Patients with non-White ethnicity and from poorer social classes are sicker at initial presentation to hospital with COVID-19 infection

Abstract

Objectives

During the COVID-19 pandemic, individuals from non-White and with poorer socio-economic status (SES) had higher rates of mortality than their counterparts. The hypothesis that these individuals had more severe respiratory failure at the time of first presentation to hospital was tested.

Study design

Observational cross-sectional study using routinely collected physiological measurements.

Methods

The study population consisted of all individuals admitted to Nottingham University Hospitals NHS Trust from 1 February 2020 and 31 December 2021. Severity of respiratory failure was measured by the oxygen saturation fraction ratio (SFR, oxygen%/inspired oxygen concentration%).

Results

Patients from the areas of highest quintiles of deprivation had an adjusted SFR of 12.6 (95 % confidence intervals [CI]: 7.4 to 17.8) units lower than patients from areas of the lowest deprivation. Patients from an Asian ethnic group has a lower SFR than those from a White ethnic group (−10.9 units; 95 % CI: −19.1 to −2.7). Sensitivity analysis adjusting for the measurement error of pulse oximetry by ethnicity increased this differential for Asian and Black ethnic groups.

Conclusions

These data suggest that individuals from both non-White ethnic groups and poorer SES are sicker at the time of presentation to hospital with COVID-19 infection. Public health strategies are required to understand these observations and counter them with appropriate interventions. These may vary from proximal factors such as enhanced access to healthcare to more distal ones including building trust in modern medical treatments. These data are from one centre and hence should be interpretated cautiously particular with generalisability to other healthcare settings.