Disproportionate COVID-19 mortality in England linked to non-white ethnicity and poverty
England has one of the highest coronavirus disease 19 (COVID-19) deaths in developed countries, and studies show the COVID-19 pandemic can significantly widen existing inequalities in national health.
Although some risk factors have been identified for an increased risk for COVID-19 mortality, not much is known about the characteristics that make some communities vulnerable and others resilient to the mortality impact of the pandemic.
Studies show that the effects of the pandemic can disproportionately affect the populations most in need of medical care, namely people with chronic illnesses, the elderly, people belonging to ethnic minorities and people living in deprived areas. The number of confirmed severe coronavirus 2 (SARS-CoV-2) infections with acute respiratory syndrome, COVID-19 illnesses and related deaths varies significantly across England.
Two factors considered to be major contributors to increasing COVID-19 mortality in industrialized countries are population density and urbanization. The local differences in pandemic mortality or their community determinants, however, are hardly known.
Determination of local differences in COVID-19 mortality
In an article published on the preprint server medRxiv *, researchers from various departments of Imperial College London, Great Britain, discuss how they analyzed mortality data from people aged 40 and over in local communities in England in order to determine local differences in the increased mortality during the first wave determine the pandemic – between March 1 and May 31, 2020 – and to identify the community factors associated with these mortality patterns.
Researchers used a two-tier Bayesian spatial model to examine inequalities in excess mortality at the community level during the first few months of the pandemic. They used geocoded data on COVID-19 deaths in 6,791 communities between March and May 2020 and compared it to the 2015-2019 period.
Maps of Medium Super Output Areas (MSOAs) in England with excessive deaths per 100,000 people aged 40+. (A) Excessive deaths per 100,000 men (left) / women (right) from March 1 to May 31, 2020 compared to the same period over the past five years. (B) Rear probability that excessive deaths are> 0. The community characteristics of the MSOAs were:% population with income support; Population density; % Of the population does not know; % of the population live in overcrowded houses; Air pollution (NO2 and PM2.5); Nursing homes per 1,000 residents. We map the rear probability, which measures the extent to which an estimate of over / fewer deaths is likely to represent a real increase / decrease. If the total posterior distribution of estimated excess deaths for an MSOA is greater than zero, there is a ~ 1 posterior probability of an actual increase, and conversely, if the total posterior distribution is less than zero, there is a ~ 0 posterior probability of a real increase. That rearward probability would be ~ 0.5 for an MSOA where an increase is statistically indistinguishable from a decrease.
Poor communities with overcrowded homes are more prone to excessive COVID-19 mortality
The study showed that communities at increased risk of excessive COVID-19 mortality had high densities of nursing homes or high proportions of residents in overcrowded homes, or high percentages of black, Asian and other ethnic minority groups living on income support.
However, no association was found between air pollution or population density and increased mortality. Overall, environmental and social variables accounted for about 15% of the mortality differences at the community level.
The results of this study underscore the importance of nursing home density as a predictor of excess mortality in the local community. This is in line with the National Health Service’s policy of discharging nearly 15,000 medically healthy inpatients to avoid overburdening hospitals.
The authors think it likely that many elderly people laid off under the policy would need care home assistance to get out and may not have been tested for COVID-19 prior to discharge.
Higher exposure and inadequate access to health care increase the risk of death in some communities
The study also reveals the links between poverty, non-white ethnicity, and overcrowded housing and excessive mortality at the community level. People who live in poor and overcrowded communities have fewer opportunities to take steps that help reduce transmission, such as preventing transmission. B. Social distancing.
“Our study also highlights the links between excess mortality and poverty, non-white ethnicity, and overcrowded housing at the community level.”
In addition to being more exposed to the virus, they may also not have adequate access to health care to treat COVID-19 and other diseases. Several ongoing research studies indicate that higher ethnicity-related mortality risks are due to higher frontline representation in health professionals, poorer access to health care, and possibly a higher incidence of comorbidities such as obesity and diabetes.
The authors believe that there is urgent and effective public health action needed in England and other developed countries for vulnerable communities to prevent mortality inequalities from widening during the second wave of the pandemic. More research, shedding light on the pathways behind these associations, is needed to develop a long-term strategy to address the social and environmental factors of inequality that lead to different mortality rates during the COIVD-19 pandemic.
“In parallel, economic measures to support job security and provide financial compensation to low-wage workers who are required to self-isolate are essential to support population-level compliance with public health recommendations.”
* Important NOTE
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or be treated as established information.