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The Impact of COVID-19 on BAME communities in the UK

The COVID-19 pandemic has impacted on all communities across the United Kingdom. However, emerging data shows that the ethnic minority community (BAME) has been disproportionately affected by the virus.

BAME Hand

The BAME community make up around 14% of the UK population yet make up over 16% of deaths. Not much difference? Well consider the following headline statistics from a newly published report by Public Health England (PHE).

  • People of Bangladeshi ethnicity had around twice the risk of death as people of White British ethnicity.
  • People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British.
  • Comparing to previous years mortality was almost 4 times higher than expected among Black males for this period, almost 3 times higher in Asian males and almost 2 times higher in White males. There were similar disparities although at slightly lower levels among females, deaths.
  • A recent study undertaken by Kings College Hospital found that 31% of admissions to their hospital were from BAME communities.

Understanding why...

As the PHE report comments “There is unlikely to be a single explanation here and different factors may be more important for different groups.”

So, any assumption that the increased vulnerability of BAME communities to COVID-19 can somehow be tied to genetic factors is misleading.

The table below uses key vulnerability factors for the general population outlined in the PHE report and shows how these affect the BAME population in the UK.

Factors affecting vulnerability to COVID-19

Factors

General Population

BAME communities

Age

People who were 80 or older were seventy times more likely to die than those under 40.

BAME populations are relatively more youthful than their white British counterparts, so you would expect them to be less vulnerable.

Gender

Working age males diagnosed with COVID-19 were twice as likely to die as females and made up 71% of admissions.

Geography

People living in urban areas have increased odds of testing positive for COVID-19. Authorities, which are mostly urban, in London, the North West, the West Midlands and the North East had the highest rates.

95% of BAME communities live in urban area, concentrated in London, and the conurbations of West Midlands and the North-West.

Occupation

high increase in all cause deaths those in a range of caring occupations including social care and nursing auxiliaries and assistants; those who drive passengers in road vehicles those working as security guards; and those in care homes.

BAME communities work in occupations likely to bring them into contact with public Bangladeshi/Pakistani; 56%.

Black and Afro-Caribbean communities; 48%.

The combined Pakistani and Bangladeshi ethnic group had the lowest percentage of workers in 'professional' jobs; 18%.

18% of Black workers were in caring, leisure and other services’ jobs, the highest percentage out of all ethnic groups.

Deprivation

The mortality rates from COVID-19 in the most deprived areas were more than double the least deprived areas, for both males and females.

BAME communities are more likely to be found in deprived areas. 28% of Bangladeshis, 30% of Pakistanis and 20% of afro- Caribbean heritage live in deprived areas.

There is evidence showing that deprivation and ethnic background impact a person’s likelihood to access healthcare.

Co-Morbidities

(underlying health conditions)

A significant number of death certificates mention underlying causes (co-morbidities); diabetes, hypertensive diseases, chronic kidney disease, chronic obstructive pulmonary disease and dementia.

People of Bangladeshi and Pakistani background have higher rates of cardiovascular disease than people from White British ethnicity.

People of Black Caribbean and Black African ethnicity have higher rates of hypertension compared with other ethnic groups.

Data from the National Diabetes Audit suggests that type II diabetes prevalence is higher in people from BAME communities.

The most deprived people in the UK are over two and half times more likely to develop diabetes than the rest of the population.

Obesity

A study using data from over 400,000 patients aged 40 to 69 found that higher BMI was associated with a positive COVID-19 diagnosis.

74% Black adults overweight.

56% Asian adults overweight.

Government data.

Care Homes

There have been 2.3 times the number of deaths in care homes than expected between 20 March and 7 May when compared to previous years, which equates to around 20,457 excess deaths (46% COVID-19).

No reliable data on the % of care home residents from BAME background.

In addition, overcrowding reduces the ability to socially distance: Yet thirty per cent of the UK Bangladeshi population are considered to live in overcrowded housing compared with 2% among the white British population. Fifteen per cent of black African people also live in overcrowded conditions, as do 16% of Pakistanis.

Conclusions and additional thoughts

As the table shows, the BAME communities tick nearly all of the “vulnerability” boxes. As you consider this, what should become clear is that significant numbers of the BAME population live in deprived urban areas working in “high risk” (and relatively low paid ) occupations and is exacerbated by the increased tendency to develop underlying health conditions which significantly reduce their chances of survival.

Note: The well-publicised shortage of personal protective equipment for “front line” workers further increased the risk of contracting COVID-19.

Not surprising then that the BAME communities have been disproportionately affected.

But inequalities in health and wellbeing are not new. In 2007 a post note from the Parliamentary Office of Science and technology noted;

Black and minority ethnic (BME) groups generally have worse health than the overall population, although some BME groups fare much worse than others, and patterns vary from one health condition to the next. Evidence suggests that the poorer socio-economic position of BME groups is the main factor driving ethnic health inequalities.

Sadly, not enough seems to have been done to rectify the situation and as the PHE report notes:

The impact of COVID-19 has replicated existing health inequalities and, in some cases, has increased them.

  • The high death rates in black and Asian communities are a significant reversal of previous trends, because until the pandemic white Britons were the ethnic group most likely to die from any cause.
  • Death rates from COVID-19 were highest among people of Black and Asian ethnic groups. This is the opposite of what is seen in previous years, when the mortality rates were lower in Asian and Black ethnic groups than white ethnic groups.

A note on Type 2 Diabetes

Diabetes was more likely to be mentioned on the death certificate in more deprived areas. In the most deprived areas, 26% of COVID-19 deaths also mentioned diabetes. This is significantly higher than in the least deprived areas (16%). The proportion of COVID-19 deaths where diabetes is mentioned ranged from 18% in the White ethnic group, 43% in the Asian group to 45% in the Black group (PHE report).

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