Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland
Objective Minority ethnic groups disproportionately experienced adverse COVID-19 outcomes, partly a consequence of disproportionate exposure to socioeconomic disadvantage and high-risk occupations. We examined whether minority ethnic groups were also disproportionately vulnerable to the consequences...
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BMJ Publishing Group
2025-04-01
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| Online Access: | https://bmjopen.bmj.com/content/15/4/e092727.full |
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| author | Aziz Sheikh Alastair H Leyland Chris Robertson Srinivasa Vittal Katikireddi Colin R Simpson Anna Pearce Evangelia Demou Colin McCowan Lewis Ritchie Eliud Kibuchi Ronan McCabe Sarah Amele Patricia Irizar Karen Jeffrey Igor Ruden |
| author_facet | Aziz Sheikh Alastair H Leyland Chris Robertson Srinivasa Vittal Katikireddi Colin R Simpson Anna Pearce Evangelia Demou Colin McCowan Lewis Ritchie Eliud Kibuchi Ronan McCabe Sarah Amele Patricia Irizar Karen Jeffrey Igor Ruden |
| author_sort | Aziz Sheikh |
| collection | DOAJ |
| description | Objective Minority ethnic groups disproportionately experienced adverse COVID-19 outcomes, partly a consequence of disproportionate exposure to socioeconomic disadvantage and high-risk occupations. We examined whether minority ethnic groups were also disproportionately vulnerable to the consequences of socioeconomic disadvantage and high-risk occupations in Scotland.Design We investigated effect modification and interaction between area deprivation, education and occupational risk and ethnicity (assessed as both a binary white vs non-white variable and a multi-category variable) in relation to severe COVID-19 (hospitalisation or death). We used electronic health records linked to the 2011 census and Cox proportional hazards models, adjusting for age, sex and health board. We were principally concerned with additive interactions as a measure of vulnerability, estimated as the relative excess risk due to interaction (RERI).Results Analyses considered 3 730 837 individuals aged ≥16 years (with narrower age ranges for analyses focused on education and occupation). Severe COVID-19 risk was typically higher for minority ethnic groups and disadvantaged socioeconomic groups, but additive interactions were not consistent. For example, non-white ethnicity and highest deprivation level experienced elevated risk ((HR=2.7, 95% CI: 2.4, 3.2) compared with the white least deprived group. Additive interaction was not present (RERI=−0.1, 95% CI: −0.4, 0.2), this risk being less than the sum of risks of white ethnicity/highest deprivation level (HR=2.4, 95% CI: 2.3, 2.5) and non-white ethnicity/lowest deprivation level (1.4, 95% CI: 1.2, 1.7). Similarly, non-white ethnicity/no degree education (HR=2.5, 95% CI: 2.2, 2.7; RERI=−0.1, 95% CI: −0.4, 0.2) and non-white ethnicity/high-risk occupation (RERI=0.3, 95% CI: −0.2, 0.8) did not experience greater than additive risk. No clear evidence of effect modification was identified when using the multicategory ethnicity variable or on the multiplicative scale either.Conclusion We found no definitive evidence that minority ethnic groups were more vulnerable to the effect of social disadvantage on the risk of severe COVID-19. |
| format | Article |
| id | doaj-art-7945ef14ba1b46a9bdd59d43e1fa8075 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-7945ef14ba1b46a9bdd59d43e1fa80752025-08-20T02:12:28ZengBMJ Publishing GroupBMJ Open2044-60552025-04-0115410.1136/bmjopen-2024-092727Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for ScotlandAziz Sheikh0Alastair H Leyland1Chris Robertson2Srinivasa Vittal Katikireddi3Colin R Simpson4Anna Pearce5Evangelia Demou6Colin McCowan7Lewis Ritchie8Eliud Kibuchi9Ronan McCabe10Sarah Amele11Patricia Irizar12Karen Jeffrey13Igor Ruden14Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKDepartment of Mathematics and Statistics, University of Strathclyde, Glasgow, Glasgow, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKVictoria University of Wellington, Wellington, Wellington, New ZealandMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKUniversity of St Andrews, St Andrews, UKGeneral Practice and Primary Care, University of Aberdeen, Aberdeen, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKDepartment of Sociology, The University of Manchester, Manchester, UKUsher Institute, The University of Edinburgh, Edinburgh, UKUsher Institute, The University of Edinburgh, Edinburgh, UKObjective Minority ethnic groups disproportionately experienced adverse COVID-19 outcomes, partly a consequence of disproportionate exposure to socioeconomic disadvantage and high-risk occupations. We examined whether minority ethnic groups were also disproportionately vulnerable to the consequences of socioeconomic disadvantage and high-risk occupations in Scotland.Design We investigated effect modification and interaction between area deprivation, education and occupational risk and ethnicity (assessed as both a binary white vs non-white variable and a multi-category variable) in relation to severe COVID-19 (hospitalisation or death). We used electronic health records linked to the 2011 census and Cox proportional hazards models, adjusting for age, sex and health board. We were principally concerned with additive interactions as a measure of vulnerability, estimated as the relative excess risk due to interaction (RERI).Results Analyses considered 3 730 837 individuals aged ≥16 years (with narrower age ranges for analyses focused on education and occupation). Severe COVID-19 risk was typically higher for minority ethnic groups and disadvantaged socioeconomic groups, but additive interactions were not consistent. For example, non-white ethnicity and highest deprivation level experienced elevated risk ((HR=2.7, 95% CI: 2.4, 3.2) compared with the white least deprived group. Additive interaction was not present (RERI=−0.1, 95% CI: −0.4, 0.2), this risk being less than the sum of risks of white ethnicity/highest deprivation level (HR=2.4, 95% CI: 2.3, 2.5) and non-white ethnicity/lowest deprivation level (1.4, 95% CI: 1.2, 1.7). Similarly, non-white ethnicity/no degree education (HR=2.5, 95% CI: 2.2, 2.7; RERI=−0.1, 95% CI: −0.4, 0.2) and non-white ethnicity/high-risk occupation (RERI=0.3, 95% CI: −0.2, 0.8) did not experience greater than additive risk. No clear evidence of effect modification was identified when using the multicategory ethnicity variable or on the multiplicative scale either.Conclusion We found no definitive evidence that minority ethnic groups were more vulnerable to the effect of social disadvantage on the risk of severe COVID-19.https://bmjopen.bmj.com/content/15/4/e092727.full |
| spellingShingle | Aziz Sheikh Alastair H Leyland Chris Robertson Srinivasa Vittal Katikireddi Colin R Simpson Anna Pearce Evangelia Demou Colin McCowan Lewis Ritchie Eliud Kibuchi Ronan McCabe Sarah Amele Patricia Irizar Karen Jeffrey Igor Ruden Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland BMJ Open |
| title | Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland |
| title_full | Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland |
| title_fullStr | Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland |
| title_full_unstemmed | Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland |
| title_short | Effect modification and interaction between ethnicity and socioeconomic factors in severe COVID-19: analyses of linked national data for Scotland |
| title_sort | effect modification and interaction between ethnicity and socioeconomic factors in severe covid 19 analyses of linked national data for scotland |
| url | https://bmjopen.bmj.com/content/15/4/e092727.full |
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