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The impact of ethnicity on clinical outcomes in COVID-19: A systematic review

journal contribution
posted on 2020-05-27, 16:01 authored by Manish Pareek

Background The relationship between ethnicity and COVID-19 is uncertain. We performed a systematic review to assess whether ethnicity has been reported in patients with COVID-19 and its relation to clinical outcomes.


We searched EMBASE, MEDLINE, Cochrane Library and PROSPERO for English-language citations on ethnicity and COVID-19 (1st December 2019-15th May 2020). We also reviewed: COVID-19 articles in NEJM, Lancet, BMJ, JAMA, clinical trial protocols, grey literature, surveillance data and preprint articles on COVID-19 in MedRvix to evaluate if the association between ethnicity and clinical outcomes were reported and what they showed. PROSPERO:180654.


Of 207 articles in the database search, five reported ethnicity; two reported no association between ethnicity and mortality. Of 690 articles identified from medical journals, 12 reported ethnicity; three reported no association between ethnicity and mortality. Of 209 preprints, 34 reported ethnicity – 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported adverse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups.


Data on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggests BAME individuals are at an increased risk of acquiring SARS-CoV-2 infection and also adverse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance.




DP and SS are supported by NIHR Academic Clinical Fellowships. MP is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr Manish Pareek, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. JSM is supported by a NIHR Clinical Lectureship. LBN is supported by the Academy of Medical Sciences and the MRC/AHRC/ESRC. KK, MP, IBS acknowledge the NIHR Applied Research Collaborations – East Midlands, the NIHR Leicester Biomedical Research Centre and the Centre for Black Minority Ethnic Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.



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