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Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study
OBJECTIVE: To describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers. SETTING: Five acute National Health Service Hospit...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813387/ https://www.ncbi.nlm.nih.gov/pubmed/33455936 http://dx.doi.org/10.1136/bmjopen-2020-042140 |
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author | Apea, Vanessa J Wan, Yize I Dhairyawan, Rageshri Puthucheary, Zudin A Pearse, Rupert M Orkin, Chloe M Prowle, John R |
author_facet | Apea, Vanessa J Wan, Yize I Dhairyawan, Rageshri Puthucheary, Zudin A Pearse, Rupert M Orkin, Chloe M Prowle, John R |
author_sort | Apea, Vanessa J |
collection | PubMed |
description | OBJECTIVE: To describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers. SETTING: Five acute National Health Service Hospitals in east London. DESIGN: Prospectively defined observational study using registry data. PARTICIPANTS: 1737 patients aged 16 years or over admitted to hospital with confirmed COVID-19 infection between 1 January and 13 May 2020. MAIN OUTCOME MEASURES: The primary outcome was 30-day mortality from time of first hospital admission with COVID-19 diagnosis during or prior to admission. Secondary outcomes were 90-day mortality, intensive care unit (ICU) admission, ICU and hospital length of stay and type and duration of organ support. Multivariable survival analyses were adjusted for potential confounders. RESULTS: 1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) black and 707 (40%) white backgrounds. Compared with white patients, those from minority ethnic backgrounds were younger, with differing comorbidity profiles and less frailty. Asian and black patients were more likely to be admitted to ICU and to receive invasive ventilation (OR 1.54, (95% CI 1.06 to 2.23); p=0.023 and OR 1.80 (95% CI 1.20 to 2.71); p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 (95% CI 1.19 to 1.86); p<0.001) and black (HR 1.30 (95% CI 1.02 to 1.65); p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk factor-adjusted analyses accounting for major comorbidities, obesity, smoking, frailty and ABO blood group. CONCLUSIONS: Patients from Asian and black backgrounds had higher mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. Higher rates of invasive ventilation indicate greater acute disease severity. Our analyses suggest that patients of Asian and black backgrounds suffered disproportionate rates of premature death from COVID-19. |
format | Online Article Text |
id | pubmed-7813387 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-78133872021-01-20 Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study Apea, Vanessa J Wan, Yize I Dhairyawan, Rageshri Puthucheary, Zudin A Pearse, Rupert M Orkin, Chloe M Prowle, John R BMJ Open Infectious Diseases OBJECTIVE: To describe outcomes within different ethnic groups of a cohort of hospitalised patients with confirmed COVID-19 infection. To quantify and describe the impact of a number of prognostic factors, including frailty and inflammatory markers. SETTING: Five acute National Health Service Hospitals in east London. DESIGN: Prospectively defined observational study using registry data. PARTICIPANTS: 1737 patients aged 16 years or over admitted to hospital with confirmed COVID-19 infection between 1 January and 13 May 2020. MAIN OUTCOME MEASURES: The primary outcome was 30-day mortality from time of first hospital admission with COVID-19 diagnosis during or prior to admission. Secondary outcomes were 90-day mortality, intensive care unit (ICU) admission, ICU and hospital length of stay and type and duration of organ support. Multivariable survival analyses were adjusted for potential confounders. RESULTS: 1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) black and 707 (40%) white backgrounds. Compared with white patients, those from minority ethnic backgrounds were younger, with differing comorbidity profiles and less frailty. Asian and black patients were more likely to be admitted to ICU and to receive invasive ventilation (OR 1.54, (95% CI 1.06 to 2.23); p=0.023 and OR 1.80 (95% CI 1.20 to 2.71); p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 (95% CI 1.19 to 1.86); p<0.001) and black (HR 1.30 (95% CI 1.02 to 1.65); p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk factor-adjusted analyses accounting for major comorbidities, obesity, smoking, frailty and ABO blood group. CONCLUSIONS: Patients from Asian and black backgrounds had higher mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. Higher rates of invasive ventilation indicate greater acute disease severity. Our analyses suggest that patients of Asian and black backgrounds suffered disproportionate rates of premature death from COVID-19. BMJ Publishing Group 2021-01-17 /pmc/articles/PMC7813387/ /pubmed/33455936 http://dx.doi.org/10.1136/bmjopen-2020-042140 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Infectious Diseases Apea, Vanessa J Wan, Yize I Dhairyawan, Rageshri Puthucheary, Zudin A Pearse, Rupert M Orkin, Chloe M Prowle, John R Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title | Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title_full | Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title_fullStr | Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title_full_unstemmed | Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title_short | Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study |
title_sort | ethnicity and outcomes in patients hospitalised with covid-19 infection in east london: an observational cohort study |
topic | Infectious Diseases |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813387/ https://www.ncbi.nlm.nih.gov/pubmed/33455936 http://dx.doi.org/10.1136/bmjopen-2020-042140 |
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