Ethnic-minority groups in England and Wales-factors associated with the size and timing of elevated COVID-19 mortality: a retrospective cohort study linking census and death records

Abstract

Background: We estimated population-level associations between ethnicity and coronavirus disease 2019 (COVID-19) mortality using a newly linked census-based data set and investigated how ethnicity-specific mortality risk evolved during the pandemic.

Methods: We conducted a retrospective cohort study of respondents to the 2011 Census of England and Wales in private households, linked to death registrations and adjusted for emigration (n = 47 872 412). The outcome of interest was death involving COVID-19 between 2 March 2020 and 15 May 2020. We estimated hazard ratios (HRs) for ethnic-minority groups compared with the White population, controlling for individual, household and area characteristics. HRs were estimated on the full outcome period and separately for pre- and post-lockdown periods.

Results: In age-adjusted models, people from all ethnic-minority groups were at elevated risk of COVID-19 mortality; the HRs for Black males and females were 3.13 (95% confidence interval: 2.93 to 3.34) and 2.40 (2.20 to 2.61), respectively. However, in fully adjusted models for females, the HRs were close to unity for all ethnic groups except Black [1.29 (1.18 to 1.42)]. For males, the mortality risk remained elevated for the Black [1.76 (1.63 to 1.90)], Bangladeshi/Pakistani [1.35 (1.21 to 1.49)] and Indian [1.30 (1.19 to 1.43)] groups. The HRs decreased after lockdown for all ethnic groups, particularly Black and Bangladeshi/Pakistani females.

Conclusion: Differences in COVID-19 mortality between ethnic groups were largely attenuated by geographical and socio-demographic factors, though some residual differences remained. Lockdown was associated with reductions in excess mortality risk in ethnic-minority populations, which has implications for a second wave of infection.

Keywords: BAME; COVID-19; census; coronavirus; ethnicity; mortality; social determinants of health.

Figure 1

Hazard ratios for COVID-19 related death for ethnic-minority groups compared with the White population, stratified by sex. Results obtained from Cox-regression models adjusted for age, population density, area and household deprivation, socio-economic status (SES), household composition, occupational exposure, self-reported health, with baseline hazards specific to local-authority district (LAD). Error bars represent limits of 95% confidence intervals of the hazard ratio. Details of the covariates can be found in Table 1. Numerical results can be found in Supplementary Tables 3 and 4, available as Supplementary data at IJE online.

Figure 2

Fully adjusted hazard ratios for COVID-19-related death for ethnic-minority groups compared with the White population, before and after lockdown plus 21 days, stratified by sex. Results obtained from a Cox-regression model adjusted for age, population density, deprivation, SES, household composition, occupational exposure, self-reported health, with baseline hazards specific to LAD. Errors bars represent limits of 95% confidence intervals of the hazard ratio. Estimates for each ethnic group are stratified by a time variable indicating pre- and post-lockdown periods.