Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis
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Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis Antony Raharja 1 & Alice Tamara 2 & Li Teng Kok 1 Received: 29 August 2020 / Revised: 29 August 2020 / Accepted: 1 November 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Objectives This article evaluates if ethnicity is an independent poor prognostic factor in COVID-19 disease. Methods MEDLINE, EMBASE, Cochrane, WHO COVID-19 databases from inception to 15/06/2020 and medRxiv. No language restriction. Newcastle-Ottawa Scale (NOS) and GRADE framework were utilised to assess the risk of bias and certainty of evidence. PROSPERO CRD42020188421. Results Seventy-two articles (59 cohort studies with 17,950,989 participants, 13 ecological studies; 54 US-based, 15 UK-based; 41 peer-reviewed) were included for systematic review and 45 for meta-analyses. Risk of bias was low: median NOS 7 of 9 (interquartile range 6–8). Compared to White ethnicity, unadjusted all-cause mortality was similar in Black (RR: 0.96 [95% CI: 0.83–1.08]) and Asian (RR: 0.99 [0.85–1.16]) but reduced in Hispanic ethnicity (RR: 0.69 [0.57–0.84]). Age- and sex-adjusted risks were significantly elevated for Black (HR: 1.38 [1.09–1.75]) and Asian (HR: 1.42 [1.15–1.75]), but not for Hispanic (RR: 1.14 [0.93–1.40]). Further adjusting for comorbidities attenuated these associations to non-significance: Black (HR: 0.95 [0.72– 1.25]); Asian (HR: 1.17 [0.84–1.63]); Hispanic (HR: 0.94 [0.63–1.44]). Subgroup analyses showed a trend towards greater disparity in outcomes for UK ethnic minorities, especially hospitalisation risk. Conclusions This review could not confirm a certain ethnicity as an independent poor prognostic factor for COVID-19. Racial disparities in COVID-19 outcomes may be partially attributed to higher comorbidity rates in certain ethnicity. Keywords Ethnicity . COVID-19 . Mortality . Hospitalisation . Acute kidney injury . Intubation
Introduction Up to 85% of individuals affected by SARS-CoV-2 are asymptomatic or have mild illness, 15% require oxygen and 5% critically ill requiring intensive care unit (ICU) admission [1]. Several risk factors such as age, male sex and comorbidities have been shown to correlate with more severe disease Antony Raharja, Alice Tamara and Li Teng Kok are equally contributing co-first authors. Highlights • Ethnicity is not an independent poor prognostic factor in COVID-19 disease. • Racial disparities in COVID-19 outcomes can be attributed to higher rates of medical comorbidities in ethnic minority groups. • Disproportionate impact of COVID-19 on ethnic minorities is possibly largely driven by increased infection rates amongst ethnic minorities. * Antony Raharja [email protected] 1
Guy’s and St Thomas’ NHS Foundation Trust, London, UK
2
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
[2]. Understanding the demographic risk factors for severe disease is of paramount importance not only to inform clinical practice but also to inform risk stratification at workplace and focus public health
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