Ethnic minority groups experienced higher rates of severe illness and death during the Covid-19 pandemic because of their greater risk of infection, according to an analysis of ethnic inequalities.
The research by the University of Manchester analysed results from 77 research studies, covering 200 million people from around the world.
Earlier research had shown a higher risk of severe illness or death for people from ethnic minority groups, but it was not clear if this was because of higher infection risk, poorer prognosis once infected, or both.
The study found that the biggest driver of ethnic inequalities was exposure to infection. Compared with the White majority group, South Asian people were three times more likely to test positive for infection, Black people were 1.8 times more likely, and Mixed and Other ethnic groups were 1.3 times more likely.
Among studies that looked at the risk of severe illness or death from Covid-19 in the whole population, Black people were 1.5 times more likely to be admitted to hospital than the White majority, Indigenous people were 1.9 times more likely and Hispanic people were 1.32 times more likely, the team concluded.
The risk of needing intensive care was also higher: South Asian, East Asian, Indigenous, Hispanic and Black groups all had more than triple the risk than White majority groups.
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Indigenous people had twice the risk of dying than White majority people, with the Mixed ethnic group at 1.4 times the risk and the Hispanic group at 1.3 times the risk.
The fact that more people from ethnic minority groups were admitted to hospital and more of them died seems to be because of a greater proportion of people being exposed to the virus and becoming infected, the researchers concluded.
When looking at studies that only included people infected with Covid-19, the risk of severe illness was similar for ethnic minority groups and White majority group.
However, after being admitted to hospital with Covid-19, ethnic minority people were more likely to be admitted to ICU compared to White people.
These higher rates may be a reflection of poorer health before infection with Covid-19, or inequalities in access to healthcare or service quality, the research team argued, adding these were all a result of structural and institutional racism.
Higher infection rates could also be driven by socioeconomic inequalities experienced by ethnic minority groups, which were exacerbated by the pandemic, and occupational risks.
Different patterns of employment, income and housing impacted the level of risk faced by people from different ethnicities – people from ethnic minority groups are more likely to have public-facing jobs, less likely to be able to self-isolate or work from home, more likely to live in overcrowded housing and less likely to have access to open spaces. These factors all increased the risk of Covid-19 infection, they argued.
“These findings are of vital public health importance, and should inform strategic recovery responses such as policy interventions to address ethnic inequalities in exposure to infectious diseases,” said the study’s lead author, Dr Patsy Irizar from The University of Manchester.
“The Covid-19 pandemic has worsened existing ethnic inequalities in health, and recovery responses must focus on tackling the drivers of these inequalities, including structural racism and racial discrimination,” Dr Irizar added.
