Evidence that ethnic minorities are at elevated risk of contracting and dying from Covid-19 compared with their white counterparts is well established. But a new sweeping analysis in England shows that between the first and second waves of the pandemic in 2020, death rates in black communities improved, but continued to remain high in people from Bangladeshi and Pakistani backgrounds.
The analysis – which is yet to be peer-reviewed or published in a medical journal – suggests that while the public health messaging focused on ethnic minorities has had a beneficial impact on some communities, others need customised outreach, the authors said.
The study analysed data from the Office for National Statistics (ONS) and from GPs for roughly 29 million adults aged 30 to 100. The researchers examined differences in the risk of death between ethnic minorities and the white population in the first wave (January to August 2020) versus the second wave (September to December 2020).
Their findings took into account factors such as age, geography, socio-demographic characteristics (using 2011 census data), and pre-pandemic health conditions.
In the first wave, all ethnic minority groups had a higher risk than white people, but in the second wave the risk levels improved for black African and black Caribbean groups, while remaining substantially higher in people from a Bangladeshi background, and worsening in people from a Pakistani background, said study author Dr Nazrul Islam at Oxford University’s Nuffield Department of Population Health.
Overall, a slightly higher proportion of Covid-related death occurred among white British people in wave 2 (87.6%) compared with wave 1 (83.6%), while the proportion of death decreased from 1.44% in wave 1 to 0.35% in wave 2 among people from the black African community, and 2.4% to 0.89% among people with a black Caribbean background.
The numbers among the Bangladeshi community were roughly the same – 0.9% in wave 2 from 0.7% in wave 1 – but the Pakistani population saw a dramatic rise from 3.36% in wave 2 from 1.86% in wave 1.
Demographic, geographical and socioeconomic factors – how and where you work and live – in many ways determine your exposure to the virus. These factors tend not to favour some ethnic minorities, who also carry a greater risk of underlying conditions such as cardiovascular disease and diabetes. Another possibility under consideration is that people from ethnic minorities are more genetically susceptible to this virus.
Initially, some researchers thought the disproportionate risk of Covid-19 death in ethnic minorities was rooted in underlying health conditions or even genetic differences, said lead author Vahé Nafilyan, a statistician at ONS and researcher at the London School of Hygiene and Tropical Medicine. “But what this [analysis and other research] shows is that it is likely to be driven by infection – because of differences in exposure to the virus.”
People from Bangladeshi and Pakistani communities are more likely to live in deprived areas as part of large, multigenerational families – all of which are ingredients for a higher risk of virus exposure, the researchers noted. Adding further risk is that a high proportion of Pakistani and Bangladeshi men work as taxi drivers, shopkeepers and proprietors – more than people of any other ethnic background, they said.
While the study accounted for these socio-demographic factors – such as household composition and occupational exposure – the data used to glean this information comes from the 2011 census and is not necessarily reflective of the situation at the start of the pandemic, the authors cautioned.
Other explanations could be linked to linguistic/cultural barriers that thwart access to public health messaging, behavioural differences, and the relative prevalence of misinformation in different communities, the authors said, suggesting that the disparities are likely to arise from a combination of all of the above.
“I’m really concerned about these two communities … We can do much better,” said Islam. “We need to focus on customised ways of reaching these ethnic minority people.”