McCabe Ronan, Kibuchi Eliud, Amele Sarah, Irizar Patricia, Sheikh Aziz, Jeffrey Karen, Ruden Igor, Simpson Colin R, McCowan Colin, Ritchie Lewis, Robertson Chris, Leyland Alastair H, Demou Evangelia, Pearce Anna, Katikireddi Srinivasa Vittal
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
BMJ Open. 2025 Apr 14;15(4):e092727. doi: 10.1136/bmjopen-2024-092727.
Minority ethnic groups disproportionately experienced adverse COVID-19 outcomes, partly a consequence of disproportionate exposure to socioeconomic disadvantage and high-risk occupations. We examined whether minority ethnic groups were also disproportionately vulnerable to the consequences of socioeconomic disadvantage and high-risk occupations in Scotland.
We investigated effect modification and interaction between area deprivation, education and occupational risk and ethnicity (assessed as both a binary white vs non-white variable and a multi-category variable) in relation to severe COVID-19 (hospitalisation or death). We used electronic health records linked to the 2011 census and Cox proportional hazards models, adjusting for age, sex and health board. We were principally concerned with additive interactions as a measure of vulnerability, estimated as the relative excess risk due to interaction (RERI).
Analyses considered 3 730 837 individuals aged ≥16 years (with narrower age ranges for analyses focused on education and occupation). Severe COVID-19 risk was typically higher for minority ethnic groups and disadvantaged socioeconomic groups, but additive interactions were not consistent. For example, non-white ethnicity and highest deprivation level experienced elevated risk ((HR=2.7, 95% CI: 2.4, 3.2) compared with the white least deprived group. Additive interaction was not present (RERI=-0.1, 95% CI: -0.4, 0.2), this risk being less than the sum of risks of white ethnicity/highest deprivation level (HR=2.4, 95% CI: 2.3, 2.5) and non-white ethnicity/lowest deprivation level (1.4, 95% CI: 1.2, 1.7). Similarly, non-white ethnicity/no degree education (HR=2.5, 95% CI: 2.2, 2.7; RERI=-0.1, 95% CI: -0.4, 0.2) and non-white ethnicity/high-risk occupation (RERI=0.3, 95% CI: -0.2, 0.8) did not experience greater than additive risk. No clear evidence of effect modification was identified when using the multicategory ethnicity variable or on the multiplicative scale either.
We found no definitive evidence that minority ethnic groups were more vulnerable to the effect of social disadvantage on the risk of severe COVID-19.
少数族裔群体在新冠疫情中承受了不成比例的不良后果，部分原因是他们不成比例地暴露于社会经济劣势和高风险职业中。我们研究了在苏格兰，少数族裔群体是否也在社会经济劣势和高风险职业的影响下，更易受到伤害。
我们调查了地区贫困、教育程度、职业风险与种族（分为白人与非白人二元变量以及多类别变量）之间对于严重新冠疫情（住院或死亡）的效应修正和相互作用。我们使用了与2011年人口普查相关联的电子健康记录以及Cox比例风险模型，并对年龄、性别和健康委员会进行了调整。我们主要关注相加相互作用作为衡量易感性的指标，通过相互作用导致的相对超额风险（RERI）来估计。
分析纳入了3730837名年龄≥16岁的个体（针对教育和职业的分析年龄范围更窄）。少数族裔群体和处于社会经济劣势的群体感染严重新冠的风险通常更高，但相加相互作用并不一致。例如，与最不贫困的白人组相比，非白人且处于最高贫困水平的人群风险升高（风险比[HR]=2.7，95%置信区间[CI]：2.4，3.2）。不存在相加相互作用（RERI=-0.1，95%CI：-0.4，0.2），该风险小于白人种族/最高贫困水平（HR=2.4，95%CI：2.3，2.5）和非白人种族/最低贫困水平（1.4，95%CI：1.2，1.7）的风险总和。同样，非白人且未接受过高等教育（HR=2.5，95%CI：2.2，2.7；RERI=-0.1，95%CI：-0.4，0.2）以及非白人且从事高风险职业（RERI=0.3，95%CI：-0.2，0.8）并未经历高于相加风险的情况。在使用多类别种族变量或乘法尺度时，也未发现明确的效应修正证据。
我们没有找到确凿证据表明少数族裔群体在社会劣势对严重新冠风险的影响方面更易受到伤害。
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