Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis

• Published in: Journal of racial and ethnic health disparities Vol. 8; no. 6; pp. 1563 - 1572
• Main Authors: Raharja, Antony, Tamara, Alice, Kok, Li Teng
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2021; Springer Nature B.V
• Subjects: Age; Bias; Black people; Cardiovascular disease; Cohort analysis; Comorbidity; COVID-19; COVID-19 - ethnology; COVID-19 - therapy; Ecological studies; Epidemiology; Ethnic groups; Ethnicity; Ethnicity - statistics & numerical data; Hispanic Americans; Hospitalization; Humans; Medical prognosis; Medicine; Medicine & Public Health; Meta-analysis; Minority & ethnic groups; Minority groups; Mortality; Observational studies; Patient Acuity; Preprints; Prognosis; Quality of Life Research; Race factors; Racial inequality; Risk analysis; Risk assessment; Risk Factors; Severe acute respiratory syndrome coronavirus 2; Social Inequality; Social Structure; Socioeconomic factors; Subgroups; Systematic review; United Kingdom > UK; United States > US; COVID-19; Ethnicity; Intubation; Mortality; Acute kidney injury; Hospitalisation
• ISSN: 2197-3792; 2196-8837; 2196-8837
• DOI: 10.1007/s40615-020-00921-5

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.