Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis

OBJECTIVES: This article evaluates if ethnicity is an independent poor prognostic factor in COVID-19 disease. METHODS: MEDLINE, EMBASE, Cochrane, WHO COVID-19 databases from inception to 15/06/2020 and medRxiv. No language restriction. Newcastle-Ottawa Scale (NOS) and GRADE framework were utilised to assess the risk of bias and certainty of evidence. PROSPERO CRD42020188421. RESULTS: Seventy-two articles (59 cohort studies with 17,950,989 participants, 13 ecological studies; 54 US-based, 15 UK-based; 41 peer-reviewed) were included for systematic review and 45 for meta-analyses. Risk of bias was low: median NOS 7 of 9 (interquartile range 6–8). Compared to White ethnicity, unadjusted all-cause mortality was similar in Black (RR: 0.96 [95% CI: 0.83–1.08]) and Asian (RR: 0.99 [0.85–1.16]) but reduced in Hispanic ethnicity (RR: 0.69 [0.57–0.84]). Age- and sex-adjusted risks were significantly elevated for Black (HR: 1.38 [1.09–1.75]) and Asian (HR: 1.42 [1.15–1.75]), but not for Hispanic (RR: 1.14 [0.93–1.40]). Further adjusting for comorbidities attenuated these associations to non-significance: Black (HR: 0.95 [0.72–1.25]); Asian (HR: 1.17 [0.84–1.63]); Hispanic (HR: 0.94 [0.63–1.44]). Subgroup analyses showed a trend towards greater disparity in outcomes for UK ethnic minorities, especially hospitalisation risk. CONCLUSIONS: This review could not confirm a certain ethnicity as an independent poor prognostic factor for COVID-19. Racial disparities in COVID-19 outcomes may be partially attributed to higher comorbidity rates in certain ethnicity. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40615-020-00921-5.