Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis





  






  






  






  






  






  






  






  






  






  






  






  






  Mesh:NoExp] OR pneumonia virus*[tiab] OR cov[tiab]) AND (outbreak[tiab] OR wuhan[tiab] OR novel[all] OR 19[tiab] OR 2019[tiab] OR epidem*[tiab] OR epidemy[all] OR epidemic*[all] OR pandem*[all] OR new[tiab])) OR coronavirus*[tiab] OR corona virus*[tiab] OR ncov[tiab] OR 2019ncov[tiab] OR covid19[tiab] OR "covid 19"[tiab] OR "sars cov 2"[tiab] OR sars2[tiab] OR "ncov 2019"[tiab] OR "sars coronavirus 2"[tiab] OR "sars corona virus 2"[tiab] OR "severe acute respiratory syndrome cov 2"[tiab] OR "severe acute respiratory syndrome cov2"[tiab] OR severe acute respiratory syndrome cov*[tiab] OR cov2[tiab]) AND ("2019/12"[Date -Entrez] : "3000"[Date -Entrez])Age, sex, BMI, smoking status, and comorbidities BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) 


	Supplemental material Supplemental material		BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance placed on this supplemental material which has been supplied by the author(s) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance BMJ Global Health placed on this supplemental material which has been supplied by the author(s)	BMJ Global Health BMJ Global Health
	Van Gerwen, M.	Severe disease	United States (NA)	Non-Hispanic White	Non-Hispanic Black	Other	Unknown				Ref.	1.31 1.77) (0.97-	1.52 1.98) (1.16-	1.53 2.55) (0.92-	Age, sex, BMI, smoking status, and comorbidities
	Appendix: Search strategy PubMed ("COVID-19"[Supplementary Concept] OR "severe acute respiratory syndrome coronavirus 2"[Supplementary Concept] OR (("Coronavirus"[MeSH Terms] OR "Coronavirus 1. Infection Test positive Test negative 2. Hospitalization Hospitalized Not hospitalized 3. Severe symptoms Severe symptoms Non-severe symptoms 4. ICU admission Admitted to ICU Not admitted to ICU 5. Death Death Alive Outcome Country Group 1 Group 2 Group 3 Group 4 Group 5 Group 6 Group 7 Group 8 group 1 OR Severe disease United States (NA) Non-Hispanic White Non-Hispanic Black Hispanics Other Ref. Infection United States (NA) Non-black Black Ref. United ICU States White Latinx Asian Black Other Ref. admission (NA) Infection United States (NA) Non Hispanic White Non Hispanic Black Non Hispanic Asian Non Hispanic Mixed/Other Hispanic Ref. United ICU States White Black Other Unknown Ref. admission (NA) Infection United States (NA) White Black Other Unknown Ref. ICU admission United States (NA) Non Hispanic White Non Hispanic Black Hispanic Non Hispanic Unknown Ref. Other Martin, C. A. Infection Author Mendy, A. Adegunsoye, A. Costa Monteiro, A. C. Dublin, S. Gu, T. Gu, T. Kim, L. United Kingdom (EU) White Caucasian South Asian Black Ref. Niedzwiedz, C. L. Infection United Kingdom (EU) White British White Irish White Other Mixed South Asian Black Chinese Other Ref. De Lusignan, S. Infection United Kingdom (EU) White Asian Black Mixed, other Ref. McCarty, T. R. ICU admission United States (NA) White Black Latinx Ref. Adegunsoye, A. Death United States (NA) Non-Black Black Ref. Golestaneh, L. Death United States (NA) Non-hispanic White Non-Hispanic Black Hispanic Other Ref. Kim, L. Death United States (NA) Non-Hispanic White Non-Hispanic Black Hispanic Non Hispanic Other Unknown Ref. Infections"[Embase Ovid 1 exp Coronavirus/ 2 exp Coronavirus Infections/ 3 (coronavirus* or corona virus* or OC43 or NL63 or 229E or HKU1 or HCoV* or ncov* or covid* General population Confirmed COVID-19 cases Hospitalised COVID-19 cases Hospitalised COVID-19 cases Hospitalised COVID-19 OR group 2 OR group 3 OR group 4 group 5 OR 3.15 (1.71-5.79) 2.78 (1.29-Not estimated 5.96) 3.30 (2.75-2.63 5.44 5.19 2.98 (0.63-(0.62-(0.81-(0.46-11.03) 47.71) 33.44). 19.26) 3.97) 4.03 (3.19-5.11) 2.23 (1.71-2.90) 0.90 (0.58-1.40) 2.67 (2.05-1.15 0.86 0.60 (0.73-(0.42-(0.18-1.82) 1.78) 2.04) 3.47) 3.56 (2.90-4.37) 1.57 (1.19-2.06) 0.78 (0.51-1.01 0.96 1.06 0.93 (0.89-(0.76-(0.83-(0.74,-1.15) 1.21) 1.37) 1.15) 1.20) 2.44 (2.01-2.97) 2.56 (1.71-3.84) 1.132 (0.851-1.507) 1.020 (0.718-1.449) 0.896 (0.479-1.675) 1.279 (0.908-1.802) 1.46 (0.94-2.29) 4.75 (2.65-8.51) 1.71 (0.97-3.01) 0.77 (0.39-1.53) 1.50 (0.89-2.52) 0.68 (0.14-3.18) 1.2 (0.7-2.0) 1.0 (0.6-1.7) 1.3 (0.7-2.2) 1.07 (0.85-1.35) 1.17 (0.91-1.51) 1.26 (0.86-1.82) 1.30 (0.74-2.31) or sars-cov* or sarscov* or Sars-coronavirus* or Severe Acute Respiratory Syndrome Coronavirus*).mp. cases Rozenfeld, Y. Infection United States (NA) White American Indian/ Alaska Native Asian Black/African American Native Hawaiian /Pacific Unknown Ref. 0.63 (0.36-1.12) 1.43 (1.18-1.72) 1.51 (1.25-1.83) 1.02 (0.66-1.57) United 0.39 0.55 McCarty, T. Death States White Black Latinx Ref. (0.13-(0.23-R. (NA) 1.12) 1.29) Islander Adegunsoye, A. Hospita-lization United States (NA) Non-black Black Ref. 3.77 (2.38-McPadden, J. Death United States (NA) Unknown 1.22 1.34 1.18 1.76 Black/African Hispanic White Asian Ref. (0.64-(0.75-(0.65-(0.54--American 2.36) 2.37) 2.14) 5.18) 5.99) Dublin, S. Hospita-lization United States (NA) Non Hispanic White Non Hispanic Black Non Hispanic Asian Non Hispanic Mixed/Other Hispanic Ref. 1.20 (0.68-2.12) 0.94 (0.54-1.63) 0.42 (0.11-1.62) 1.07 (0.49-Mikami, T. Death United States (NA) White African American Asian Others Ref. 0.78 (0.65-0.95) 0.94 (0.83-1.08) 1.00 (0.83-1.19) 2.36) Gu, T. Hospita-lization United States (NA) White Black Other Unknown Ref. 1.72 (1.15-2.58) 1.42 (0.79-2.54) 0.72 (0.28-Musoke, N. Death United States (NA) 1.20 0.75 1.31 African Caucasian Hispanic Other Ref. (0.38-(0.22-(0.52-American 3.77) 2.52) 3.32) 1.84) Ingraham, N. E. Hospita-lization United States (NA) White Black Asian Hispanic Declined Other Ref. 1.50 (1.15-1.94) 2.39 (1.74-3.29) 3.80 (2.72-5.30) 1.82 (1.16-2.87) Peterson, E. Death United States (NA) 1.157 0.992 African Caucasian Others Ref. (0.385-(0.492-American 3.482) 1.997) Killerby, M. E. Hospita-lization United States White Black Other Missing Ref. 3.2 (1.8-5.8) Not reported Not reported Price-Haywood, E. G. Death United States (NA) White Non-Hispanic 1.14 Black Non-Ref. (0.88-Hispanic 1.49) (NA) McPadden, J. Hospita-lization United States (NA) Unknown Asian Black Hawaiian/ Pacific Islander Hispanic White American Indian Ref. 1.58 (1.02-2.41) 1.43 (1.14-1.78) 1.45 (0.53-3.52) 1.81 (1.50-2.18) Van Gerwen, M. Death United States (NA) Non-hispanic White 0.96 0.98 1.00 Non-Hispanic Other Unknown Ref. (0.72-(0.76-(0.56-Black 1.28) 1.27) 1.66)	OR group 6 1.289 (0.978-1.699) 1.34 (1.18-1.52) 2.04 (1.04-4.00) 0.85 (0.70-1.03)	OR group 7 2.373 (1.326-4.246) 0.44 (0.02-2.68)	OR group 8 1.119 (0.735-1.702)	Adjustment factors Age, sex, smoking status Age, sex, zip code Age, sex, smoking status, comorbidities Age, sex, comorbidities, BMI, smoking status, medications Age, sex, comorbidities, neighborhood SES Age, sex, comorbidities, neigborhood SES Age, sex, smoking status, obesity, comorbidities Age, sex, EWS at presentation, decile of IMD, estimated household size and comorbidities Age, sex, assessment centre, country of birth, education level, household size, socioeconomic deprivation, housing tenure, urbanicity, employment status, manual occupation, healthcare worker, longstanding illness/disability, number of chronic conditions, self-rated health, body mass index, smoking status, alcohol consumption Age, sex, socioeconomic deprivation level, household size, rural/urban, smoking status, BMI, comorbidities Age, sex, obesity, comorbidities Age, sex, zip code Age, sex, comorbidities, smoking, obesity, SES, household size, % black residents, >60% residents using public transportation regularly Age, sex, smoking status, obesity, comorbidities Age, sex, region, education, religion, marital status, language, BMI, comorbidities, primary care type, symptoms Age, sex, obesity, comorbidities Age, sex, zip code Age, sex, comorbidities Age, sex, comorbidities, BMI, smoking status, medications Age, sex, smoking status, comorbidities, clinical parameters (e.g. resp. rate, eGFR, labs) Age, sex, comorbidities, neighborhood SES Age, sex, BMI, comorbidities, therapeutic antigoagulation Age, sex, comorbidities, area deprivation, rural/urban, marital status, English speaking Age, sex, BMI, comorbidities Age, sex, obesity, smoking status, insurance status, comorbidities Age, sex, charlson comorb index, residence in low income area, obsesity Age, sex, comorbidities
	Petrilli, C. M.	Hospita-lization	United States (NA)	Non-Hispanic white	Non-Hispanic African-American	Asian	Hispanic	Other/ multiracial	Unknown	Ref.	0.81 (0.65-1.01)	1.29 (0.97-1.72)	1.63 (1.35-1.97)	1.6 (1.21-2.11)	0.89 1.23) (0.65-	Age, sex, smoking status, BMI, comorbidities, week of admission
	Price-Haywood, E. G. Van Gerwen, M. Mendy, A. McCarty, T. R.	Hospita-lization Hospita-lization 8 9 Hospita-lization Severe disease	United States (NA) coronavirus* or corona virus or Pandemi*2)) or ((covid or covid19 or covid-19) and White Non-Hispanic Black Non-Ref. Hispanic United States (NA) Non-Hispanic White Non-Hispanic Other Unknown Ref. Black pandemic*2) or (coronavirus* and pneumonia)).mp. (coronavirus disease 2019 or severe acute respiratory syndrome coronavirus 2).sh,dj. or United States (NA) Non-Hispanic White Non-Hispanic Hispanics Other Ref. Black (630575119 OR 630830186 OR 630941329 OR 631043694 OR 631260659 OR 631272428 OR 1.96 (1.62-2.37) 1.08 (0.86-1.35) 2.23 (1.41-3.53) 631272880 OR 631286076 OR 631290163 OR 631308782 OR 631324397 OR 631352500 OR 631416440 OR 631431802 OR 631452886 OR 631456079 OR 631457551 OR 631462438 OR United 0.89 (NA) 1.79) States White Black Latinx Ref. (0.45-	1.51 (1.24-1.85) 1.91 (1.11-3.29) 1.34 2.28) (0.79-	0.89 (0.61-1.29) 0.59 (0.29-1.18)	Fully adjusted models are adjusted for: age, sex, charlson comorb index, residence in low income area, obsesity (and insurance in case of the hospitalization model) Age, sex, BMI, smoking status, and comorbidities Age, sex, smoking status Age, sex, obesity, comorbidities
			631462876 OR 631465538 OR 631465685 OR 631469310 OR 2004499662 OR 2004505338 OR		
			2005280837 OR 2005387675 OR 2005408544 OR 2005484987 OR 2005549151).an. [Articles not	
			captured by this search when created in April 2020, pending further indexing by NLM/Elsevier]		
		10	(or/6-9) and 20191201:20301231.(dc). [Lines 5 to 8 are specific to Covid-19]						
		11	5 or 10													
																	, et al. Agyemang C , et al. Agyemang C	BMJ Global Health BMJ Global Health	2021; 2021;	:e007433. 6 :e007433. 6	doi: 10.1136/bmjgh-2021-007433 doi: 10.1136/bmjgh-2021-007433
							, et al. Agyemang C , et al. Agyemang C	BMJ Global Health BMJ Global Health	2021; 2021;	:e007433. 6 :e007433. 6	doi: 10.1136/bmjgh-2021-007433

4 (or/1-3) and 20190101:20301231.(dc). [this set is the sensitive/broad part of the search] 5 4 not (SARS or SARS-CoV or MERS or MERS-CoV or Middle East respiratory syndrome or camel* or dromedar* or equine or coronary or coronal or covidence* or covidien or influenza virus or HIV or bovine or calves or TGEV or feline or porcine or BCoV or PED or PEDV or PDCoV or FIPV or FCoV or SADS-CoV or canine or CCov or zoonotic or avian influenza or H1N1 or H5N1 or H5N6 or IBV or murine corona*).mp. [line 5 removes noise in the search results] 6 ((pneumonia or covid* or coronavirus* or corona virus* or ncov* or 2019-ncov or sars*).mp. or exp pneumonia/) and Wuhan.mp. 7 (coronavirus disease 2019 or 2019-ncov or ncov19 or ncov-19 or 2019-novel CoV or severe acute respiratory syndrome coronavirus 2 or sars-cov2 or sars-cov-2 or sarscov2 or sarscov-2 or Sars-coronavirus2 or Sars-coronavirus-2 or SARS-like coronavirus* or coronavirus-19 or covid19 or covid-19 or covid 2019 or ((novel or new or nouveau) adj2 (CoV or nCoV or covid BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health doi: 10.1136/bmjgh-2021-007433
Charles Agyemang, Anke Richters, Shahab Jolani, Stevie Hendriks, Saurabh Zalpuri, Evan Yu, Bart Pijls, Maria Prins, Karien Stronks, Maurice P Zeegers
Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis