Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths: Analysis of 2 years of a record linked national cohort study in Scotland

Amele, S, Kibuchi, E ORCID: 0000-0002-5091-6450, McCabe, R ORCID: 0000-0001-8649-6913, Pearce, A ORCID: 0000-0003-0085-5263, Henery, P, Hainey, K, Fagbamigbe, AF, Kurdi, A, McCowan, C, Simpson, CR ORCID: 0000-0002-5194-8083, Dibben, C, Buchanan, D ORCID: 0000-0002-6784-0034, Demou, E ORCID: 0000-0001-8616-525X, Almaghrabi, F, Anghelescu, G, Taylor, H, Tibble, H, Rudan, I, Nazroo, J ORCID: 0000-0001-6744-2207, Bécares, L et al (2023) Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths: Analysis of 2 years of a record linked national cohort study in Scotland. Journal of Epidemiology and Community Health, 77 (10). pp. 641-648. ISSN 0143-005X

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Abstract

Background This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland. Methods We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time. Findings Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave. Interpretation Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.

Item Type:	Article
Uncontrolled Keywords:	COVID-19; epidemiology; ethnic groups; health inequalities; public health; Humans; Ethnicity; Cohort Studies; SARS-CoV-2; COVID-19; Minority Groups; Hospitalization; Scotland; Prognosis; 1117 Public Health and Health Services; 1604 Human Geography; Epidemiology; 4202 Epidemiology; 4206 Public health
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Divisions:	Psychology (from Sep 2019)
Publisher:	BMJ
Date of acceptance:	17 July 2023
Date of first compliant Open Access:	18 February 2025
Date Deposited:	18 Feb 2025 16:09
Last Modified:	03 Jul 2025 15:30
DOI or ID number:	10.1136/jech-2023-220501
URI:	https://researchonline.ljmu.ac.uk/id/eprint/25661

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