This is the FIRST review analysis on the outcomes of ethnicity on the clinical outcomes of SARS-CoV-2 infection. The authors concluded that:
“Black Asian Minority or Ethnic (BAME) individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance.”
AUTHORS: Daniel Pana, b,1 , Shirley Szec,1 , Jatinder S. Minhas c , Mansoor N. Bangash d,e , Nilesh Pareek f, Pip Divall g , Caroline ML. Williams a,b , Marco R. Oggionih , Iain B. Squirec , Laura B. Nellumsi , Wasim Hanif j, Kamlesh Khunti k , Manish Pareek a,b, * a
AUTHOR AFFILIATIONS:
a Department of Respiratory Sciences, University of Leicester, United Kingdom
b Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, United Kingdom
c Department of Cardiovascular Sciences, University of Leicester, United Kingdom
d Department of Intensive Care, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
e Institute of Clinical Sciences, University of Birmingham, United Kingdom
f School of Cardiovascular Medicine and Sciences, King’s BHF Centre of Excellence, London, United Kingdom
g University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
h Department of Genetics and Genome Biology, University of Leicester, United Kingdom
i Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
j Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
k Leicester Diabetes Centre, University of Leicester, United Kingdom
ABSTRACT:
Background: The relationship between ethnicity and COVID-19 is uncertain. We performed a systematic review to assess whether ethnicity has been reported in patients with COVID-19 and its relation to clinical outcomes.
Methods: We searched EMBASE, MEDLINE, Cochrane Library and PROSPERO for English-language citations on ethnicity and COVID-19 (1st December 2019-15th May 2020). We also reviewed: COVID-19 articles in NEJM, Lancet, BMJ, JAMA, clinical trial protocols, grey literature, surveillance data and preprint articles on COVID-19 in MedRxiv to evaluate if the association between ethnicity and clinical outcomes were reported and what they showed. PROSPERO:180654.
Findings: Of 207 articles in the database search, five reported ethnicity; two reported no association between ethnicity and mortality. Of 690 articles identified from medical journals, 12 reported ethnicity; three reported no association between ethnicity and mortality. Of 209 preprints, 34 reported ethnicity 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported worse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups compared to White groups.
Interpretation: Data on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggest BAME individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance.
Funding: NIHR © 2020
Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
Please cite this article as: D. Pan et al., The impact of ethnicity on clinical outcomes in COVID-19: A systematic review, EClinicalMedicine (2020), https://doi.org/10.1016/j.eclinm.2020.100404
