Health.
Notes to Editors
For more information please contact Corinne Scotland, Senior Media Officer at the University of Leicester, on firstname.lastname@example.org/ 07590403166.
This work was supported by the NIHR Leicester BRC, NIHR ARC-EM and a grant from the UKRI-DHSC COVID-19 Rapid Response Rolling Call (MR/V020536/1).
UK Biobank uses a large prospective cohort of middle-aged adults designed to support health research focused on improving the prevention, diagnosis, and treatment of chronic diseases. In this study, UK Biobank data was used with linked COVID-19 outcomes occurring between 16th March 2020 and 24th August 2020.
Mediation analysis report key information
- 15,044 (53.0% women) South Asian andBlack and 392,786 (55.2% women)White individuals were included in the study.
- There were 151 (1.0%) positive tests, 91 (0.6%) severe cases and 31 (0.2%) deaths due to COVID-19 in South Asian andBlack individuals compared to 1,471 (0.4%), 895 (0.2%) and 313 (0.1%), respectively, inWhite individuals.
- Compared toWhite individuals, the relative risk of testing positive for COVID-19, developing severe disease and COVID-19 mortality in South Asian andBlack individuals were 2.73 (95% CI: 2.26, 3.19), 2.96 (2.31, 3.61) and 4.04 (2.54, 5.55), respectively.
South Asian andBlack individuals were analysed as a single ethnic minority group. This approach was subject to a sensitivity analysis. Other minority ethnic groups, including those self-reporting a mixed ethnicity, were not included due to low numbers and existing evidence that the risk of COVID-19 outcomes is highest for South Asian andBlack individuals.
For this analysis, the mediator - material deprivation, was included as a binary variable - categorised at the 75th percentile of the Townsend score (value = 0.4). It has previously been shown that the Townsend score at the area level correlates strongly with measures of deprivation at the individual level.
About the University of Leicester
The University of Leicester is a leading UK university committed to international excellence through the creation of world changing research and high quality, inspirational teaching. Leicester is consistently one of the most socially inclusive of the UK's leading universities with a long-standing commitment to providing fairer and equal access to higher education.
Our mission is to create a culture of equality and diversity and change lives for the better through transformative research and education. Our core objective is to provide a vibrant, robust, and inclusive research environment that enables high-quality research, delivering health, social, and economic benefits locally and globally.
Our exceptional people and their teams are committed to tackling significant global issues and improving the lives of the world's most disadvantaged people and societies. Together we are delivering knowledge and insights that are helping to change our world. By showcasing this we are hoping to inspire and excite our future students and the experts of tomorrow.
We are in the Top 10 UK universities to receive funding to research COVID-19. Our researchers are establishing best practice in managing the care of COVID-19 patients and investigating how to curb the spread of the disease. The long-term effects of COVID-19 are still being discovered. Our academics are investigating how the disease progresses and researching the needs of patients after the initial phase has passed. With the UK's biggest respiratory health department and world-leading research on ethnic health, we are leading one of the world's largest studies into the long-term health impacts of COVID-19.
Nationally, our health-related research is embedded in the NHS through our partnerships with Leicestershire NHS Trusts.
The NIHR Leicester Biomedical Research Centre
The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC) is a partnership between University Hospitals of Leicester NHS Trust, the University of Leicester and Loughborough University. It is funded by the National Institute for Health Research (NIHR).
The NIHR Leicester BRC undertakes translational clinical research in priority areas of high disease burden and clinical need. These include cardiovascular disease, respiratory disease, and lifestyle, obesity and physical activity. There is also a cross-cutting theme for precision medicine. The BRC harnesses the power of experimental science to explore and develop ways to help prevent and treat chronic disease. It brings together 70 highly skilled researchers, 30 of which are at the forefront of clinical services delivery. By having scientists working closely with clinicians, the BRC can deliver research that is relevant to patients and the professionals who treat them.
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research.
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care.
European Journal of Public Health