Why are black and Asian people at greater risk of coronavirus? Here's what we found
The coronavirus pandemic has significantly raised awareness of health inequalities. Researchers have long understood that ethnicity and socio-economic conditions play an important role in influencing our health, but the pandemic has demonstrated these strong inequalities and the need for urgent action to address them.
In our research, we examined how the risk for COVID-19 differs depending on ethnicity and socioeconomic background.
We analyzed data from nearly 400,000 people in England who participated in the UK biobank study, which collected information on people's lives from 2006 to 2010. This information was combined with Corona Virus laboratory test data from Public Health England to assess risk across ethnic groups. In this way, we were able to investigate how people's health and living conditions were related to the development of COVID-19 disease during the pandemic about a decade ago.
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We have noticed striking inequalities. Black people needed hospitalization for COVID-19 four times more often than whites, and South Asian (especially Pakistani) ethnic groups were three times more likely.
The greatest inequalities persisted when we considered factors such as pre-pandemic health, regardless of whether people smoked or whether they were health care workers during baseline data collection. Taking socioeconomic factors into account reduced these differences to some extent, but not entirely - the risk for black people was still twice as high as for white people when we took these factors into account.
Since then, further research has confirmed our results. The National Statistics Office has investigated COVID-19 deaths based on ethnicity information from census records and death certificates. Their report also found an increased risk of death among ethnic minorities. They found again that these higher risks were reduced but not eliminated when the socio-economic background was taken into account with the measures available.
Where do health inequalities come from?
What does that mean? First, and in line with what we already knew about ethnic health inequalities, there will almost certainly not be a single explanation that ethnic minorities are disproportionately affected by the corona virus. A number of factors are very likely to play a role, including structural racism and discrimination.
While we know that ethnicity is largely a social variable, it doesn't mean that potential biological differences don't matter at all. For example, South Asian people are known to be at particular risk of diabetes, at least in part due to the tendency to accumulate fat around the abdomen, which is strongly related to the risk of developing diabetes.
One possible explanation that has been widely discussed is the possible contribution of different vitamin D levels between ethnic groups. However, our team's analysis of UK biobank data did not provide any evidence.
But even if biological differences play a role in health inequalities, their effects are rather small compared to the role of social forces.
This brings us to the effect of social factors. Concerns about access to personal protective equipment by healthcare workers are widespread. Access among ethnic minorities could be even more restricted, which puts them at an unfair risk. However, the data to investigate this remains limited.
Finally, there are numerous indications that racism experiences have a direct impact on health. Racism, particularly experienced by key forces, is now recognized as an important factor in ethnic inequalities in COVID-19. Discrimination could put ethnic minorities in a more dangerous role in the front line. The broader impact also means that people from ethnic minorities are more likely to experience unsafe work, for example in the “gig economy”. Racism's psychosocial stress is also believed to have a direct impact on health.
Racism continues to exist within the NHS, as highlighted in a recent issue of the British Medical Journal, with limited progress in addressing this over the past 25 years.
Time to respond to the evidence
Public Health England recently published its highly anticipated report on ethnic inequalities in COVID-19. However, only a small fraction actually focused on ethnicity and was unable to deliver anything new or make recommendations.
Expected evidence from the Public Health England regional director for London, Kevin Fenton, was not taken into account, although he developed a number of recommendations based on a comprehensive engagement exercise. Ignoring this evidence can further damage public trust when it is most needed.
While ethnic health inequalities have long existed, they are not inevitable.
We need sustained government policy efforts to address these inequalities. In the short term, we need to monitor ethnicity health outcomes, adjust public health messages to reach everyone, and remove obstacles to health care to minimize further damage from the virus. Restricting health care for migrants is an important obstacle as documentation requirements may reduce the need for urgently needed health services.
In the long term, we have to deal with racism and discrimination in order to create a fairer society in which everyone can experience good health. If something positive emerges from this pandemic, be it the long overdue recognition and fight against the structural causes of health inequalities.
This article is republished by The Conversation under a Creative Commons license. Read the original article.
S Vittal Katikireddi receives funding from an NRS Senior Clinical Fellowship (SCAF / 15/02), the Medical Research Council (MC_UU_12017 / 13) and the Chief Scientist Office of the Scottish Government (SPHSU13). He has also independently advised the UK Government's Scientific Advisory Group on Emergencies (SAGE) and is a member of the Scottish Government's Expert Group on Ethnicity and COVID-19.
Claire Niedzwiedz was funded by the Medical Research Council and the Chief Scientist Office.
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