COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills.

Soltan, Marina A, Varney, Justin, Sutton, Benjamin, Melville, Colin R, Lugg, Sebastian T, Parekh, Dhruv, Carroll, Will, Dosanjh, Davinder P and Thickett, David R (2021) COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills. BMJ open respiratory research, 8 (1). ISSN 2052-4439.

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Abstract

BACKGROUND

Ethnic minorities account for 34% of critically ill patients with COVID-19 despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand deterioration risk factors to inform clinical risk tool development.

METHODS

Multicentre cohort study of hospitalised patients with COVID-19 (n=3671) exploring determinants of health, including Index of Multiple Deprivation (IMD) subdomains, as risk factors for presentation, deterioration and mortality by ethnicity. Receiver operator characteristics were plotted for CURB65 and ISARIC4C by ethnicity and area under the curve (AUC) calculated.

RESULTS

Ethnic minorities were hospitalised with higher Charlson Comorbidity Scores than age, sex and deprivation matched controls and from the most deprived quintile of at least one IMD subdomain: indoor living environment (LE), outdoor LE, adult skills, wider barriers to housing and services. Admission from the most deprived quintile of these deprivation forms was associated with multilobar pneumonia on presentation and ICU admission. AUC did not exceed 0.7 for CURB65 or ISARIC4C among any ethnicity except ISARIC4C among Indian patients (0.83, 95% CI 0.73 to 0.93). Ethnic minorities presenting with pneumonia and low CURB65 (0-1) had higher mortality than White patients (22.6% vs 9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004).

CONCLUSIONS

Ethnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities.

Item Type: Article
Subjects: W Public health. Health statistics. Occupational health. Health education
WA Patients. Primary care. Medical profession. Forensic medicine
WF Respiratory system. Respiratory medicine
WU Dentistry. Oral surgery
Divisions: Emergency Services > Acute Medicine and AMU
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 26 Aug 2021 13:25
Last Modified: 26 Aug 2021 13:25
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4584

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