Background This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland.
Methods We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals≥16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time.
Findings Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81–3.58), Pakistani 1.75 (1.59–1.73) and African 1.61 (1.28–2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave.
Interpretation Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.
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Amele, S., Kibuchi, E., McCabe, R., Pearce, A., Henery, P., Hainey, K., Fagbamigbe, A., Kurdi, A., McCowan, C., Simpson, C., Dibben, C., Buchanan, D., Demou, E., Almaghrabi, F., Anghelescu, G., Taylor, H., Tibble, H., Rudan, I., Nazroo, J., Bécares, L., Daines, L., Irizar, P., Jayacodi, S., Pattaro, S., Sheikh, A. & Katikireddi, S. 2023, 'Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths: analysis of 2 years of a record linked national cohort study in Scotland', Journal of Epidemiology and Community Health. http://dx.doi.org/10.1136/jech-2023-220501