Ethnicity and COVID-19 cardiovascular complications: a multi-center UK cohort

Abstract

Background: Recent reports suggest an association between ethnicity and COVID-19 mortality. In the present multi-center study, we aimed to assess the differences underlying this association, and ascertain whether ethnicity also mediates other aspects of COVID-19 like cardiovascular complications.

Methods: Data were collected from a mixed-ethnicity UK cohort of 613 patients admitted and diagnosed COVID-19 positive, across six hospitals in London during the second half of March 2020: 292 were White Caucasian ethnicity, 203 were Asian and 118 were of Afro-Caribbean ethnicity.

Results: Caucasian patients were older (P<0.001) and less likely to have hypertension (P=0.038), while Afro-Caribbean patients had higher prevalence of diabetes mellitus (P<0.001). Asian patients were more likely to present with venous thromboembolic disease (adj.OR=4.10, 95% CI 1.49-11.27, P=0.006). On the other hand, Afro-Caribbean had more heart failure (adj.OR=3.64, 95% CI 1.50-8.84, P=0.004) and myocardial injury (adj.OR=2.64, 95% CI 1.10-6.35, P=0.030). Importantly, our adjusted multi-variate Cox regression analysis revealed significantly higher all-cause mortality both for Asian (adj.HR=1.89, 95% CI 1.23-2.91, P=0.004) and Afro-Caribbean ethnicity (adj.HR=2.09, 95% CI 1.30-3.37, P=0.002).

Conclusions: Our data show that COVID-19 may have different presentations and follow different clinical trajectories depending on the ethnicity of the affected subject. Awareness of complications more likely to arise in specific ethnicities will allow a more timely diagnosis and preventive measures for patients at risk. Due to increased mortality, individuals of Afro-Caribbean and Asian ethnicity should be considered as high-risk groups. This may have an impact on health-resource allocation and planning, definition of vulnerable groups, disease management, and the protection of healthcare workers at the frontline.

Keywords: COVID-19; ethnicity; mortality.

Figure 1

Adjusted odds ratio of cardiovascular outcomes across ethnicities (caucasian as comparator).