Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank

Journal article

Objectives Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake.Design A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021.Setting The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010.Participants 405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white.Primary and secondary outcome measures The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions.Results 18 172 (4.5%) individuals tested positive, 3285 (0.8%) tested negative and then positive, 1490 (6.9% of those tested positive) were hospitalised, and 129 (0.6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17.4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1.24 (95% CI 1.02 to 1.52)), testing positive (95% CI 1.44 (1.33 to 1.55)) and direct hospitalisation (1.61 (95% CI 1.28 to 2.03)). Black participants had an increased risk of hospitalisation following a positive test (1.71 (95% CI 1.29 to 2.27)) and direct hospitalisation (1.90 (95% CI 1.51 to 2.39)). Although not the case for Asians (aHR 1.00 (95% CI 0.98 to 1.02)), black participants had a reduced vaccination probability (0.63 (95% CI 0.62 to 0.65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0.64 (95% CI 0.57 to 0.73)), of testing positive (0.40 (95% CI 0.28 to 0.57)) and of vaccination (0.78 (95% CI 0.74 to 0.83)).Conclusions We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake

Authors: Urdiales, T; Dernie, F; Català, M; Prats-Uribe, A; Prats, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Open
• Volume: 13
• Issue: 9
• Pages: e074367-e074367
• Publication date: 2023-09-21
• DOI: 10.1136/bmjopen-2023-074367
• EISSN: 2044-6055
• ISSN: 2044-6055
• Language: English
• Keywords: Infectious disease (medical specialty); Disease; Bioinformatics; Pandemic; Medicine; Public health; Vaccination; Cohort study; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Gerontology; Demography; 2019-20 coronavirus outbreak; Epidemiology; Virology; Outbreak; Coronavirus disease 2019 (COVID-19); Pathology; Cohort; Ethnic group; Family medicine; Internal medicine; Biobank