The Office for National Statistics (ONS) have published new figures detailing COVID-19 related deaths by ethnic group.
Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:
“It’s good research done, and reported, well. It does tell us that the sizes of the differences in death rates between ethnic groups are partly due to differences in where people live (urban/rural, which region they live in, how deprived the area they live in is), some characteristics of households such as the size and the relationships between people there, some measures of socio-economic position, some measures of health, etc.), but that differences remain after taking all these into account. But that can’t tell us about the reasons for the remaining differences. One could speculate about what they are. Maybe more current data on people’s state of health would be useful. But without data we can’t tell.”
Prof Sylvia Richardson, MRC Biostatistics Unit, University of Cambridge, on behalf of the Royal Statistical Society Covid-19 Task Force, said:
“We welcome all the efforts that ONS is making to give as full a picture as possible of the deaths resulting from Covid-19. The work linking various administrative data records is impressive and offers insight, increasingly in the months to come.
“The current analysis concerns 12,805 COVID-mention deaths in England and Wales that occurred between 2 March and 10 April and were registered by 17 April 2020, 2,079 (16.2%) of whom were non-white. Within these 2,079 Black, Asian and Minority Ethnic (BAME) COVID-mention deaths, the two largest sub-groups were 766 Black and 483 Indian.
“Some caution against overinterpretation is warranted as the modest number of deaths up to 10 April in major sub-groups makes it difficult to have certainty over the conclusions. In terms of the socio-demographic adjustment factors extracted from the 2011 census, we note that response rates to the census and other surveys are famously low among some groups and in parts of London, where the bulk of the outbreak was in March and early April.
“While the report highlights a disproportionate risk of COVID-mention death for those from ethnic minorities, the higher rate could be due to factors that the ONS admits it could not control for: the professions followed by ethnic minorities, for example, in health or transport, are not inherently anything to do with ethnicity. It will thus be important to investigate further why the risk is being disproportionately experienced in ethnic minorities.
“While the death-rate in the black community might be substantially higher than in the white community, it is important to keep in mind that other factors have an overall larger impact in determining the risk to an individual. In particular, the risk of COVID-mention death to anyone who is neither elderly nor suffering from one or more of a number of specific pre-existing conditions is small.”
Prof Robin May, Professor of Infectious Diseases & Director of the Institute of Microbiology and Infection, University of Birmingham, said:
“This analysis looks at death rates from COVID-19 across different ethnic groups. Ethnic minority groups are often disadvantaged in society and, since we know that such disadvantages (lower income, reduced ‘baseline’ health status, etc.) correlate with increased risk of many infections, it is possible that mortality from COVID-19 is higher amongst ethnic minorities as a result of these secondary factors. However, this ONS analysis controls for these ‘confounding’ factors and still demonstrates that individuals from particular ethnic groups are more likely to die of COVID-19. In particular, black men and women are almost twice as likely to die from COVID-19 as age-matched white individuals.
“Broadly speaking, there are two possible explanations for this. Firstly, it may be that there are additional confounding factors involved here, which we are currently unaware of – for instance, a subtle dietary, cultural, social or similar factor that varies between ethnic populations and has a disproportionately large impact on COVID-19 susceptibility.
“Alternatively, this increased risk of death may reflect population-level difference in genetics between different populations. We already know that many immune genes have variants that are present at different frequencies in different ethnic groups. Consequently, some ethnic groups are at higher risk of immune conditions than others – for instance, the autoimmune disease lupus is almost three times as common in Afro-Caribbean women in the UK than it is in white women. It is thus possible that one or more of these genetic variants alter the patient’s immune response to SARS-CoV-2, therefore raising the risk of death following infection. Ultimately, testing this will require a more detailed understanding of both the virus and the immune response to it, but this epidemiological analysis provides an important first step to start guiding those experimental approaches in the future.”
Dr Manish Pareek, Associate Clinical Professor in Infectious Diseases, University of Leicester said:
“Today’s statistics clearly show a link between ethnicity and increased risk of death involving COVID-19 – something which the University of Leicester was one of the first to raise concerns about.
“Although the exact causes linking ethnicity to greater risk haven’t been confirmed, the statistics raise important questions around the management of healthcare for the general population, and how the NHS will seek to minimise risk to those people from BAME backgrounds that are receiving care.
“Additionally, due to the increased risk to healthcare workers from BAME backgrounds serving on the NHS frontline, today’s figures make it even more critical that urgent guidance is issued to ensure they are protected and not placed at unnecessary risk.”
Dr Saffron Karlsen, Senior Lecturer in Social Research, University of Bristol, said:
“Today’s report from the ONS confirms the developing picture regarding the disproportionate impact of Covid-19 on some of those with minority ethnicities. It also provides important new evidence, building on that published by the IFS on Friday, regarding what might explain these.
“To date, explanations offered for these ethnic differences have relied on assumptions about genetic predispositions – to Covid-19 or other health conditions – and particular ‘cultural’ behaviours such as hand-washing. Today’s ONS report shows clearly that the evidence for this as the principal explanation for these differences is unconvincing.
“It also shows that identifying the actual explanations requires the disentangling of a number of complex and inter-related processes. These are issues which have already been identified as important in understanding the different risks between different population groups, but they have generally been considered irrelevant as explanations for these ethnic differences.
“The first of these relates to age. We already know that those with older ages are more likely to die from Covid-19. We also know that on average people with minority ethnicities are much younger than the white British population. As such, the problem isn’t only that they die more, but that all other things being equal, they should be dying less. The scale of the problem is actually even bigger than we imagine. This also means that the patterns we thought we saw were not quite what they seemed. There has been some debate in the media and elsewhere regarding the reasons why some Muslim groups appeared protected from Covid-19, while others with minority ethnicities were not. These figures show that these differences were actually caused by differences in age, rather than any particular ‘Muslimness’. Once we remove this age effect, we find that Black people (males and females) are over four times more likely than white people to experience a COVID-19-related death. There is also a statistically significantly higher risk of Covid-19-related death among people of Bangladeshi and Pakistani, Indian, and Mixed ethnicities.
“The second relates to the role of socioeconomic factors. This is important not only because it is directly related to experience of Covid-19 but also because it helps explain the ethnic differences in other health conditions. Again, these ethnic health differences are not genetic – as many commentators would have us believe – they are societal. They relate to the ways in which opportunities are given to some people and not others, and the impacts that this has on people’s lives and (directly and indirectly) their health.
“By taking account of the combined effects of differences in age, health/disability and socioeconomic characteristics, the difference in the risk of death from Covid-19 between Black and white people is halved, from four times the risk to two. There is a similar risk (of 1.8) among Bangladeshi and Pakistani men and a slightly lower risk among Bangladeshi and Pakistani women (at 1.6 times that of white women).
“Socioeconomic differences between the groups are therefore an important part of the explanation for ethnic differences in deaths from Covid-19. This is in terms of the direct ways that socioeconomic disadvantage increases risk of contracting the virus and also the consequences it has for managing its symptoms, due, for example, to the impact of poverty on increased risk of other diseases. But this is not the whole story, because some ethnic differences in Covid-19 appear to persist. There are a number of reasons why this might be.
“One is that these measures, particularly of socioeconomic status, don’t work very well (and actually work much better for white people than those with minority ethnicities). It is unlikely that these methods can measure these differences perfectly, such that no ethnic differences in socioeconomic status remain.
“The other factor that has been found important for explaining ethnic inequalities in other health conditions relates to the experience of living in a society which doesn’t accept you. Racism works in many ways. It affects people’s access to opportunities – to good education, jobs, housing and healthcare. Ethnic inequalities in health are explained by experiences of racism. It also leads to long-term stress which causes cardiovascular disease, and other health problems like obesity. Unfortunately, this complexity is much more difficult to measure.”
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“These results are from a well described and executed study. The headline rate of a fourfold increase amongst the black ethnic group is misleading.
“The really important result is that there risk is nearly double in the Black group as is the Pakistani/Bangladeshi group which is not headlined as much. This figure is after adjusting for other known factors and therefore the most important number.
“Not adjusting for where more cases are, deprivation factors, urban rural split and others factors means any group who are more likely to live in centres with more cases, deprived and urban areas will appear to be at higher risk because of these factors when in fact they may not be. Likewise age is important as not only death is more common in older people, BAME groups are on average younger hence lowering their risk. These steps are crucial in quality epidemiological analyses.
“Panel B – fully adjusted model is the correct analysis. Figure 2 shows how the risks alter after adjusting for important known associations.”
Dr Riyaz Patel, Associate Professor of Cardiology, UCL, said:
“This is an important report that further adds to our understanding of the disproportionate impact of COVID19 on BAME people.
“It differs from prior hospital mortality reports by including all deaths including those in the community and care homes and attempts to account for several socioeconomic and geographical factors as well as some self reported health measures. It finds that despite these other factors, such as type of living environment and degree of deprivation, the excess risk for BAME people remains.
“The results support what we have seen from multiple prior studies that people from BAME backgrounds are at higher risk than White people. However there are some factors that need to be considered when interpreting these numbers. For example the analysis relies on data from the 2011 census, which is now almost 10 years old and population demographics are likely to have shifted in this time. Also 10% of deaths could not be linked to the census, which could either increase or decrease the observed risks. Finally the report is for deaths until April 10 and we know since then that the peak has passed, especially in major cities where many BAME people live, so figures could yet change by the next analysis.
“Despite these caveats, the collective evidence is clear that BAME people are at higher risk and unmeasured factors that contribute to health and social inequality are very likely driving this difference.”
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