Ethnicity and Clinical Outcomes in COVID-19: A Systematic Review and Meta-Analysis

Sze, S., Pan, D., Nevill, C. R., Gray, L. J., Martin, C. A., Nazareth, J., Minhas, J. S., Divall, P., Khunti, K., Abrams, K. R., Nellums, L. B., & Pareek, M. (2020). Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine, 29–30, 100630. https://doi.org/10.1016/j.eclinm.2020.100630

Abstract

Patients from ethnic minority groups are disproportionately affected by Coronavirus disease
(COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19.
Methods: Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st
August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654.
Findings: 18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the
United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a
higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67 – 2.44; pooled adjusted RR for Asian: 1.50, 95% CI
1.24 – 1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black:
1.85, 95%CI: 1.46 – 2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22 – 1.88). Individuals of Asian ethnicity
may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34 – 2.89) (but no studies had
yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99 – 1.50]).
Interpretation: Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared
to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical
public health importance in informing interventions to reduce morbidity and mortality amongst ethnic
minority groups.
© 2020 The Author(s). Published by Elsevier Ltd.