{"id":38517,"date":"2020-07-22T07:21:55","date_gmt":"2020-07-22T07:21:55","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=38517"},"modified":"2020-08-18T15:37:33","modified_gmt":"2020-08-18T15:37:33","slug":"significant-covid-19-outcomes-by-race-reported-in-london-study-higher-risk-of-mortality-in-asian-or-black-compared-to-white-participants","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38517","title":{"rendered":"Higher mortality from COVID-19 in London study in Asian or Black compared to white participants"},"content":{"rendered":"

<\/b>Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n

Research from five leading acute London hospitals in east London, part of the largest NHS Trust, reports significantly worse outcomes from COVID-19 in people from Black, Asian and minority ethnic (BAME) backgrounds.<\/span><\/strong><\/p>\n

This important paper, by Vanessa Apea and colleagues reports from a prospective observational majority ethnic diverse (60%) cohort of almost 2000 admission records of confirmed SARS CoV-2 in adults (>16 years). The results are published online, but ahead of peer review. [1]<\/span><\/p>\n

After excluding 259 records due to lack of ethnicity data, the study included 1737 participants from January to May 2020, <\/span>511 of whom had died by day 30 (29%). Overall, 538\/1739 (31%) were from Asian, 340 (20%) Black, 156 (7\u00b78%) other and 707 (40%) white backgrounds.<\/span><\/p>\n

BAME participants were younger (median 64 years for Black and 59 for Asian vs 73 white, p<0.001)) and were less frail with different comorbidity profiles (available for 85%). Being Black or Asian was significantly associated with admission to intensive care and receiving invasive ventilation (OR 1.54; 95% CI: 1.06 to 2.23], p=0.023 and 1.80; 95%CI: 1.20 to 2.71], \u00a0p=0.005, respectively). Admission to ICU occurred for 20%, 18% and 11% for Asian, Black and white participants, respectively (p<0.001) although there were no significant differences in use of mechanical ventilation or length of stay in ICU (median 8 to 9 days).<\/span><\/p>\n

Although a larger proportion of white participants died (33%) overall, after adjusting for age and race, the primary endpoint of mortality by day 30 was significantly higher in <\/span>Asian (hazard ratio: 1.49; 95%CI: 1.19 to 1.86, p<0.001) and Black (HR: 1.30; 95%CI: 1.02 to 1.63, p=0\u00b7036) participants.<\/p>\n

After further adjusting for other factors associated with clinical outcomes (including comorbidities, BMI and smoking) the link with mortality persisted in Asian (HR 1.48, CI 1.09 to 2.01, p=0.011) but not in Black (HR 1.32; 95%CI: 0.96 to 1.84, p=0.090) participants. However, in sensitivity analyses, the association with mortality remained for both these groups.<\/span><\/p>\n

After admission to ICU, being Black and Asian was linked to short time before death compared to white participants: median 6 days (IQR: 3 to 12) and 5 (IQR: 3 to 11) vs 9 (IQR: 4 to 16) respectively, p<0.001.<\/span><\/p>\n

Also important, acute kidney injury within seven days of admission was highest in Black (35%) participants (vs Asian (22%) and white (24%), p=0.003), who also had higher levels of inflammation (measured by CRP and D-dimer) compared to other ethnicities.<\/p>\n

comment<\/span><\/h3>\n

The significant links between race and increased mortality from COVID-19, even after adjusting for comorbidities and socioeconomic factors urgently need further research.<\/span><\/strong><\/p>\n

This is likely be a combination of medical, biological and other behavioural\/social factors, which are also likely linked to structural ways that related to accessing healthcare in the UK.<\/span><\/strong><\/p>\n

The paper itself concludes that the relative contribution of different factors is currently unclear. <\/span><\/strong><\/p>\n

Although AIDS was reported as an infrequent comorbidity in five (1.7%) Black and one (0.2%) white participants, it is unclear whether this referred to HIV status or advanced HIV (ie CD4 <200 cells\/mm3<\/sup>).<\/span><\/strong><\/p>\n

A recent US study also highlighted the disproportionate impact of race in a cohort of 47 HIV positive people with confirmed (n=36) or probable (n=11) COVID-19. <\/span><\/strong>Comorbidities were common (85%) but 77% of the COVID-19 cohort were Black and Latinx compared to 40% of the HIV clinic overall. [2]<\/span><\/strong><\/p>\n

References<\/span><\/p>\n

    \n
  1. Apea VJ et al. Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study. Before peer review. MedRxiv. DOI: <\/span>10.1101\/2020.06.10.20127621. (12 June 2020).
    \nhttps:\/\/www.medrxiv.org\/content\/10.1101\/2020.06.10.20127621v1<\/a><\/li>\n
  2. Meyerowitz E et al. Disproportionate burden of COVID-19 among racial minorities and those in congregate settings among a large cohort of people with HIV. AIDS, <\/span>doi: 10.1097\/QAD.0000000000002607. \u00a0(25 June 2020).
    \n<\/span>    https:\/\/pubmed.ncbi.nlm.nih.gov\/32604138<\/a><\/li>\n<\/ol>\n

    This report was first posted on 10 July 2020.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Research from five leading acute London hospitals in east London, part of the largest NHS Trust, reports significantly worse outcomes from COVID-19 in people from Black, Asian and minority ethnic (BAME) backgrounds. This important paper, by …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[290,278],"tags":[],"class_list":["post-38517","post","type-post","status-publish","format-standard","hentry","category-covid-19-pathogenesis","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=38517"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38517\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38517"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}