There have been disproportionate rates of premature death from Covid-19 among patients of Asian and black ethnicity, a large cohort study has found.

The research, published in the journal BMJ Open, is based on nearly 1,800 patients admitted to five acute hospitals within Barts Health NHS Trust between January 1 and May 13 2020.

The study found that patients from minority ethnic backgrounds were younger and less frail, compared with white patients.

It also showed that black patients were 1.8 times, and Asian patients 1.54 times, more likely to be admitted to an intensive care unit (ICU) and need mechanical ventilation.

Study author Dr Yize Wan, clinical lecturer at Queen Mary University of London and specialty registrar in intensive care medicine and anaesthesia at Barts Health NHS Trust, said: “Our study shows the disproportionate impact of Covid-19 on black and Asian groups in the first peak.

“Black and Asian people admitted to Barts Health hospitals with Covid-19 were significantly younger in age, had greater acute disease severity, and higher mortality relative to white patients of the same age and baseline health.

“As the impact of Covid-19 continues to be seen within our community, the importance of responding to the ethnic disparities unmasked during the Covid-19 pandemic is crucial to prevent entrenching and inflicting them on future generations.”

The clinicians looked at the data from 1,737 patients aged 16 and over who were admitted to hospital and had a confirmed Covid-19 diagnosis, 511 of whom died 30 days later.

The cohort comprised 538 (31%) Asian patients, 340 (20%) black patients, and 707 (40%) from white backgrounds.

Black and Asian ethnicity patients were significantly younger – with median ages of 64 and 59 respectively – compared with 73 in the white group, the researchers said.

In addition, both groups were found to be at 50%–80% increased risk of receiving mechanical ventilation in ICU, compared with white patients of a similar age.

After adjusting for factors such as age, sex, obesity, smoking and frailty, the researchers found that, compared with those from white backgrounds, Asian patients were 1.49 times, and black patients 1.3 times, more likely to die from Covid-19.

The experts said that while their study had a large number of patients, they were unable to get a more detailed ethnicity breakdown.

They said further research is needed to understand the reasons why those from Asian and black backgrounds have higher mortality from Covid-19 infection.

First author Dr Vanessa Apea, a consultant physician in sexual health and HIV at Barts Health NHS Trust and honorary senior lecturer at Queen Mary University of London, said: “Authentic community-based participatory research to understand the drivers of these differences, and co-creation of solutions are key to achieving health equity in these communities.”

More than 16% of people who had tested positive for coronavirus when they died were from black, Asian and minority ethnic (BAME) communities, new data shows.

On Monday, NHS England released data showing the ethnic breakdown of people who have died with coronavirus for the first time.

The figures, using data up to 5pm on April 17, reveal that of 13,918 patients in hospitals in England who had tested positive for Covid-19 at time of death, 73.6% were of white ethnicity, 16.2% were of BAME ethnicity and 0.7% had mixed ethnicity.

The remaining 9.5% had no stated or identifiable ethnicity.

The statistics come days after a review was announced to examine what appears to be a disproportionate number of BAME people who have been affected by Covid-19.

In the 2011 UK census around 7.5% of the population were Asian and 3.3% black.

Last week Downing Street confirmed the NHS and Public Health England will lead the review of evidence, following pressure on ministers to launch an investigation.

According to the new data, the 16.2% figure for BAME ethnicity breaks down as Indian 3.0%, Pakistani 2.1%, Bangladeshi 0.6%, any other Asian background 1.6%, Caribbean 2.9%, African 1.9%, any other black background 0.9%, Chinese 0.4% and any other ethnic group 2.8%.

Of the more than 60 NHS workers who have died with Covid-19, a significant proportion were from BAME backgrounds.

Discussing the review, Professor Chris Whitty, the chief medical officer for England, said ethnicity is “less clear” than three others factors in determining who is most at risk from coronavirus.

“This is something we are very keen to get extremely clear.

“We’ve asked Public Health England to look at this in some detail and then what we really want is, if we see any signal at all, we want to then know what next we can do about it to minimise risk.”

A London doctor working with Covid-19 patients said the virus has exposed health inequalities for minority communities.

Speaking to the PA news agency, Mohammed Abbas Khaki, 34, a GP with Barking, Havering and Redbridge University Hospitals NHS Trust, said: “Existing inequalities will be more greatly exposed at a time of crisis. For example, south Asians live in more deprived areas and have more diabetes, kidney and cardiovascular disease.

“Additionally, south Asian people often live in larger, multi-generational households, where social isolation may not be as easy.

“Many of these workers may also be in key worker jobs – combining their frontline roles with their living arrangements might be a reason that we are seeing so many of the BAME population in intensive care units.”

What are the basics? Well, over the last 2 decades much investment has been placed into dialogue and engagement projects, many of which have done some great work, though on a stop and start basis where groups have come in, organised sets of people together and then left, having ticked off a box. Or, depending on a specific theme, campaigns have been run which are based on shared experiences and shared interpretations of life experiences. So far so good, though have they made a real and long lasting difference to the integration of communities so that they feel a part of their local environment and communities?

Even after all of this investment, the pressures of austerity, global political instability, the rise of hatred and intolerance on social media and other factors have placed extreme pressures on communities in Europe and the UK. Add to this, the poison of Islamist extremism and their very adept social media tactics and the bully-boy anger and poisonous social media tactics of far right groups and it is easy to see why communities feel such pressure.

Any Integration strategy needs to reflect on life chances and opportunities and in giving young men and women hope for future employment. It needs to give women the options of having training, the chance to learn English, develop personal confidence and most of all, support perceptions that they have opportunities which can allow them to do something that builds a sense of self-worth in them, if they have not worked for years. Integration also means feeling part of a shared set of values, of belonging and of engagement with other communities and individuals at an equal level. Many of these things may seem aspirational, but they are the cornerstones of a holistic integration strategy, showing how complex and subtle this work is.

Then there are the more difficult elements of supporting institutional independence meaning that the use of public services come with them, a set of core values and ideals that need to be respected. If an institution believes that certain religious or cultural beliefs and practices may impinge on the rights of the user or on the rights of others, should they challenge them? More of these cases are coming to light and no doubt, there will be a greater frequency of such cases where schools may object to religious clothing. Such contentious issues are part of the Integration debate and no doubt, will elicit further responses. Within that public debate, there is no room for groups who attempt to bully and intimidate institutions. If we allow this to happen, we allow thuggery to become the norm and that must be resisted at all costs.

Lastly, we must always stress that integration is a process that can affect many communities. For example, is there a discussion to be had around the integration of some disaffected white men who feel that they have reduced life chances and who have not worked for many years? Such individuals may well feel marginalised and therefore, we need to get away from the immediacy of thinking that integration only affects migrant or Black and Minority Ethnic communities. It potentially affects all communities. 

So, as the Integration Strategy is in the process of being released, we hope that it covers a range of such issues and is not seen as a strategy just for specific communities. If it does that, it will be counter-productive.