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 March 1 ,2020, with follow-up to April 17, 2022. Self-reported ethnic group was taken from the Census and Cox proportion hazard models estimated hazard ratios (HRs) for COVID-19 infections, 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- 3.06)) and Pakistani 2.09(1.90-2.29) groups compared with White Scottish. The risk of COVID-19 hospitalisation or death following confirmed infection 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) relative to White Scottish. However, COVID-19 related deaths following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared to fourth wave. Interpretation: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment are not substantially contributing 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 two 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

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Last updated: 03 May 2024
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