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Meta-Analysis
. 2021 Nov;6(11):e007433.
doi: 10.1136/bmjgh-2021-007433.

Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis

Charles Agyemang #  1 , Anke Richters #  2 , Shahab Jolani  3   4 , Stevie Hendriks  5 , Saurabh Zalpuri  6 , Evan Yu  7   8 , Bart Pijls  9 , Maria Prins  10   11 , Karien Stronks  12 , Maurice P Zeegers  13
Affiliations
Meta-Analysis

Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis

Charles Agyemang et al. BMJ Glob Health. 2021 Nov.

Abstract

Introduction: Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes.

Methods: PubMed and Embase were searched from December 2019 through September 2020. Studies reporting extractable data (ie, crude numbers, and unadjusted or adjusted risk/ORs) by ethnic group on any of the five studied outcomes: confirmed COVID-19 infection in the general population, hospitalisation among infected patients, and disease severity, intensive care unit (ICU) admission and mortality among hospitalised patients with SARS-CoV-2 infection, were included using standardised electronic data extraction forms. We pooled data from published studies using random-effects meta-analysis.

Results: 58 studies were included from seven countries in four continents, mostly retrospective cohort studies, covering a total of almost 10 million individuals from the first wave until the summer of 2020. The risk of diagnosed SARS-CoV-2 infection was higher in most ethnic minority groups than their White counterparts in North American and Europe with the differences remaining in the US ethnic minorities after adjustment for confounders and explanatory factors. Among people with confirmed infection, African-Americans and Hispanic-Americans were also more likely than White-Americans to be hospitalised with SARS-CoV-2 infection. No increased risk of COVID-19 outcomes (ie, severe disease, ICU admission and death) was found among ethnic minority patients once hospitalised, except for a higher risk of death among ethnic minorities in Brazil.

Conclusion: The risk of SARS-CoV-2 diagnosis was higher in most ethnic minorities, but once hospitalised, no clear inequalities exist in COVID-19 outcomes except for the high risk of death in ethnic minorities in Brazil. The findings highlight the necessity to tackle disparities in social determinants of health, preventative opportunities and delay in healthcare use. Ethnic minorities should specifically be considered in policies mitigating negative impacts of the pandemic.

Prospero registration number: CRD42020180085.

Keywords: COVID-19; SARS; public health; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram for assessment of eligible studies in the systematic review and meta-analysis. EPPI Centre (COVID-19: a living systematic map of the evidence) was consulted up to 31 March 2020 (available through https://eppi.ioe.ac.uk/COVID19_MAP/covid_map_v5.html).
Figure 2
Figure 2
Pooled unadjusted and adjusted risk of SARS-CoV-2 infection among the general population in the USA.
Figure 3
Figure 3
Pooled unadjusted and adjusted risk of hospitalisation among COVID-19-infected patients in the USA.
Figure 4
Figure 4
Pooled unadjusted and adjusted risk of severe disease among hospitalised COVID-19-infected patients in the USA.
Figure 5
Figure 5
Pooled unadjusted and adjusted risk of ICU admission among hospitalised COVID-19 patients in the USA.
Figure 6
Figure 6
Pooled unadjusted and adjusted risk of death among hospitalised COVID-19 patients in the USA.
See this image and copyright information in PMC

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