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Ethnic disparities in COVID-19 hospitalizations and mortality have been reported but there is scant understanding of how these inequalities are embodied. The UK Biobank prospective cohort study comprises around half a million people who were aged 40-69 years at study induction between 2006 and 2010 when information on ethnic background and potential explanatory factors was captured. Study members were linked to a national mortality registry. In an analytical sample of 448,664 individuals (248,820 women), 354 deaths were ascribed to COVID-19 between 5th March and the end of follow-up on 17th September 2020. In age- and sex-adjusted analyses, relative to White participants, Black study members experienced around seven times the risk of COVID-19 mortality (odds ratio; 95% confidence interval: 7.25; 4.65, 11.33), while there was a doubling in the Asian group (1.98; 1.02, 3.84). Controlling for baseline comorbidities, socioeconomic circumstances, and lifestyle factors explained 53% of the differential in risk for Asian people (1.37; 0.68, 2.77) and 27% in Black study members (4.28; 2.67, 6.86). The residual risk in ethnic minority groups for COVID-19 deaths may be ascribed to unknown genetic factors or unmeasured phenotypes, most obviously racial discrimination.
ABSTRACT
ObjectiveThere is growing evidence of, and biological plausibility for, elevated levels of high-density lipoprotein cholesterol (HDL-C), being related to lower rates of severe infection. Accordingly, we tested whether pre-pandemic HDL-C within the normal range is associated with subsequent COVID-19 hospitalisations and death. ApproachWe analysed data on 317,306 participants from UK Biobank, a prospective cohort study, baseline data for which were collected between 2006 and 2010. Follow-up for COVID-19 was via hospitalisation records and a national mortality registry. ResultsAfter controlling for a series of confounding factors which included health behaviours, inflammatory markers, and socio-economic status, higher levels of HDL-C were related to a lower risk of later hospitalisation for COVID-19. The effect was linear (p-value for trend 0.001) such that a 0.2 mmol/L increase in HDL-C was associated with a corresponding 9% reduction in risk (odds ratio; 95% confidence interval: 0.91; 0.86, 0.96). A very similar pattern of association was apparent when COVID-19 mortality was the outcome of interest (odds ratio per 0.2 mmol/l increase in HDL-C: 0.90; 0.81, 1.00); again, a stepwise effect was evident (p-value for trend 0.03). ConclusionsThese novel results for HDL-C and COVID-19 events warrant testing in other studies.
ABSTRACT
BackgroundThe impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. MethodsWe conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification ( infectious, chronic, and other). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation. FindingsData on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37.0 {+/-} 25.2 and 30.3 {+/-} 21.7 in 2016-2019 and 45.5 {+/-} 24.7 and 39{middle dot}5 {+/-} 23.3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366.5 and 358.25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394.75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2.39, 2017= 2.74, 2018= 2.39, 2019= 2.01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. InterpretationDuring the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations. Key PointsO_ST_ABSQuestionC_ST_ABSHow has the application of COVID-19 sanitary measures affected emergency medical consultations from March to July 2020 compared to previous years? FindingThe rates of infectious diseases decreased as rates of chronic diseases stayed stagnant with the application of sanitary measures. Among the infectious and chronic disease consultations, no racial/ethnic disparities were observed. MeaningUnderstanding the effects of the sanitary measures against COVID-19 in Sub-Saharan Africa has helped emphasize the possibility of limiting the spread of other infectious diseases in this part of the world where they are still highly prevalent and the efficiency of controlling the spread of the virus while avoiding racial/ethnic disparities.
ABSTRACT
ImportanceDifferentials in COVID-19 incidence, hospitalization and mortality according to ethnicity are being reported but their origin is uncertain. ObjectiveWe aimed to explain any ethnic differentials in COVID-19 hospitalization based on socioeconomic, lifestyle, mental and physical health factors. DesignProspective cohort study with national registry linkage to hospitalisation for COVID-19. SettingCommunity-dwelling. Participants340,966 men and women (mean age 56.2 (SD=8.1) years; 54.3% women) residing in England from the UK Biobank study. ExposuresEthnicity classified as White, Black, Asian, and Others. Main Outcome(s) and Measure(s)Cases of COVID-19 serious enough to warrant a hospital admission in England from 16-March-2020 to 26-April-2020. ResultsThere were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of being hospitalised (odds ratio; 95% confidence interval: =4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the other non-white group (1.84; 1.13, 2.99). After controlling for 15 confounding factors which included neighbourhood deprivation, education, number in household, smoking, markers of body size, inflammation, and glycated haemoglobin, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31). Conclusions and RelevanceOur findings show clear ethnic differences in risk of hospitalization for COVID-19 which do not appear to be fully explained by known explanatory factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage. Key pointsO_ST_ABSQuestionC_ST_ABSWhat explains ethnic differences in rates of hospitalisation for COVID-19? FindingIn a large, community-based cohort, Black and Asian individuals had a markedly higher risk of hospitalisation. After adjustment for socioeconomic, lifestyle, comorbidities, and biomarkers, Black individuals still experienced more than a doubling of risk compared to white individuals though the effect for the Asian group was diminished. MeaningIn England, the marked ethnic disparities in the risk of hospitalisation for COVID-19, if replicated, has implications for health policy, including the targeting of prevention advice and vaccination coverage.
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BackgroundSince December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19), is spreading worldwide, causing significant morbidity and mortality. No specific treatment has yet clearly shown to improve the diseases evolution. Validated therapeutic options are urgently needed. MethodsIn this retrospective study, we aimed to evaluate determinants of the prognosis of the disease in 70 patients with COVID-19 severe pneumonia (i.e. requiring at least 3 liters of oxygen) hospitalized between 10 March and 9 April, 2020, in the Centre Hospitalier Alpes Leman, France. The main outcome was oro-tracheal intubation and the exposure of interest was corticotherapy. Since this was not a randomized trial, we used propensity score matching to estimate average treatment effect. ResultsThere was evidence that corticotherapy lowered the risk of intubation with a risk difference of -47.1% (95% confidence interval -71.8% to -22.5%). ConclusionCorticosteroid, a well-known, easily available, and cheap treatment, could be an important tool in management of severe COVID-19 patients with respiratory failure. Not only could it provide an individual benefit, but also, in the setting of the COVID-19 ongoing pandemic, lower the burden on our vulnerable healthcare systems. Key pointsBy propensity score matching analysis, the average treatment effect of corticosteroids on 70 patients with severe COVID-19 pneumonia was estimated. Corticosteroid therapy lowered the risk of intubation with a risk difference of -47.1% (95% confidence interval -71.8% to -22.5%).
