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      Ethnicity and COVID-19: an urgent public health research priority

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          Abstract

          As the coronavirus disease 2019 (COVID-19) pandemic continues advancing globally, reporting of clinical outcomes and risk factors for intensive care unit admission and mortality are emerging. Early Chinese and Italian reports associated increasing age, male sex, smoking, and cardiometabolic comorbidity with adverse outcomes. 1 Striking differences between Chinese and Italian mortality indicate ethnicity might affect disease outcome, but there is little to no data to support or refute this. Ethnicity is a complex entity composed of genetic make-up, social constructs, cultural identity, and behavioural patterns. 2 Ethnic classification systems have limitations but have been used to explore genetic and other population differences. Individuals from different ethnic backgrounds vary in behaviours, comorbidities, immune profiles, and risk of infection, as exemplified by the increased morbidity and mortality in black and minority ethnic (BME) communities in previous pandemics. 3 As COVID-19 spreads to areas with large cosmopolitan populations, understanding how ethnicity affects COVID-19 outcomes is essential. We therefore reviewed published papers and national surveillance reports on notifications and outcomes of COVID-19 to ascertain ethnicity data reporting patterns, associations, and outcomes. Only two (7%) of 29 publications reported ethnicity disaggregated data (both were case series without outcomes specific to ethnicity). We found that none of the ten highest COVID-19 case-notifying countries reported data related to ethnicity; UK mortality reporting, for example, does not require information on ethnicity. This omission seems stark given the disproportionate number of deaths among health-care workers from BME backgrounds.4, 5 Recent UK data from intensive care units indicate that over a third of patients are from BME backgrounds. 6 Given previous pandemic experience, it is imperative that policy makers urgently ensure ethnicity forms part of a minimum dataset. More importantly, ethnicity-disaggregated data must occur to permit identification of potential outcome risk factors through adjustment for recognised confounders. BME communities might be at increased risk of acquisition, disease severity, and poor outcomes in COVID-19 for several reasons (figure ). Specific ethnic groups, such as south Asians, have higher rates of some comorbidities, such as diabetes, hypertension, and cardiovascular diseases, which have been associated with severe disease and mortality in COVID-19. 7 Ethnicity could interplay with virus spread through cultural, behavioural, and societal differences including lower socioeconomic status, health-seeking behaviour, and intergenerational cohabitation. Disentangling the relative importance of these factors requires both prospective studies, focusing on quantifying absolute risks and outcomes, and qualitative studies of behaviours and responses to pandemic control messages. Figure The potential interaction of ethnicity related factors on SARS-CoV-2 infection likelihood and COVID-19 outcomes COVID-19=coronavirus disease 2019. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. If ethnicity is found to be associated with adverse COVID-19 outcomes, this must directly, and urgently, inform public health interventions globally.

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          “Race” and “ethnicity” in biomedical research: How do scientists construct and explain differences in health?

           C. LEE (2008)
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            Author and article information

            Contributors
            Journal
            Lancet
            Lancet
            Lancet (London, England)
            Elsevier Ltd.
            0140-6736
            1474-547X
            21 April 2020
            21 April 2020
            Affiliations
            [a ]Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
            [b ]Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
            [c ]Leicester Diabetes Centre, University of Leicester, Leicester LE1 7RH, UK
            [d ]Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
            [e ]Department of Intensive Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
            [f ]Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
            [g ]Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
            [h ]School of Cardiovascular Medicine and Sciences, King's BHF Centre of Excellence, London, UK
            Article
            S0140-6736(20)30922-3
            10.1016/S0140-6736(20)30922-3
            7173801
            © 2020 Elsevier Ltd. All rights reserved.

            Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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