Prevalence of suspected COVID-19 infection in patients from ethnic minority populations: a cross-sectional study in primary care

Abstract

Background: The first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care.

Aim: To quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record.

Design and setting: Cross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England.

Method: Suspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status.

Results: GPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57).

Conclusion: Using data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.

Keywords: COVID-19; ethnicity; multimorbidity; primary care.

Figure 1.

Comparison of test-positive COVID-19 cases in the whole of England, London, and the east London study area from 23 February to 30 April 2020. ^aTestpositive cases in England are shown at 50% of total value for scaling purposes. ^bAll data from the UK’s Government Digital Service website.

Figure 2.

Test-positive COVID-19 cases across the study area compared with daily counts of GP-suspected COVID-19 cases from 10 February to 30 April 2020. ^aData on study area test-positive cases from UK’s Government Digital Service website.Results from these positive tests were not routinely returned to general practices.

Figure 3.

Comparison of GP-suspected COVID-19 cases with GP-coded URTI/LRTI across the study area from 1 January to 30 April 2020. ^aDaily counts of GP-coded entries. LRTI = lower respiratory tract infection. URTI = upper respiratory tract infection.