Lancet study: Work needed to minimize exposure of ethnic minority groups to coronavirus

12-Nov-2020 - Last updated on 12-Nov-2020 at 15:41 GMT

The clear evidence of increased risk of COVID-19 infection amongst ethnic minority groups, people from Black and Asian backgrounds, is of urgent public health importance, according to the authors of a paper published today by The Lancet.

Society must work to minimize exposure to the virus in these at-risk groups by facilitating their timely access to healthcare resources, says one of the authors of that study, Dr Shirley Sze, clinical lecturer and specialist registrar in cardiology at the UK's University of Leicester.

She said it was critical to also target the social and structural disparities that contribute to health inequalities.

The study confirmed that people of Black ethnicity are twice as likely to be infected with COVID-19 compared to those of White ethnicity.

It also found that people from Asian backgrounds are 1.5 times more likely to become infected with the virus compared to White individuals.

Researchers also determined those of Asian ethnicities to be at higher risk of admission to an intensive therapy unit (ITU) and death.

Data analysis

In a meta-analysis of the effect of ethnicity on clinical outcomes in patients with COVID-19, which screened over 1500 articles, the research team pooled data from more than 18 million people who had taken part in 50 studies in the UK and the US.

Studies included in the analysis were published between December 1, 2019 and August 31, 2020 in peer-reviewed journals or as pre-prints waiting for peer-review.

All the patients included in the study who had COVID-19 were defined as such by a positive nasal swab test or clinical signs and symptoms of the virus, along with radiology and laboratory tests.

According to the paper, ethnicity has come under scrutiny as an important risk factor for infection, severe disease and death, with evidence that ethnic minorities may be at increased risk of COVID-19 morbidity and mortality.

“Understanding the relationship between ethnicity and COVID-19 is an urgent research priority, in order to reduce the disproportionate burden of disease in Black, Asian and other minority ethnic groups,” said the team.

Dr Manish Pareek, associate clinical professor in infectious diseases at the University of Leicester, consultant in infectious diseases at the University Hospitals of Leicester NHS Trust and one of the authors, said many explanations exist as to why there may be an elevated level of COVID-19 infection in ethnic minority groups.

There was little evidence the risks were driven by genetic factors.

People belonging to ethnic minorities were more likely to work in front-line roles and live in large households with several generations, he said.

Boosting diversity in clinical trials

Meanwhile, this week saw the US Food and Drug Administration (FDA) release guidance on how to enhance diversity in clinical trials and encourage inclusivity in drug development.

FDA chief, Stephen Hahn, commenting on the publication, said: “We have seen these health care disparities… during our fight against COVID-19, as certain segments of the population - older adults, pregnant women, children, and racial and ethnic minorities - are affected in different ways.

“This difference in impact illustrates why we must encourage developers of any medical product such as treatments or vaccines for COVID-19 – as well as medical products more broadly – to endeavor to include diverse populations to understand their risks or benefits across all groups.

“To further promote and protect public health, it is important that people who are in clinical trials represent the populations most likely to use the potential medical product.”