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Ethnic minorities and COVID-19: Examining whether excess risk is mediated through deprivation.

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journal contribution
posted on 27.05.2021, 10:42 by Cameron Razieh, Francesco Zaccardi, Nazrul Islam, Clare L Gillies, Yogini Chudasama, Alex Rowlands, David E Kloecker, Melanie J Davies, Kamlesh Khunti, Thomas Yates


People from South Asian and black minority ethnic groups are disproportionately affected by the COVID-19 pandemic. It is unknown whether deprivation mediates this excess ethnic risk.


We used UK Biobank with linked COVID-19 outcomes occurring between 16th March 2020 and 24th August 2020. A four-way decomposition mediation analysis was used to model the extent to which the excess risk of testing positive, severe disease and mortality for COVID-19 in South Asian and black individuals, relative to white individuals, would be eliminated if levels of high material deprivation were reduced within the population.


15,044 (53.0% women) South Asian and black and 392,786 (55.2% women) white individuals were included. There were 151 (1.0%) positive tests, 91 (0.6%) severe cases and 31 (0.2%) deaths due to COVID-19 in South Asian and black individuals compared to 1,471 (0.4%), 895 (0.2%) and 313 (0.1%), respectively, in white individuals. Compared to white individuals, the relative risk of testing positive for COVID-19, developing severe disease and COVID-19 mortality in South Asian and black individuals were 2.73 (95% CI: 2.26, 3.19), 2.96 (2.31, 3.61) and 4.04 (2.54, 5.55), respectively. A hypothetical intervention moving the 25% most deprived in the population out of deprivation was modelled to eliminate between 40-50% of the excess risk of all COVID-19 outcomes in South Asian and black populations, whereas moving the 50% most deprived out of deprivation would eliminate over 80% of the excess risk of COVID-19 outcomes.


The excess risk of COVID-19 outcomes in South Asian and black communities could be substantially reduced with population level policies targeting material deprivation.


This work was supported by the National Institute of Health Research (NIHR) Leicester Biomedical Research Centre (BRC), NIHR Applied Research Collaboration-East Midlands (ARC-EM) and a grant from the UKRI-DHSC COVID-19 Rapid Response Rolling Call (MR/V020536/1)



European Journal of Public Health, ckab041,

Author affiliation

Diabetes Research Centre, College of Life Sciences


AM (Accepted Manuscript)

Published in

European Journal of Public Health


Oxford University Press (OUP)





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