“The extent to which known or unknown factors contribute to the greater COVID-19 burden or severity among BAME people is not known.” Covid-19 and ethnicity

A collaboration between researchers at the Universities of Aberdeen, Cambridge and Leicester, UK and Emory University in the USA, looks in detail at the inclusion and recording of ethnicity in research studies.

Published in The Lancet it can be accessed here: COVID-19 and ethnicity: who will research results apply to?

Covid Severity and Deaths

Global evidence shows that Covid-19 is more likely to be severe in people who are older, in men, people who are obese, poorer and those who have more than one underlying condition.

Early data also suggested that people of BAME (Black, Asian and Minority Ethinic) groups in the UK and Black, Hispanic and Native American groups in the US are disproportionately affected by severe Covid-19 complications and death.

In the UK 33% of patients critically ill with confirmed Covid-19 in intensive care came from BAME groups despite comprising around 13% of the UK population.

The picture is similar within NHS staff, where 21% of staff are from BAME backgrounds but account for 63% of Covid-19 related deaths.

The information in Scotland in official figures is very limited:

“An initial analysis of the ethnicity of COVID-19 patients in hospital and seriously ill has been carried out. While the proportion of ethnic minority patients among those seriously ill with COVID-19 appears no higher than the proportion in the Scottish population generally, numbers are currently very low and the analysis will be improved and updated as more data becomes available.” Public Health Scotland Covid19 Statistical Report As At 18th May 2020

BAME groups under-represented

The paper highlights previous studies that show BAME individuals are under-represented in research.

For example, in the UK, type 2 diabetes is disproportionately prevalent in South Asians who also have poorer long-term outcomes but in a review of 12 trials, the mean South Asian involvement was 5.5% despite South Asians representing 11.2% of the UK type 2 diabetes population. Four of the 12 studies didn’t even report ethnicity. Similar disparities were found in US studies.

Societal factors including language difficulties, lack of research awareness or mistrust of research, stigma, cultural values and beliefs about research, poor engagement from researchers and general inaccessibility to research in deprived areas are all possible barriers to participation.  There is little tailoring of recruitment approaches by researchers to support BAME involvement.

The paper concludes by highlighting best practice tool kits that are available to researchers to enable them to engage, inform and recruit BAME participants to research.

Professor Shaun Treweek from the Health Services Research Unit at the University of Aberdeen said:

“Covid-19 is shining a spotlight on a problem that has been with us for a long time.

“Results from Covid-19 research must apply to everyone in the community who will be a candidate for treatment or prevention, and people of BAME groups – often overrepresented in the toll of the disease –should be an integral part of that effort.

“Omission has consequences: people could miss out on important benefits, or not be spared harms, if research fails to engage all those who could benefit: there is no guarantee that results will apply to populations not included in the research.

“For BAME involvement in research to improve, thinking about participants’ ethnicity when designing and reporting research needs to become as routine as thinking about their age and sex.

“Researchers, research funders, public health and policy agencies all have a duty to ensure that concerted action is taken for research studies to serve and represent the whole community not just part of it.”

Professor Khunti, who is a Professor in Primary Care Diabetes and Vascular Medicine at the University of Leicester and leads the Centre for BME Health,  first highlighted the issue regarding the disproportionate impact of Covid-19 on BAME populations in the UK.

He said:

“The findings from this paper not only support previous studies but also heighten the need for urgent action to address this underrepresentation of BAME people in research.

 “To achieve this, researchers need to breakdown the barriers to make it easier for people from BAME backgrounds to access research.”