Article

COVID-19 Among Ethnic Minorities: How Missing Data and Colour-Blind Policies Perpetuate Inequalities in the United Kingdom and the European Union. Interdisciplinary Perspectives on Equality and Diversity.

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Abstract

COVID-19 continues to disproportionately impact ethnic minorities across the globe in the absence of disaggregated ethnicity-based data. In Europe, governments continue to take a "colour-blind" approach to reporting COVID-19 cases and deaths, with a purported effort to avoid discrimination. However, dichotomising populations as either Black, Asian and minority ethnic (BAME) or White masks differences between ethnic groups by homogenising risk factors including gender, age, residential area, occupation, and socioeconomic status (SES), leading to vast oversimplification. Furthermore, in some European countries, data reported by ethnicity or birth country are limited or even non-existent, although recent reports from France and Scandinavia suggest a hugely disproportionate mortality rate in immigrants from low SES countries compared with Indigenous populations. Limited data on ethnicity in relation to COVID-19 infection and mortality restricts the understanding of causation factors and outcomes, a need, which must be addressed urgently as a public health priority.

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Background : International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods : We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results : The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, we believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection, reducing occupational risks, reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.
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Background The relationship between ethnicity and COVID-19 is uncertain. We performed a systematic review to assess whether ethnicity has been reported in patients with COVID-19 and its relation to clinical outcomes. Methods We searched EMBASE, MEDLINE, Cochrane Library and PROSPERO for English-language citations on ethnicity and COVID-19 (1st December 2019-15th May 2020). We also reviewed: COVID-19 articles in NEJM, Lancet, BMJ, JAMA, clinical trial protocols, grey literature, surveillance data and preprint articles on COVID-19 in MedRxiv to evaluate if the association between ethnicity and clinical outcomes were reported and what they showed. PROSPERO:180654. Findings Of 207 articles in the database search, five reported ethnicity; two reported no association between ethnicity and mortality. Of 690 articles identified from medical journals, 12 reported ethnicity; three reported no association between ethnicity and mortality. Of 209 preprints, 34 reported ethnicity – 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported worse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups compared to White groups. Interpretation Data on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggest BAME individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance. Funding NIHR
Article
The COVID-19 pandemic retells a story that other diseases like HIV, diabetes, and cancer have clearly internationally illustrated. Minorities in developed countries across the globe - especially those of African, Hispanic, and Native American descent - suffer a greater burden of disease than whites. The evidence of the cause and effect relationship of racism on mental and minority health outcomes is staggering. Racism and its influence on policy and important structural systems allow health inequities across racial and ethnic groups to persist. What's more troubling is how systemic racism impacts children from all races and has been perpetuated across many generations dating back hundreds of years. The impact of racial oppression is seen through intergenerational trauma which impacts youth in varying ways. For this article, we offer three areas in which racism causes healthcare disparities, intergenerational trauma, social determinants, and cultural mistrust. Effective policy change and a greater level of accountability must be placed on major systems including health care, to most fully counter racism's varied role in sustaining mental health inequities.
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