The study, led by academics at the University of Birmingham College of Medical and Dental Sciences, found patients from ethnic minorities were more likely than white patients to live in places associated with environmental and housing deprivation. Patients from ethnic minorities were also more likely to present at hospital with more severe coronavirus symptoms, and to be admitted to intensive care units (ITUs).

While it’s known that COVID-19 poses a greater risk to minority ethnic groups, the reasons why are unclear. This latest study, one of the first to analyse a possible connection between the impact of the disease and social determinants of health, has yet to be formally reviewed by other scientists but is available online.

An in-depth retrospective cohort study of 408 hospitalised COVID-19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Data on deprivation was used to categorise the patients. 

Those admitted from highest living environment (LE) deprivation indices – which look at data on air pollution, poor-quality housing and road traffic accidents – were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission. Patients admitted from highest Barriers to Housing and Services (BHS) deprivation indices – which consider factors such as household overcrowding, distance to amenities, and housing affordability – were at increased risk of ITU admission. 

Admission to ITU significantly increased the risk of death, the researchers found. Black, Asian and minority ethnic (BAME) patients were more likely than white patients to present with multi-lobar pneumonia, be admitted to ITU, and be admitted from highest BHS and LE deprivation indices. In addition, the research underlined that co-morbidities and frailty significantly increased the risk of death among COVID-19 patients irrespective of deprivation. 

The study concluded that air pollution and housing quality deprivation are potential agents linked to people presenting with multi-lobar pneumonia. Furthermore, household overcrowding deprivation and presentation with multi-lobar pneumonia are potential factors in ITU admission.

Concluded the study: “Patients of black, Asian and minority ethnicity (BAME) are more likely to be admitted from regions of highest air pollution, housing quality and household overcrowding deprivation. This is likely to contribute an explanation towards the higher ITU admissions reported among COVID-19 BAME patients.

“These findings have urgent implications for supporting frontline clinical decisions, disseminating practical advice around applying social distancing messages at the household level, and informing wider pandemic strategy.” 

The researchers caution that future studies should explore the extent to which household overcrowding deprivation, housing quality deprivation and air pollution deprivation impact outcomes among COVID-19 patients – both over the long term and in different cities – as this will further inform pandemic strategic planning. They add that future studies should also explore how healthcare professionals can make use of effective tools during consultations to acquire a holistic picture of patients’ deprivation risk factors, including deprivation of housing quality, household crowding and air pollution. 

Speaking to The Guardian, David Thickett, Professor of Respiratory Medicine at the University of Birmingham and a member of the study team, said: “It’s no surprise that people living in poor areas and poor housing do badly in a pandemic. It’s been true since the Black Death and this reaffirms the importance of deprivation in influencing the pattern of disease.

“The limitation of this study is that it’s in a single centre. What you really want is data from several different areas.”

And Prof Chris Griffiths, at Barts and the London School of Medicine, told the newspaper: “This study suggests that markers of socio-economic and environment are linked to pneumonia and ITU admission with COVID-19. This is important but the [deprivation] measures used are really too broad to be able to point the finger at a specific component of each of these markers. More work is urgently needed.”