Ethnic variation in outcome of people hospitalised during the first COVID-19 epidemic wave in Wales (UK): an analysis of national surveillance data using Onomap, a name-based ethnicity classification tool

Abstract

Objective: To identify ethnic differences in proportion positive for SARS-CoV-2, and proportion hospitalised, proportion admitted to intensive care and proportion died in hospital with COVID-19 during the first epidemic wave in Wales.

Design: Descriptive analysis of 76 503 SARS-CoV-2 tests carried out in Wales to 31 May 2020. Cohort study of 4046 individuals hospitalised with confirmed COVID-19 between 1 March and 31 May. In both analyses, ethnicity was assigned using a name-based classifier.

Setting: Wales (UK).

Primary and secondary outcomes: Admission to an intensive care unit following hospitalisation with a positive SARS-CoV-2 PCR test. Death within 28 days of a positive SARS-CoV-2 PCR test.

Results: Using a name-based ethnicity classifier, we found a higher proportion of black, Asian and ethnic minority people tested for SARS-CoV-2 by PCR tested positive, compared with those classified as white. Hospitalised black, Asian and minority ethnic cases were younger (median age 53 compared with 76 years; p<0.01) and more likely to be admitted to intensive care. Bangladeshi (adjusted OR (aOR): 9.80, 95% CI 1.21 to 79.40) and 'white - other than British or Irish' (aOR: 1.99, 95% CI 1.15 to 3.44) ethnic groups were most likely to be admitted to intensive care unit. In Wales, older age (aOR for over 70 years: 10.29, 95% CI 6.78 to 15.64) and male gender (aOR: 1.38, 95% CI 1.19 to 1.59), but not ethnicity, were associated with death in hospitalised patients.

Conclusions: This study adds to the growing evidence that ethnic minorities are disproportionately affected by COVID-19. During the first COVID-19 epidemic wave in Wales, although ethnic minority populations were less likely to be tested and less likely to be hospitalised, those that did attend hospital were younger and more likely to be admitted to intensive care. Primary, secondary and tertiary COVID-19 prevention should target ethnic minority communities in Wales.

Keywords: COVID-19; epidemiology; public health.

Figure 1

Determinants of having a positive SARS-CoV-2 PCR test. Adjusted ORs with 95% CIs are given for male gender, compared with female, older age groups compared with those aged less than 50 years, small area deprivation quintile comparing with least deprived, and Onomap estimated ethnicities, compared with ‘white British’. ORs greater than 1 represent an increased risk; ORs less than 1 represent a decreased risk. Ninety-five per cent CIs not crossing 1 reflect that the OR is statistically significant.

Figure 2

Determinants of: (1) being admitted to intensive care unit (ICU); and (2) in-hospital mortality in 4046 individuals hospitalised with COVID-19 in Wales on 31 May 2020, as at 28 June 2020. Adjusted ORs (aORs) with 95% CIs are given for male gender, compared with female, older age groups compared with those aged less than 50 years, small area deprivation quintile comparing with least deprived and Onomap estimated ethnicities, compared with ‘white British’. ORs greater than 1 represent an increased risk; ORs less than 1 represent a decreased risk. Ninety-five per cent CIs not crossing 1 reflect that the OR is statistically significant.