How COVID-19 exacerbated health disparities for diverse ethnic groups in England and Wales

Each quarter, the HDR UK Impact Committee consider dozens of articles and select the most impactful examples, ranked against core pillars of the HDR UK ethos: research quality, team science, scale, open science, patient and public involvement, patient impact and diversity.

This case study comes from the CVD-COVID-UK/COVID-IMPACT Consortium, partially funded by The British Heart Foundation Data Science Centre, a partnership between HDR UK and the British Heart Foundation. The research is also part of the Data and Connectivity programme, a National Core Study led by HDR UK in partnership with the Office for National Statistics.

The challenge

Previous research has highlighted that diverse ethnic groups were disproportionately affected by the pandemic and the critical need to quantify these disparities, particularly for post-infection cardiovascular disease. While the increased COVID-19 mortality risk in groups like Asian, Black, and Mixed ethnic backgrounds in the UK was well-reported, data was lacking regarding ethnic disparities in post-COVID-19 cardiovascular disease outcomes despite prior findings indicating an association between COVID-19 and numerous cardiac complications.

The key issue the researchers aimed to solve was the unmet need for an appropriate assessment of COVID-19 outcomes in diverse communities, as prior studies often masked important heterogeneity by grouping ethnic sub-groups together.

The impact

By looking at severe outcomes following COVID-19 infection, specifically mortality and cardiovascular disease (CVD), in the population of England and Wales between January 2020 and April 2022, the study confirmed that pre-existing health inequities were significantly exacerbated by the pandemic.

Non-White populations were found to be disproportionately affected by these severe health consequences. The study identified specific sub-groups with consistently increased risks, such as Bangladeshi and Pakistani populations, who consistently emerged as presenting incremented cardiovascular disease rates compared to White British over time.

The paper fills a notable gap in the literature by comprehensively investigating post-COVID-19 CVD rates using highly granular ethnicity classifications, including over 19 distinct ethnic sub-groups in England. This novel evidence is vital for guiding healthcare providers and policy makers on where to focus efforts to address persistent health disparities through the use of highly specific classifications of self-identified ethnicity.

De-identified individual-level data was accessed via the BHF Data Science Centre’s CVD-COVID-UK/COVID-IMPACT Consortium, with sources including the NHS England Secure Data Environment (SDE) service for England and the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University covering the period from 23 January 2020 to 29 June 2022 with up to 19 NHS ethnicity classifications.

Dr Marta Pineda Moncusí, lead analyst said:

“These nation-wide studies are made possible through the advent of population-level data, high-performance compute and complex modelling tools including AI. And it underscores the importance of leveraging granular data to really understand the diverse health needs of different communities.”

 

Dr Sara Khalid, principal investigator, said:

“Health inequity is often underpinned by a complex interplay of factors. Underlying disparities were particularly exacerbated and highlighted during the COVID-19 pandemic, and these data from the national health records of millions of people in the UK indicate that certain diverse ethnic groups continued to face disproportionate cardiovascular complications after COVID-19 infection.”

What the impact committee said:

The study’s depth and granularity, combined with its commitment to equitability and participatory approaches (such as Patient and Public Involvement), is a breath of fresh air amongst COVID-19 related research. It is a great example of how context-driven health data research can improve health and well-being, while also promoting a more positive research culture.

The committee commends the researchers of the CVD-COVID-UK/COVID-IMPACT Consortium for delivering truly inspiring work that marks a crucial step toward achieving health equity.

Read the paper: ‘Ethnic disparities in COVID-19 mortality and cardiovascular disease in England and Wales between 2020-2022’

Read the news story