key: cord-0852755-mfr05i5d authors: Thomas, D. R.; Orife, O.; Plimmer, A.; Williams, C.; Karani, G.; Evans, M. R.; Longley, P.; Janiec, J.; Saltus, R.; Shankar, G. title: Ethnic variation in outcome of people hospitalised with Covid-19 in Wales (UK): A rapid analysis of surveillance data using Onomap, a name-based ethnicity classification tool date: 2020-06-26 journal: nan DOI: 10.1101/2020.06.22.20136036 sha: c836bd2cf8453829b1ed736c20290ff8e38391a2 doc_id: 852755 cord_uid: mfr05i5d There is growing evidence that ethnic minorities in Europe are disproportionately affected by Covid-19. Using a name-based ethnicity classifier, we found that hospitalised Black, Asian and minority ethnic cases were younger and more likely to be admitted to intensive care (ICU). Pakistani, Bangladeshi and White - other than British or Irish, ethnic groups were most at risk. In this study, older age and male gender, but not ethnicity, were associated with death in hospitalised patients. There is growing evidence that Black, Asian and other minority ethnic (BAME) people living in Europe are at increased risk of infection with SARS-CoV-2 and, if infected, are more likely to have severe disease. 1 In the United Kingdom, the Intensive Care National Audit and Research Centre first raised concerns that BAME people were over-represented amongst Covid-19 patients admitted to intensive care. 2 These findings were reported widely in the media and discussed in opinion pieces. [3] [4] [5] [6] [7] In Wales, the First Minister established an advisory group to examine the issue and provide recommendations to reduce ethnic inequality in Covid-19 outcomes. 8 Investigating ethnic health inequalities is hampered by poor recording of ethnicity in clinical data. This is the case for Covid-19 notifications and laboratory reports in Wales. In order to rapidly investigate ethnic variation in Covid-19 epidemiology, we applied Onomap, a name-based ethnicity classification tool developed by the Department of Geography at University College London, 9 to routinely collected, named Covid-19 laboratory test data, held by Public Health Wales Communicable Disease Surveillance Centre. We used individual person data on: (1) (3) Of 10,524 people tested positive for SARS-CoV-2 in Wales to 3 May 2020, Onomap classified 9,833 in White ethnic groups and 580 in BAME groups. Proportions with positive test results were similar for both groups: 336 per 100,000 of the White group tested positive and 316 per 100,000 in the BAME All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 26, 2020. . group. Trends in those tested positive should be interpreted with caution as they most likely reflect testing policy as well as incidence. Of all those testing positive, a smaller proportion (18.1%) of those tested in the BAME group attended hospital compared to the White group (33.4%: see Table 2 ). However, the trend was reversed in people aged 50 to 59 years: 26.4% of positive BAME individuals aged 50-59 years attended hospital, compared to 19.0% of White individuals testing positive. The median age of hospitalised BAME individuals was 51 years compared to 75 years for White individuals (p<0.01; Mann Whitney 2 sample test). Of those attending hospital, a much higher proportion (20.0%) of BAME individuals were admitted to intensive care compared to White individuals (7.7%). Proportions of hospitalised patients admitted to intensive care (ICU) were highest amongst the 'Asian and British Asian -Indian, Pakistani and Bangladeshi' (27.9%) and 'White -other' (25.3%) groups. The median age of BAME patients admitted to ICU was 51 years compared to 58 years for White individuals (p=0.02; Mann Whitney 2 sample test). Amongst hospitalised patients aged between 50-59 years, 25% of BAME patients were admitted to ICU compared to 19.5% of White patients. More patients died in hospital without being admitted to ICU. Of all those attending hospital, 9.5% of patients identified as BAME died compared to 32.3% of White patients ( Table 2) . We successfully linked all records of 3,394 people hospitalised with Covid-19, those admitted to ICU, and those who died in hospital, all as at 3 May 2020, using NHS numbers. Intensive care was more likely in hospitalised males (aOR: 1.92, 95% CI: 1.46-2.53) and in younger patients (Table 3, Figure 1 ). When specific ethnicities were examined, being admitted to ICU was more likely in All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Figure 1 ). There was a strong association between increasing age and death from Covid-19 which remained after adjusting for gender and ethnicity (aOR for aged 70 years and over: 11.77 (95% CI: 7.62-18.18). However, there was no evidence from this study that BAME groups were more likely to die from Covid-19 than White-British or Irish groups, even after adjusting for gender and age (Table 3) . To investigate further, we compared the differences in the distribution of previously reported risk factors for fatal outcome 11 in White and BAME groups who had died. BAME people who died in Wales with Covid-19 were younger than White people who died (BAME median age 74 compared to 80 for White people; p=0.06, Mann-Whitney 2 sample test). Underlying chronic disease was recorded for 48% of deaths. For those that had a medical history recorded, nearly all had an underlying chronic condition that would put them at increased risk of serious Covid-19 symptoms, and there was no difference between White and BAME groups. This was a rapid initial analysis of existing surveillance data using name-based ethnicity classification software. It adds to the increasing evidence of variation in Covid-19 outcomes in ethnic minorities in Europe. The finding that certain minority ethnic groups are at higher risk of being admitted to intensive care but are no more likely to die than the White British and Irish group was also found in the recent CO-CIN cohort study involving 23,577 Covid-19 patients attending hospitals in the UK. 14 Onomap has been used widely as a tool in public health, for example in studies investigating variation in influenza mortality, 15 hepatitis B infection 16 and HPV vaccination uptake. 17 However, Onomap has limitations, and all findings should be interpreted in light of these. We previously validated the tool using data containing self-reported or healthcare professional-reported ethnicity All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. There is an urgent need for all European countries carrying out Covid-19 surveillance to report trends by ethnicity, in order to inform local infection prevention and control policy and practice. Ethnic variation should also be considered in the design of interventions, and in crisis communication. In Wales, an occupational risk assessment tool has been developed with the aim of reducing risk of infection in those most vulnerable to severe infection. 19 This tool, developed initially for the health care sector, is for all ethnicities, but includes a weighting to account for the emerging evidence of increased risk in BAME individuals. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Paul Longley is Director of Publicprofiler Ltd. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 26, 2020. . https://doi.org/10.1101/2020.06.22.20136036 doi: medRxiv preprint Table 1 . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 26, 2020. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 26, 2020. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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