BLOG: Understanding high prevalence and mortality rates of Covid-19 in UK South Asians

A blog post written by Dr Dev Acharya and Dr Karan Jutlla

Epidemiological data shows that Covid-19 has disproportionately affected Black, Asian, and minority ethnic (BAME) population in the UK.^{1, 2} In the UK, around 14 per cent of the population are made up of BAME community but they constitute a third of Covid-19 patients admitted to critical care. BAME patients admitted to hospital with coronavirus are on average ten years younger than patients of White ethnicity.³ In particular, South Asians make more than 5 per cent of the total UK population, ⁴ but a high proportion of Covid-19 deaths have been reported among these communities. For example, over three times increased risk of Covid-19 deaths have been reported for Pakistani (3.29) and two times for Bangladeshi communities (2.41). ² In response, The UK Government has announced that there will be a review to analyse the impact of Covid-19 on minority ethnic health including those from deprived communities.

Covid-19 exposure and health outcomes can be linked to various socio-economic and cultural factors such as loss of employment, working in health sector (e.g. doctors, care workers), physical inactivity due to lockdown, lack of proper health information, genetic factors, cultural diet or social inequality.⁵ South Asians have a different culture practices including family structures such as living in a larger households. More than ninety percent of South Asians in the UK reside in urban areas; Pakistani (99.1 per cent), Bangladeshi (98.7 per cent) and Indians (97.3 per cent).⁶ People living in urban areas are more prone to the virus infection; they come in contact with other people more frequently. There might be other unknown factors linked to social contact and cultural interactions that may be contributing to high prevalence and mortality related to Covid-19. Exploring these factors can provide more understanding of the risks and approaches to develop prevention programmes.

Covid-19 deaths have mostly occurred in people who have pre-existing medical conditions such as heart disease, hypertensions, diabetes or those who are very obese (BMI≥40).⁷ South Asians have high prevalence of obesity, more prone to higher risk of diabetes and have a greater mortality rate from coronary heart disease.⁸ Traditional foods, which are high in sugar and fat, is common among South Asian communities. Lack of physical activity, biological susceptibilities and other lifestyle behaviours might be the contributing factors of diabetes which is related to Covid-19 illness and death. These issue needs to be explored further.

Accessing high quality healthcare is difficult in ethnic minorities groups which is compounded by deprivation and social exclusion. South Asians in the UK has some of the highest level of deprivation.⁹ Some International migrants group have avoided NHS services due to the fear of current NHS charging regime, although they are exempt from healthcare charges while diagnosed with Covid-19. They also elude to use NHS services as they fear of their health service data being shared with the government to restrict immigration.¹⁰ Public health communication and engagement should be culturally and linguistically appropriate to reduce barriers in accessing healthcare, thereby preventing associated illness and death.

Epidemiological studies have established the association between South Asian communities and Covid-19. However, there is a need for urgent qualitative research to enable understanding of underlying reasons of the infections from socio-economic and cultural perspectives. Such data will enable the identification of socio-economic and cultural dimensions to their understanding, illness perceptions and coping strategy, and any gaps in sources of information and knowledge.

References:

1. Kirby T. Evidence mounts on the disproportionate effect of Covid-19 on ethnic minorities. 08 May, 2020. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30228-9/fulltext#coronavirus-linkback-header. The Lancet Respiratory Medicine. (Accessed 12 May, 2020).
2. Razaq A, Harrison D, Barr B, Asaria M, Routen A, Khunti K. BAME Covid-19 Deaths-what do we know?: rapid data & evidence review. 05 May, 2020. https://www.cebm.net/Covid-19/bame-Covid-19-deaths-what-do-we-know-rapid-data-evidence-review/. Oxford Covid-19 Evidence Service. (Accessed 14 May, 2020).
3. Shah A, Dobson R. BAME COVID-19 patients 10 years younger than white counterparts, study finds. 22 May, 2020. https://www.kcl.ac.uk/news/bame-Covid-19-patients-10-years-younger-than-white-counterparts-study-finds. King’s College London. (Accessed 26 May, 2020).
4. Office for National Statistics. Population of England and Wales. Last updated 14 May, 2019. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/population-of-england-and-wales/latest#by-ethnicity. (Accessed 26 May, 2020).
5. Abrams EM, Szefler SJ. Covid-19 and the impact of social determinants of health. 18 May, 2020. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30234-4/fulltext. The Lancet Respiratory Medicine. (Accessed 29 May, 2020).
6. Office for National Statistics. Regional ethnic diversity. Last updated 11 July, 2019. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest#ethnic-groups-by-type-of-location-urban-or-rural. (Accessed 25 May, 2020).
7. National Health Service. Who's at higher risk from coronavirus? Page last reviewed 01 June, 2020. https://www.nhs.uk/conditions/coronavirus-Covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/. (Accessed 03 May, 2020).
8. Khunti K, Kumar S, Brodie J. Diabetes UK and South Asian Health Foundation recommendations on diabetes research priorities for British South Asians. London: Diabetes UK. 2009.
9. Office for National Statistics. People living in deprived neighbourhoods. Updated 17 May, 2019. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/people-living-in-deprived-neighbourhoods/latest#people-living-in-the-most-deprived-10-of-neighbourhoods-by-ethnicity. (Accessed 01 May 2020).
10. Aldridge RW, Lewer D, Katikireddi SV, et al. Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data. Wellcome Open Research. 2020 May 6 (5): 88.