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Why are more black and minority ethnic people dying from Covid-19 in hospital?

The startling ethnic differences in death rates in hospitals from Covid-19 identified recently highlight a familiar pattern of racial inequality. Whilst the government commitment to investigate the matter is welcome there are many reasons why there is scepticism about their promises given the failure to protect front-line workers in the health and social care sectors. This analysis provides updated information based on the record of deaths in hospital up to 21 st April 2020. It does not include deaths in the care sector or the wider community.

Table 1 uses the census population data from 2011 as the comparison with deaths in hospital from Covid-19 where ethnicity was recorded 1 . It includes the actual and expected number of deaths together with the relative likelihood of these deaths by detailed ethnic group. For all ethnic groups other than white British and white Irish the number of deaths exceeded what would be expected based on their age profile. The mixed and Indian ethnic groups were more than twice as likely to die in hospital; Pakistani, Bangladeshi and black Caribbean nearly three times as likely, black African more than four times more likely and other black and other ethnic group nearly eight times more likely. These suggest extreme racial inequalities that need urgent investigation.

Table 1 – Covid-19 deaths in hospital by ethnic group based on 2011 population census

Ethnicity Actual deaths Expected deaths Difference Relative Likelihood
White British  11,354  14,283 – 2,929 0.8
Irish  161  252 – 91 0.6
Other white  544  319  225 1.7
Mixed  115  44  71 2.6
Indian  492  199  293 2.5
Pakistani  332  87  245 3.8
Bangladeshi  100  26  74 3.8
Chinese  57  38  19 1.5
Other Asian  245  75  170 3.3
Black African  290  53  237 5.5
Black Caribbean  460  131  329 3.5
Other black  146  17  129 8.6
Other ethnic group  439  51  388 8.6

Source: 2011 census and Covid-19 hospital deaths at 21st April 2020

Table 2 uses a population forecast for 2019 as the comparison with deaths in hospital from Covid-19 where ethnicity was recorded 1. Whilst we do not have more up-to-date official statistics on the age and ethnic composition of the UK, the mid-year population estimates were used to generate a population forecast of the breakdown of ethnic groups.

Broadly, in England according to the mid-year population estimates 21% of the population were from ethnic minorities and 15% of people were born outside the UK. Of the ethnic minorities in England, 6% are classed as other white, 2% mixed, 8% Asian, 3% black and 2% other.

The calculations to estimate the population cannot be verified as parental ethnicity is not recorded at birth. The mid-year estimates also use a reduced set of ethnic groupings which does not provide the detailed breakdown from table 1. The results are similar with mixed ethnic groups twice as likely, Asian people nearly three times as likely to die from Covid-19 in hospital, black and other ethnic groups more than four times more likely.

Table 2 – Covid-19 deaths in hospital by ethnic group based on 2019 population forecast

Ethnicity Actual deaths Expected deaths Difference Relative likelihood
White British  11,354  14,702 – 3,348 0.8
Other White  705  648  57 1.1
Mixed  115  56  59 2.05
Asian  1,226  453  773 2.71
Black  896  213  683 4.21
Other  439  96  343 4.57

Source: 2011 census and Covid-19 hospital deaths at 21st April 2020

Further investigation

A better understanding of the data underlying these racial inequalities should be developed by providing more information about the victims and others admitted to hospital for treatment for Covid-19. A better understanding of the geography, potential exposure and personal demographic characteristics should be made available. Where they lived, their occupations, sex, age and country of birth would allow the identification of potential explanatory factors and inform actions to address them. Gathering similar data for deaths in the wider community including care homes should also be a priority.

Nigel de Noronha is Assistant Professor at the School of Geography, University of Nottingham
nigel.denoronha@nottingham.ac.uk

1 Around 9% of deaths (1,537 out of 16,272) had no ethnicity recorded