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Mitigating ethnic disparities in covid-19 and beyond

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4921 (Published 15 January 2021) Cite this as: BMJ 2021;372:m4921

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Re: Mitigating ethnic disparities in covid-19 and beyond: The UK is a world leader in ethnicity data collection

Dear Editor

Razai and his colleagues offer a cogent analysis of ethnic disparities in health and their causes,(1) but their comments on the comparative lack of information in the UK require a response.

Alongside the United States and New Zealand, the UK has been among the world leaders in this field since the 1990s, notably by inclusion of ethnicity, country of birth and subsequently religion in its national censuses from 1991.(2) This allowed the UK quickly to identify and begin to tackle the disproportionate impact of covid-19 on ethnic minorities.(3)

In particular, the UK has pioneered ethnicity and health research using data linkage: in England, between the census and death;(4,5) and in the Scottish Health and Ethnicity Linkage Study (SHELS), between the census and NHS hospitalisations, cancer registry, primary care, mental welfare commission data and death records.(6) Based on a census-linked cohort of over 4.6 million people, SHELS has generated 28 papers covering a wide range of outcomes for up to 15 ethnic groups, including all-cause mortality, lower respiratory tract infections, cervical screening and many more.(7) An overview of 29 outcomes from SHELS is available as a preprint.(8)

In January 2021, we published an analysis by ethnic group of 1.65 million cases of infection-related hospitalisations and deaths, and serological diagnoses of bloodborne viruses.(9) Demonstrating complex and sometimes enormous ethnic differences, for all infections combined and 18 specific infection categories, the study provides a useful context in which to consider the disproportionate effects of covid-19 on ethnic minorities.

1 Razai MS, Kankam HKN, Majeed A, et al. Mitigating ethnic disparities in covid-19 and beyond. BMJ 2021;372:m4921

2 Bhopal RS. Migration, Ethnicity, Race and Health in Multicultural Societies. 2nd ed. Oxford: Oxford University Press, 2014.

3 Public Health England. Disparities in the risk and outcomes of COVID-19. London: Public Health England, 2020.

4 Scott AP, Timaeus IM. Mortality differentials 1991-2005 by self-reported ethnicity: findings from the ONS Longitudinal Study. J Epidemiol Community Health 2013;67(9):743-50. doi: 10.1136/jech-2012-202265

5 Wallace M, Kulu H. Mortality among immigrants in England and Wales by major causes of death, 1971-2012: A longitudinal analysis of register-based data. Social Science & Medicine 2015; 147: 209e221

6 Bhopal R, Fischbacher C, Povey C, et al. Cohort profile: Scottish health and ethnicity linkage study of 4.65 million people exploring ethnic variations in disease in Scotland. Int J Epidemiol 2011;40(5):1168-75. doi: 10.1093/ije/dyq118

7 Usher Institute. Scottish Health and Ethnicity Linkage Study. University of Edinburgh https://www.ed.ac.uk/usher/scottish-health-ethnicity-linkage

8 Stanaway FF, Gruer L, Bhopal RS. Revealing the complex relationships between ethnicity and health: 29 outcomes from the Scottish Health and Ethnicity Linkage Study (SHELS) cohort
SSRN 2021; https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3779703

9 Gruer LD, Cézard GI, Wallace LA, et al. Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases. J Public Health 2021 doi: 10.1093/pubmed/fdaa267

Competing interests: No competing interests

22 February 2021
Laurence Gruer
Honorary Professor of Public Health
Raj S Bhopal
University of Edinburgh
Teviot Place, Edinburgh, Edinburgh, EH8 9AG