Socio-demographic heterogeneity in the prevalence of COVID-19 during lockdown is associated with ethnicity and household size: Results from an observational cohort study

Christopher A Martin; David R Jenkins; Jatinder S Minhas; Laura J Gray; Julian Tang; Caroline Williams; Shirley Sze; Daniel Pan; William Jones; Raman Verma; Scott Knapp; Rupert Major; Melanie Davies; Nigel Brunskill; Martin Wiselka; Chris Brightling; Kamlesh Khunti; Pranab Haldar; Manish Pareek; Leicester COVID-19 consortium

doi:10.1016/j.eclinm.2020.100466

Socio-demographic heterogeneity in the prevalence of COVID-19 during lockdown is associated with ethnicity and household size: Results from an observational cohort study

EClinicalMedicine. 2020 Aug:25:100466. doi: 10.1016/j.eclinm.2020.100466. Epub 2020 Jul 17.

Authors

Christopher A Martin^{1

2}, David R Jenkins³, Jatinder S Minhas⁴, Laura J Gray⁵, Julian Tang³, Caroline Williams^{1

2}, Shirley Sze⁴, Daniel Pan^{1

2}, William Jones⁶, Raman Verma^{1

7

8}, Scott Knapp⁹, Rupert Major^{5

10}, Melanie Davies^{11

8}, Nigel Brunskill^{4

10}, Martin Wiselka^{1

2}, Chris Brightling^{1

7

8}, Kamlesh Khunti^{11

8

12}, Pranab Haldar^{1

7

8}, Manish Pareek^{1

2

8}; Leicester COVID-19 consortium

Affiliations

¹ Department of Respiratory Sciences, University of Leicester, UK.
² Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
³ Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁴ Department of Cardiovascular Sciences, University of Leicester, UK.
⁵ Department of Health Sciences, University of Leicester, Leicester, UK.
⁶ Business Intelligence Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁷ Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁸ NIHR Leicester Biomedical Research Centre, Leicester, UK.
⁹ Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹⁰ John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK.
¹¹ Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
¹² NIHR Applied Research Collaboration-East Midlands, Leicester, UK.

Abstract

Background: Accumulating evidence indicates that COVID-19 causes adverse outcomes in ethnic minority groups. However, little is known about the impact of ethnicity and household size on acquiring infection with SARS-CoV-2.

Methods: We undertook a retrospective cohort study, in Leicester (UK), of all individuals assessed for COVID-19 with polymerase chain reaction (PCR) testing at University Hospitals of Leicester NHS Trust between 1st March and 28th April 2020. We used logistic regression to identify sociodemographic, clinical and temporal factors associated with SARS-CoV-2 PCR positivity before/after lockdown.

Findings: 971/4051 (24.0%) patients with suspected COVID-19 were found to be PCR positive for SARS-CoV-2. PCR positivity was more common amongst individuals from ethnic minortiy backgrounds than their White counterparts (White 20.0%, South Asian 37.5%, Black 36.1%, Other 32.2%; p<0.001 for all ethnic minority groups vs White). After adjustment, compared to White ethnicity, South Asian (aOR 2.44 95%CI 2.01, 2.97), Black (aOR 2.56 95%CI 1.71, 3.84) and Other (aOR 2.53 95%CI 1.74, 3.70) ethnicities were more likely to test positive, as were those with a larger estimated household size (aOR 1.06 95%CI 1.02, 1.11). We saw increasing proportions of positive tests in the three weeks post-lockdown amongst the ethnic minority , but not the White, cohort. Estimated household size was associated with PCR positivity after, but not before, lockdown (aOR 1.10 95%CI 1.03, 1.16).

Interpretation: In individuals presenting with suspected COVID-19, those from ethnic minority communities and larger households had an increased likelihood of SARS-CoV-2 PCR positivity. Pandemic control measures may have more rapid impact on slowing viral transmission amongst those of White ethnicity compared to ethnic minority groups, Research is urgently required to understand the mechanisms underlying these disparities and whether public health interventions have differential effects on individuals from ethnic minority groups.

Funding: 10.13039/100006662 NIHR.

Keywords: BAME; COVID-19; Ethnicity; Lockdown; SARS-CoV-2.

Abstract

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