COVID-19: Why are Asian and Black patients at greater risk?
Even after accounting for other known risk factors, such as diabetes and high blood pressure, a study found that Black and Asian patients hospitalized with COVID-19 were more likely to need mechanical ventilation and more likely to die than white patients.
Previous research suggests that people from Black, Asian, and minority ethnic (BAME) backgrounds are at greater risk of severe COVID-19 and are more likely to die from the disease.
However, the evidence is inconsistent on whether socioeconomic inequality, genetics, underlying health risks, comorbidities, or a combination of these factors, are responsible.
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For example, studies show hypertension, diabetes, obesity, and smoking increase the risk of COVID-19 severity and mortality.
Researchers can face difficulties when teasing apart these influences. Especially when they analyze data encompassing several regions that differ in their ethnic and socioeconomic makeup, and how the epidemic has unfolded.
A major study, which focused on a single, ethnically diverse region of the United Kingdom that was badly affected in the first wave of the pandemic, attempted to address some of these uncertainties.
The researchers at Queen Mary University of London and Barts Health National Health Service (NHS) Trust analyzed data from 1,737 patients aged 16 years and over with confirmed COVID-19 who received care in five hospitals in East London between January 1 and May 13, 2020.
Of these, 511 (29%) died 30 days later.
Compared with white patients, after adjusting for age and sex, Asian patients were 54% more likely to be admitted to intensive care and receive mechanical ventilation, while Black patients were 80% more likely to need the same treatment. BAME patients also tended to be younger and less frail.
After accounting for age and sex, Asian and Black patients were 49% and 30% more likely to die, respectively, compared with white patients.
These trends persisted in the Asian patients even after the researchers made adjustments for other known risk factors, including smoking, obesity, diabetes, hypertension, and chronic kidney disease. In Black patients, the general trend remained the same after adjusting for these factors, but the result was no longer statistically significant. The authors suggest this might be due to a smaller sample size of Black patients.
“As the impact of COVID-19 continues to be seen within our community, the importance of responding to the ethnic disparities unmasked during the COVID-19 pandemic is crucial to prevent entrenching and inflicting them on future generations,” says Dr. Yize Wan, one of the study authors.
Dr. Wan is a lecturer at Queen Mary University of London and a registrar in intensive care medicine and anesthesia at Barts Health NHS Trust.
The authors note that in their cohort of patients from this part of London, all ethnic groups experienced high levels of deprivation.
“[H]owever, worse deprivation was not associated with higher likelihood of mortality, suggesting ethnicity may affect outcomes independent of purely geographical and socioeconomic factors,” they write.
Research in the United States provides conflicting evidence on whether race, per se, is a risk factor for COVID-19 mortality.
A study by the Kaiser Family Foundation, for example, found that racial differences in hospitalization and mortality rates persisted after controlling for sociodemographic factors and underlying health conditions.
By contrast, a study reported by Medical News Today found that while Black and Hispanic people accounted for more than half of all COVID-19 hospital deaths, there were no significant racial differences in mortality rates after accounting for clinical and socioeconomic factors.
The latter study’s authors attributed the overall increase in mortality among Black and Hispanic people to disparities in healthcare, among other factors unrelated to genetics.
With the rollout of COVID-19 vaccines, poor access to healthcare could further exacerbate racial differences in the pandemic’s impact.
In a recent audio interview with The New England Journal of Medicine, Chief Medical Advisor Dr. Anthony Fauci expressed concerns that people of color are not getting equitable access to vaccination.
Dr. Fauci explained that we do not want to be in a situation where “most of the people who are getting it are otherwise well, middle-class white people.”
“You really want to get it to the people who are really the most vulnerable,” he added. “You want to get it to everybody, but you don’t want to have a situation where people who really are in need of it, because of where they are, where they live, what their economic status is, that they don’t have access to the vaccine.”
The authors of the new study from the U.K. note that their retrospective data, which they gathered from medical records, did not differentiate between more fine-grained ethnic categories, such as Bangladeshi, Pakistani, Black African, and Black Caribbean.
“Indeed, the descriptive term ‘BAME’ itself is particularly crude, and we recognize its limitation. Despite its size, our study lacked the power to assess a more detailed ethnicity breakdown.”
In particular, they caution that their analysis of data relating to patients of Asian ethnicity is likely to have been skewed by the large Bangladeshi community in this part of London.
They note that this community faces specific socioeconomic and healthcare inequalities.
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