April 9, 2020

expert comments on BME groups and risk of hospitalisation with COVID-19

There have been questions from journalists about apparent differences in the proportion of people hospitalised with COVID-19 who are from BME groups when compared to the proportion of said groups in the general population.

Prof Duncan Young, Professor of Intensive Care Medicine, University of Oxford, said:

“In the UK (2011 census) about 7.5% of the population were Asian and 3.3% Black (https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/population-of-england-and-wales/latest). In the ICNARC report ethnicity was known in 1966 patients. Black patients were overrepresented in ICUs while Asian patient representation in ICUs appears so far to be in line with the demographics of the populations where they are based.

“There are reports from the USA about far more than expected Black patients being hospitalised for COVID-19.

“There is a possibility of a genetic cause for the disproportionate number of ICU admissions in Black patients. The larger than expected numbers of cases in Black patients may represent an effect of different social or cultural factors leading to more cases in these groups overall that is simply being reflected in ICU admissions. Alternatively it may be the burden of chronic conditions predisposing to severe COVID infections and hence ICU admission is higher in these ethnic groups. People of Afro-Caribbean descent have high risks of hypertension and type 2 diabetes (https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/african-caribbean-background-and-heart-health). Press reports from the USA suggest that the burden of co-morbidities accounts for the larger than expected number of cases in Black populations.”

Dr Riyaz Patel, Associate Professor of Cardiology, University College London, said:

“The observational data so far do seem to suggest that Black and Asian patients are at greater risk of more severe illness from COVID19.

“As others have suggested, this could be because of socioeconomic factors, with BME patients more likely to live in densely populated areas, multi-generational families in the same household and having more public facing jobs, all of which makes the likelihood and duration of exposure to the virus more likely.

“Another explanation is that the virus has so far hit densely populated areas like London first, where BME populations are high.  Most of the data from the ITUs so far comes from big London centres. As such, as time goes on we may see a levelling off of the racial disparity as the rest of the country is affected.

“Nonetheless, there could be biological reasons for the difference which we can speculate on.  One thing very visible to us in London ITUs now is how diabetes, high blood pressure and possibly being a little overweight, seem to be such potent risk factors for having a severe lung illness, perhaps even more so than having an existing lung disease which you would think would be a greater risk.  All of these risk factors are more common in Black and Asian patients, so there could be a link here which needs further exploration.”

Prof Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine, University of Leicester, said:

“Data from UK and US has recently shown that Black Minority Ethnic Groups are more likely to have a severe disease form of COVID-19 requiring admission to intensive care unit. The exact reasons for this are not know but may be due to a number of reasons including higher prevalence of diseases that have been shown to have worse outcomes in people with COVID-19 including cardiovascular disease, hypertension and diabetes. There may also be socio-economic reasons in view of BME populations living in more deprived areas and also cultural reasons including BME populations living with extended families which may make it difficult to socially distance and self isolate.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, Said:

“South Asians are at elevated diabetes and heart disease risks so they may have lower capacity to buffer against the harmful effects of COVID-19 on the hearts and lungs and the metabolic harms of the infections. They may also be a heightened risk of infection in the first place due to harder to socially distance given their home environments and great likelihoods of over-crowding.  Whether there are additional genetic reasons that lead to a great immune response, requires to be investigated.” 

 Prof Nishi Chaturvedi, Director, MRC Unit for Lifelong Health and Ageing, UCL, said:

“Risks of diabetes, and of stroke, are several fold higher in people of South Asian and of African Caribbean descent.  In addition, South Asian people are also at risk of heart disease.  All these conditions occur at a much younger age in these ethnic minority groups than in the general white European population.  The explanations for these excess risks are not clear.  There have been many efforts to find a genetic explanation, but so far, nothing convincing has been reported.  Note that both ethnic minority groups, at least in the age group at risk, are generally less likely to smoke than white Europeans (the key exception is Bangaldeshi men).

“Socioeconomic factors are likely to play a strong role. It’s worth noting that ethnic minority groups are much more likely to live in densely populated cities, where risks of transmission are high, and ability to properly social distance are relatively low.”

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

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