Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank.

Association between ethnic background and COVID-19 morbidity, mortality and vaccination in England: a multistate cohort analysis using the UK Biobank.

Publication date: Sep 21, 2023

Despite growing evidence suggesting increased COVID-19 mortality among people from ethnic minorities, little is known about milder forms of SARS-CoV-2 infection. We sought to explore the association between ethnic background and the probability of testing, testing positive, hospitalisation, COVID-19 mortality and vaccination uptake. A multistate cohort analysis. Participants were followed between 8 April 2020 and 30 September 2021. The UK Biobank, which stores medical data on around half a million people who were recruited between 2006 and 2010. 405 541 subjects were eligible for analysis, limited to UK Biobank participants living in England. 23 891 (6%) of participants were non-white. The associations between ethnic background and testing, testing positive, hospitalisation and COVID-19 mortality were studied using multistate survival analyses. The association with single and double-dose vaccination was also modelled. Multistate models adjusted for age, sex and socioeconomic deprivation were fitted to estimate adjusted HRs (aHR) for each of the multistate transitions. 18 172 (4. 5%) individuals tested positive, 3285 (0. 8%) tested negative and then positive, 1490 (6. 9% of those tested positive) were hospitalised, and 129 (0. 6%) tested positive at the moment of hospital admission (ie, direct hospitalisation). Finally, 662 (17. 4%) died after admission. Compared with white participants, Asian participants had an increased risk of negative to positive transition (aHR 1. 24 (95% CI 1. 02 to 1. 52)), testing positive (95% CI 1. 44 (1. 33 to 1. 55)) and direct hospitalisation (1. 61 (95% CI 1. 28 to 2. 03)). Black participants had an increased risk of hospitalisation following a positive test (1. 71 (95% CI 1. 29 to 2. 27)) and direct hospitalisation (1. 90 (95% CI 1. 51 to 2. 39)). Although not the case for Asians (aHR 1. 00 (95% CI 0. 98 to 1. 02)), black participants had a reduced vaccination probability (0. 63 (95% CI 0. 62 to 0. 65)). In contrast, Chinese participants had a reduced risk of testing negative (aHR 0. 64 (95% CI 0. 57 to 0. 73)), of testing positive (0. 40 (95% CI 0. 28 to 0. 57)) and of vaccination (0. 78 (95% CI 0. 74 to 0. 83)). We identified inequities in testing, vaccination and COVID-19 outcomes according to ethnicity in England. Compared with whites, Asian participants had increased risks of infection and admission, and black participants had almost double hospitalisation risk, and a 40% lower vaccine uptake.

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Concepts Keywords
Biobank COVID-19
Socioeconomic epidemiology
Vaccination public health


Type Source Name
disease MESH COVID-19
disease MESH morbidity
disease VO vaccination
pathway REACTOME SARS-CoV-2 Infection
disease VO dose
disease MESH infection
disease VO vaccine
disease VO device
disease MESH death
disease VO time
disease VO population
drug DRUGBANK Coenzyme M
disease MESH lifestyle
disease IDO blood
drug DRUGBANK Hydroxyethyl Starch
disease MESH Comorbidity
disease VO unvaccinated
drug DRUGBANK Trestolone
disease MESH uncertainty
disease VO vaccine dose
disease VO USA
disease IDO susceptibility
disease VO effective
disease VO Equity
disease MESH influenza
disease MESH pneumonia
disease IDO history
disease MESH venous thromboembolism
disease MESH Metabolic Syndrome
disease MESH maternal deaths

Original Article

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