Data from the United Kingdom confirm that males, older people, and those with underlying health conditions have a higher risk of COVID-19 death. They also indicate that black, Asian, and ethnic minority individuals also face a heightened risk not entirely explained by preexisting health factors.

In working to find the best strategies to curb the COVID-19 pandemic, researchers have been asking a key question for prevention: Who is most at risk of severe outcomes if they develop COVID-19?

Existing evidence has suggested that the people most likely to face a higher risk of COVID-19 death are older males (over 50 years), especially if they have a chronic underlying health condition, such as cardiovascular problems or diabetes.

Yet there is some indication that there may be another significant risk factor for severe COVID-19 outcomes, namely, a person’s race, and their ethnicity.

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For example, data from the United Kingdom’s Office for National Statistics (ONS) have shown that black males are 4.2 times more likely than white males to die with COVID-19.

Also, according to the ONS, black females are 4.3 times more likely than white females to die from COVID-19-related causes.

But why this may be remains unclear, which has prompted researchers to call for urgent in-depth investigations into how COVID-19 impacts people from black, Asian, and minority ethnic (BAME) groups.

Now, a team of researchers from the OpenSAFELY Collaborative — an initiative from the University of Oxford and the London School of Hygiene & Tropical Medicine, in collaboration with other U.K. institutions — has set out to pinpoint more potential major risk factors for COVID-19 deaths.

‘Very concerning’ findings

The investigators weighed the data of 17,425,445 adults who had registered with a general practitioner in the U.K. for at least 1 year.

They searched for people who had been hospitalized with COVID-19 between February 1 and April 21, 2020. Then, they linked these data with other patient information processed through OpenSAFELY, a platform that anonymizes patient information in primary care records.

The researchers report their findings online, in preprint form, prior to the peer review process.

From the total number of patients treated for COVID-19 in hospital, 5,683 died of reasons related to this respiratory disease.

According to the team’s analysis, males, as well as older individuals, people with uncontrolled diabetes, and those with severe forms of asthma face a higher risk of COVID-19 death than the general population, confirming previous findings.

Yet another important finding of the analysis was that Asian and black people seemed to have a higher risk of COVID-19 death when the team compared them with white people.

When looking at the available information more closely, the researchers found that the higher risk is, for the most part, independent of possible confounding factors, such as preexisting cardiovascular disease or diabetes.

The investigators also observed that individuals from poorer socioeconomic backgrounds also faced a higher risk of death due to COVID-19 than the rest of the population. As with ethnicity, deprivation seemed to link to severe outcomes quite independently of other confounding risk factors.

These observations led the team to conclude that both deprivation and belonging to a BAME group may be major risk factors for COVID-19 death.

“We need highly accurate data on which patients are most at risk in order to manage the pandemic and improve patient care,” explains co-lead author Prof. Liam Smeeth from the London School of Hygiene & Tropical Medicine.

“The answers provided by this OpenSAFELY analysis are of crucial importance to countries around the world. For example, it is very concerning to see that the higher risks faced by people from [BAME] backgrounds are not attributable to identifiable underlying health conditions.”

– Prof. Liam Smeeth

The researchers advise that it is necessary to find out exactly what makes people from BAME groups more at risk of severe COVID-19 outcomes.

At present, other analyses using the OpenSAFELY platform are looking at additional questions of interest in the fight against COVID-19, including the potential effects of common medication on the risk of developing this respiratory disease.

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