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Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out: a retrospective, population-based cohort study

Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out: a retrospective, population-based cohort study
Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out: a retrospective, population-based cohort study

Background: Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. Methods: We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. Results: Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]). Conclusions: Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.

COVID-19, Coronavirus, Ethnic group, Ethnicity, Mortality, SARS-CoV-2, Vaccination
1741-7015
Bosworth, Matthew L
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Ahmed, Tamanna
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Larsen, Tim
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Lorenzi, Luke
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Morgan, Jasper
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Ali, Raghib
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Goldblatt, Peter
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Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Khunti, Kamlesh
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Raleigh, Veena
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Ayoubkhani, Daniel
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Bannister, Neil
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Glickman, Myer
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Nafilyan, Vahe
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et al.
Bosworth, Matthew L
05d73c95-7103-4d63-9764-c2dba76f0c22
Ahmed, Tamanna
b2dd4666-a138-4c6f-8bf9-11da6f506d90
Larsen, Tim
7d90fc82-f17b-4703-8d09-6c3606c5b68f
Lorenzi, Luke
8758dc68-2ce7-4dfd-b430-31c50575181f
Morgan, Jasper
06cc0fec-7f9e-412d-926a-ad851c69f1f4
Ali, Raghib
6ba6761f-3786-4b42-9cca-a7a36e57175f
Goldblatt, Peter
cdafeabb-81c8-4566-98ff-aa93b7823a59
Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Khunti, Kamlesh
3e64e5f4-0cc9-4524-aa98-3c74c25101c3
Raleigh, Veena
5d55c9fd-6b9d-492b-952d-2962cd47c6d1
Ayoubkhani, Daniel
cfd1b0e2-6685-4edb-a53f-299582b89280
Bannister, Neil
c5d795ff-d763-4263-8186-ab7281bcefc1
Glickman, Myer
61b66cbc-a403-4cd6-b7b5-eb18fccae968
Nafilyan, Vahe
542d70f5-e4b4-4b4c-b9f6-5b039999f8e9

Bosworth, Matthew L, Ahmed, Tamanna, Larsen, Tim and Islam, Nazrul , et al. (2023) Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine roll-out: a retrospective, population-based cohort study. BMC Medicine, 21 (1), [13]. (doi:10.1101/2022.02.14.22270940).

Record type: Article

Abstract

Background: Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. Methods: We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. Results: Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]). Conclusions: Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.

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Accepted/In Press date: 12 December 2022
Published date: 8 January 2023
Additional Information: Funding Information: None. Publisher Copyright: © 2023, Crown.
Keywords: COVID-19, Coronavirus, Ethnic group, Ethnicity, Mortality, SARS-CoV-2, Vaccination

Identifiers

Local EPrints ID: 470499
URI: http://eprints.soton.ac.uk/id/eprint/470499
ISSN: 1741-7015
PURE UUID: 54c3ed0a-a992-4770-b3e2-fb7027acbfc2
ORCID for Nazrul Islam: ORCID iD orcid.org/0000-0003-3982-4325

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Date deposited: 11 Oct 2022 17:02
Last modified: 06 Jun 2024 02:15

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Contributors

Author: Matthew L Bosworth
Author: Tamanna Ahmed
Author: Tim Larsen
Author: Luke Lorenzi
Author: Jasper Morgan
Author: Raghib Ali
Author: Peter Goldblatt
Author: Nazrul Islam ORCID iD
Author: Kamlesh Khunti
Author: Veena Raleigh
Author: Daniel Ayoubkhani
Author: Neil Bannister
Author: Myer Glickman
Author: Vahe Nafilyan
Corporate Author: et al.

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