Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis
Introduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes.Methods PubMed and E...
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BMJ Publishing Group
2021-11-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/11/e007433.full |
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| author | Karien Stronks Charles Agyemang Maurice P Zeegers Maria Prins Evan Yu Shahab Jolani Stevie Hendriks Anke Richters Saurabh Zalpuri Bart Pijls |
| author_facet | Karien Stronks Charles Agyemang Maurice P Zeegers Maria Prins Evan Yu Shahab Jolani Stevie Hendriks Anke Richters Saurabh Zalpuri Bart Pijls |
| author_sort | Karien Stronks |
| collection | DOAJ |
| description | Introduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes.Methods PubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis.Results 58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil.Conclusion The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic.PROSPERO registration number CRD42020180085. |
| format | Article |
| id | doaj-art-2c46791d453d465cbd8fa4a5b557f957 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-2c46791d453d465cbd8fa4a5b557f9572025-08-20T02:35:59ZengBMJ Publishing GroupBMJ Global Health2059-79082021-11-0161110.1136/bmjgh-2021-007433Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysisKarien Stronks0Charles Agyemang1Maurice P Zeegers2Maria Prins3Evan Yu4Shahab Jolani5Stevie Hendriks6Anke Richters7Saurabh Zalpuri8Bart Pijls9Public and Occupational Health, Meibergdreef 9, Amsterdam UMC, Amsterdam, The NetherlandsDepartment of Public Health, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The NetherlandsCare and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The NetherlandsInfectious Diseases, Amsterdam UMC Location AMC, Amsterdam, The NetherlandsDepartment of Complex Genetics and Epidemiology, Maastricht University, Maastricht, The NetherlandsDepartment of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The NetherlandsSchool of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The NetherlandsDepartment of Research and Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The NetherlandsReal World Evidence, UCBPharma, Breda, The NetherlandsDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The NetherlandsIntroduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes.Methods PubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis.Results 58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil.Conclusion The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic.PROSPERO registration number CRD42020180085.https://gh.bmj.com/content/6/11/e007433.full |
| spellingShingle | Karien Stronks Charles Agyemang Maurice P Zeegers Maria Prins Evan Yu Shahab Jolani Stevie Hendriks Anke Richters Saurabh Zalpuri Bart Pijls Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis BMJ Global Health |
| title | Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis |
| title_full | Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis |
| title_fullStr | Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis |
| title_full_unstemmed | Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis |
| title_short | Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis |
| title_sort | ethnic minority status as social determinant for covid 19 infection hospitalisation severity icu admission and deaths in the early phase of the pandemic a meta analysis |
| url | https://gh.bmj.com/content/6/11/e007433.full |
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