key: cord-0816412-0v282si1 authors: Kakkar, Dr Nishchay; Dunphy, Dr Jessica; Raza, Dr Mohammad title: Ethnicity profiles of COVID-19 admissions and outcomes date: 2020-05-27 journal: J Infect DOI: 10.1016/j.jinf.2020.05.059 sha: 3d48ed7628431b995121a2a189ddb003249357e8 doc_id: 816412 cord_uid: 0v282si1 nan A recent letter in this journal by Tang and his colleagues compared hospitalised, community and staff Coronavirus disease 2019 (COVID-19) infection rates during the early phase of the evolving COVID-19 epidemic, 1 but an emerging factor is the ethnicity of individuals. In this letter, we report our investigation into the potential associations between ethnicity and COVID-19. Despite only 15% of the UK population being from black and ethnic minority (BAME) backgrounds, 2 recent data has identified that 34% of patients admitted to intensive care (ITU) with COVID-19 belong to BAME groups. 3 The potential difference in outcomes associated with ethnicity for patients with COVID-19 has caused concern within the scientific community, with many calling for further research. 4, 5 Consequently, we analysed routinely collected data from adult patients at Sheffield Teaching Hospitals (STH) between 01/03/20 and 25/04/20. Ethnicities were categorised into BAME (including Black, Asian-subcontinent, mixed and any other non-White background), White and Not Known. A total of 3018 patients were tested for COVID-19, of whom 1493 were female and 1499 male (26 gender-unknown). Median age for BAME patients was 54 years and for White patients was 71 years. Overall data showed that of the 3018 patients tested, 806(26·7%) were positive for COVID-19, including 95 from a BAME and 631 from a White background (Table 1) . BAME patients were significantly more likely to test positive than the White cohort (X 2 (1, n=726) =4·9561, p=·026). Whilst there was an almost equal gender split in terms of population tested, men were significantly more likely to test positive than women ((X 2 (1,n=2922)=16·90189,p<·00001). BAME men were significantly more likely to test positive compared to both BAME women (X 2 (1,n=296)=7·2608,p=·007) and White men (X 2 (1,n=1349)=6·7514,p=·009). Furthermore, positive BAME patients were significantly younger than White patients, with a median age of 55 years compared to 77 years (Mann-Whitney U=15155, p<0·001 two-tailed). Of positive patients, 755 were admitted to hospital for further treatment or were tested whilst inpatient. There was no significant difference between BAME and White groups in terms of overall admissions (X2(1, n=726) =3·0032, p=·083). BAME inpatients were, however, significantly more likely to be admitted to ITU compared to White inpatients (X2(1, n=695) =23·977, p<·00001). After age adjustment, black (2·97, p=0·010) and sub-continental groups (2·43, p = 0·087) had much higher odds than the white cohort (1) for ITU admission. Whilst men accounted for just over half (450/806) of positive tests, they were responsible for almost three-quarters (59/79) of ITU admissions and were significantly more likely to be admitted to ITU (X2(1, n=752) =10·1446, p=·001) . BAME men were significantly more likely to be admitted to ITU than White men (X2(1,n=389)=11·9572,p=·0005) but not compared to BAME women (X2(1,n=89)=0·9403,p=·332). When considering mortality, a total of 198 patients died following COVID-19 diagnosis. We separated ethnicity data to investigate mortality as there were only deaths in the White, Black and Sub-continent ethnic groups. Whilst the odds of death were decreased in Black and Sub-continent groups compared to the White population, this difference was not significant (p=0·2 and p=0·6 respectively). Age, however, was found to be a significant predictor of mortality. Those over 65 years were significantly more likely to die than the 40-49 (p=0·002) and 50-59 (p<0·001) age brackets, though there was no significant difference to the 60-64 age bracket (p=0·168). In addition, men were significantly more likely to die than women (X 2 (1, n=726) =4·0596, p=·044) however, there was no significant difference when comparing deaths with ethnicity and gender. Pareek et al. 4 discussed the need for urgent research into a link between ethnicity and COVID-19. We found that BAME men were significantly more likely to test positive compared to white men and BAME women in our cohort, and were at highest risk of ITU admission. The reasons for this are likely to be multifactorial, but we postulate that these may include a genetic predisposition to COVID-19 or because underlying co-morbidities make BAME groups more prone to becoming infected. 6, 7 The difference in ITU admissions may be related to the comparatively young age of our BAME cohort and therefore a potentially greater physiological reserve and/or likelihood of the ITU clinician accepting the referral based on age. Given Sheffield boasts an ethnically diverse populace (19% BAME groups), 8 testing and admission rates at STH were lower than expected in the BAME cohort at only 10% of tests. Given that our baseline BAME cohort was significantly younger than the White cohort (p<0·001), this suggests that older BAME patients are potentially not being tested for COVID-19. The reasons for this are unclear; however, previous research has shown that health behaviours may be contributing to this disparity. 9 We recognise that there are limitations to the data collected, including a lack of information about associated comorbidities and the exclusion of occupational health records. Since our initial data was in keeping with the ICNARC, however, we believed that disseminating this information in a timely manner was critical whilst we continue to further analyse data and factor in other confounders. We declare no competing interests. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Report on COVID-19 in critical care Correspondence Ethnicity and COVID-19 : an urgent public health research priority Is ethnicity linked to incidence or outcomes of covid-19? Ethnic variations in morbidity and mortality from lower respiratory tract infections: A retrospective cohort study Cardiovascular multimorbidity: The effect of ethnicity on prevalence and risk factor management Census Briefing Note 1.2 : Ethnicity, National Identity, Country of Birth and Religion Engaging 'hard to reach' groups in health promotion: The views of older people and professionals from a qualitative study in England Ethnic Group Patients Tested Positive for Covid-19 We acknowledge the support and suggestions of Dr Cariad Evans and Dr Dan Green. Death BAME 296 95 86 20 16 White 2424 631 599 43 170 Not known 298 80 70 11 12 Total 3018 806 755 74 198 Table 1 . Total figures of patients tested for COVID-19 at Sheffield Teaching Hospitals categorised by ethnic group