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Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Our take —

Using data from the National Health Service on 16,272 COVID-19 patient deaths in England, there were observed differences in mortality by race and ethnicity. The observed differences in the COVID-19 standardized mortality ratios of whites and ethnic minority groups likely reflect existing inequities in society, whereby individuals from minority ethnic groups experience greater social and economic vulnerability to infection and death from COVID-19 and other conditions compared to whites. Strategies for mitigating social inequities could decrease observed racial disparities in deaths from COVID-19 and other conditions in this population.

Study design

Cross-Sectional

Study population and setting

The authors used data from the National Health Service (NHS) on COVID-19 patients who died in hospitals in England between March 1, 2020 and April 21, 2020. Standardized mortality ratios (SMR)—i.e., observed deaths divided by expected deaths—were calculated by ethnicity using indirect standardization. The reference group for calculations was the whole population using age ranges of 0–19; 20–39; 40–59; 60–79 and 80+ years from the 2011 UK Census.

Summary of Main Findings

Overall, 16,272 deaths were observed in the study period and ethnicity information was available for 90.6% of these deaths. SMRs were statistically significantly higher for Black African (SMR 3.24, 95% CI: 2.90-3.62), Black Caribbean (SMR 2.21, 95% CI: 2.02-2.41), Pakistani (SMR 3.29, 95% CI: 2.96-3.64), Bangladeshi (SMR 2.41, 95% CI: 1.98-2.91), and Indian (SMR 1.70, 95% CI: 1.56-1.85) minority ethnic groups. Conversely, SMRs were statistically significantly lower for white Irish (SMR 0.52, 95% CI: 0.45-0.60) and white British persons (0.88, 95% CI: 0.86-0.0.89). SMRs were not statistically significantly different for Chinese or persons of mixed race. Even after accounting for geographical location, the authors found that differences in SMRs of whites and Black and Asian ethnic minorities still held.

Study Strengths

A major strength of this study was the large sample size, and the ability to ascertain ethnicity for a large percentage of COVID-19 patients who died (90.6%).

Limitations

A major limitation of the study is that data were not broken down by sex or socio-economic information, which meant that the authors were unable to examine or adjust for the influence of these socio-demographic factors. In addition, since the study only used information for persons who died in hospital, the SMRs are likely to be biased if the characteristics of those who died outside hospital settings differ substantially from those who died in hospital. Specifically, the authors noted that COVID-19 deaths outside the hospital are happening in care homes, which include a larger number of white British persons. Thus, the calculated standardized mortality ratios may be somewhat underestimated among older white British persons.

Value added

This study presents comparisons of hospital-based COVID-19 deaths across ethnic groups in England and adds evidence regarding disparities in mortality rates from COVID-19 in England.

This review was posted on: 17 August 2020