In the UK and beyond, the Covid-19 pandemic is thought to have disproportionately affected minority ethnic groups. Now, the largest study to date of more than 17 million adults in England, has confirmed this.

The study, published in The Lancet, found that minority ethnic groups had a higher risk of testing positive for Covid-19, hospitalisation, admission to intensive care and death compared with white groups in England.

In order to gather the data, the research team analysed partially anonymised electronic health data collected by GPs, covering 40% of England. These GP records were linked to other national coronavirus-related data sets for the first and second waves of the pandemic – including testing, hospital data and mortality records. Ethnicity was self-reported by participants in GP records and grouped into five census categories (white, South Asian, Black, other, mixed) and then a further 16 sub-groups.

The study accounted for a large number of possible explanatory factors, such as sex, age, deprivation, occupation, household size and underlying health conditions (such as asthma and diabetes), across all ethnic groups and at different stages of Covid-19, from testing to mortality.

The largest disparities were seen in ICU admissions

Of 17,288,532 adults included in the study, 63% (10,877,978) were white, 5.9% (1,025,319) South Asian, 2% (340,912) Black, 1.8% (320,788) other, and 1% (170,484) mixed. Ethnicity was unknown for 26.3% (4,553,051) people.

During wave 1, nearly all minority ethnic groups had higher relative risk for testing positive, hospitalisation, ICU admission, and death compared to white groups. The largest disparities were seen in ICU admissions, which were more than doubled for all minority ethnic groups compared with white groups, with Black people more than three times more likely to be admitted to ICU after accounting for other factors.

The proportion of people testing positive for SARS-CoV-2 in wave 1 was higher in South Asian groups (0.9% test positivity), Black (0.7%) and mixed groups (0.5%) and compared with white people (0.4%).

The relative risk for testing positive, hospitalisation, ICU admission, and death were smaller in wave 2 (compared to wave 1) for all minority ethnic communities compared to white people, with the exception of South Asian groups. South Asian groups remained at higher risk for testing positive, with relative risks for hospitalisation, ICU admission, and death greater in magnitude in wave 2 compared to wave 1.

After accounting for age and sex, social deprivation was the biggest potential explanatory factor for disparities in all minority ethnic groups except South Asian. In South Asian groups, health factors (e.g., BMI, blood pressure, underlying health conditions) played the biggest role in explaining excess risks for all outcomes. Household size was an important explanatory factor for the disparity for Covid-19 mortality in South Asian groups only.

Implications for practice and policy 

The authors of the study are now calling for public policy efforts to overcome these inequalities. To tackle ethnic disparities in Covid-19 risks and reduce structural disadvantage and inequality, access to healthcare and the quality of this care must be improved, as well as the uptake of testing and vaccination. They also stress the need for more intensive strategies tailored to improve outcomes in South Asian communities.

Dr Rohini Mathur of the London School of Hygiene and Tropical Medicine and lead author of the study, said: “Minority ethnic groups in the UK are disproportionately affected by factors that also increase the risk for poor Covid-19 outcomes, such as living in deprived areas, working in front-line jobs, and having poorer access to healthcare.

“Our study indicates that even after accounting for many of these factors, the risk for testing positive, hospitalisation, ICU admission and death was still higher in minority ethnic groups compared with white people in England. To improve Covid-19 outcomes, we urgently need to tackle the wider disadvantage and structural racism faced by these communities, as well as improving access to care and reducing transmission.”