Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom.

1. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA.
Authors
Lo CH^{1,

3}
Nguyen LH^{1,

3}
Drew DA^{1,

3}
Warner ET¹
Joshi AD^{1,

3}
Guo CG^{1,

3}
Ma W^{1,

3}
Mehta RS^{1,

3}
Kwon S^{1,

3}
Song M^{1,

3}
Chan AT^{1,

3}
(11 authors)
2. School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Authors
Graham MS²
Sudre CH²
Ourselin S²
(3 authors)
3. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Authors
Lo CH^{1,

3}
Nguyen LH^{1,

3}
Drew DA^{1,

3}
Joshi AD^{1,

3}
Anyane-Yeboa A³
Guo CG^{1,

3}
Ma W^{1,

3}
Mehta RS^{1,

3}
Kwon S^{1,

3}
Song M^{1,

3}
Chan AT^{1,

3}
(11 authors)
4. Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Authors
Shebl FM⁴
(1 author)
5. Computational Epidemiology Lab and Division of Endocrinology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Authors
Astley CM⁵
(1 author)

Show all (11)

ORCIDs linked to this article

Show all (8)

Eclinicalmedicine, 17 Jul 2021, 38:101029
https://doi.org/10.1016/j.eclinm.2021.101029 PMID: 34308322 PMCID: PMC8285255

This article is in the Europe PMC Open access subset. Refer to the copyright information in the article for licensing details.

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This article is based on a previously available preprint.

Abstract

Background

There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19).

Methods

We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509.

Findings

Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18-1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33-1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02-1.34), South Asian (OR, 1.39; 95% CI, 1.30-1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18-1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively.

Interpretation

Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities.

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EClinicalMedicine. 2021 Aug; 38: 101029.

Published online 2021 Jul 17. https://doi.org/10.1016/j.eclinm.2021.101029

PMCID: PMC8285255

PMID: 34308322

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

Chun-Han Lo,^a,^b,^c,^† Long H. Nguyen,^a,^b,^d,^† David A. Drew,^a,^b,^† Erica T. Warner,^a,^e,^† Amit D. Joshi,^a,^b Mark S. Graham,^f Adjoa Anyane-Yeboa,^b Fatma M. Shebl,^g Christina M. Astley,^h,ⁱ Jane C. Figueiredo,^j Chuan-Guo Guo,^a,^b,^k Wenjie Ma,^a,^b Raaj S. Mehta,^a,^b,^d Sohee Kwon,^a,^b Mingyang Song,^a,^b,^c,^l Richard Davies,^m Joan Capdevila,^m Carole H. Sudre,^f Jonathan Wolf,^m Yvette C. Cozier,ⁿ Lynn Rosenberg,ⁿ Lynne R. Wilkens,^o Christopher A. Haiman,^p,^q Loïc Le Marchand,^o Julie R. Palmer,ⁿ Tim D. Spector,^r Sebastien Ourselin,^f Claire J. Steves,^r,^s Andrew T. Chan,^a,^b,^i,^t, and COPE Consortium, on behalf of the

Chun-Han Lo

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^cDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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Long H. Nguyen

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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David A. Drew

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Erica T. Warner

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^eHarvard/MGH Center on Genomics, Vulnerable Populations, And Health Disparities, Massachusetts General Hospital, Boston, MA, USA

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Amit D. Joshi

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Mark S. Graham

^fSchool of Biomedical Engineering & Imaging Sciences, King's College London, London, UK

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Adjoa Anyane-Yeboa

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Fatma M. Shebl

^gMedical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Christina M. Astley

^hComputational Epidemiology Lab and Division of Endocrinology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA

ⁱBroad Institute of Harvard and MIT, Cambridge, MA, USA

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Jane C. Figueiredo

^jDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California, USA

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Chuan-Guo Guo

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^kDepartment of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China

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Wenjie Ma

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Raaj S. Mehta

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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Sohee Kwon

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

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Mingyang Song

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

^cDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

^lDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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Richard Davies

^mZoe Limited, London, UK

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Joan Capdevila

^mZoe Limited, London, UK

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Carole H. Sudre

^fSchool of Biomedical Engineering & Imaging Sciences, King's College London, London, UK

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Jonathan Wolf

^mZoe Limited, London, UK

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Yvette C. Cozier

ⁿSlone Epidemiology Center, Boston University, Boston, MA, USA

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Lynn Rosenberg

ⁿSlone Epidemiology Center, Boston University, Boston, MA, USA

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Lynne R. Wilkens

^oEpidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA

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Christopher A. Haiman

^pDepartment of Preventive Medicine, Keck School of Medicine, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA

^qCenter for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

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Loïc Le Marchand

^oEpidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA

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Julie R. Palmer

ⁿSlone Epidemiology Center, Boston University, Boston, MA, USA

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Tim D. Spector

^rDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK

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Sebastien Ourselin

^fSchool of Biomedical Engineering & Imaging Sciences, King's College London, London, UK

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Claire J. Steves

^rDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK

^sDepartment of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK

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Andrew T. Chan

^aClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, 15th Floor, Boston, MA 02114, USA

^bDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

ⁱBroad Institute of Harvard and MIT, Cambridge, MA, USA

^tDepartment of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA

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