Infectious Disease

Underrepresented groups with ESKD are twice as likely to die from COVID-19 as white patients

August 27, 2021

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Tabinor does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

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A study of patients with end-stage kidney disease and COVID-19 found those who came from historically underrepresented groups had more than twice the death rate of their white counterparts.

The study, which included patients treated at a single kidney center in the UK, showed that race / ethnicity and mortality associations persisted after investigators adjusted for age, socioeconomic deprivation, comorbidities and frailty.

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Relationship between race / ethnicity, mortality

“Ethnicity emerges as a risk factor for COVID-19 mortality in various population groups, but the reasons for this association remain unclear. This is important to the ESKD population as the prevalence of Black, Asian and Ethnic Minority (BAME) patients is twice that of the UK population and a recent systematic review shows that[ing] ESKD patients from some ethnic minorities have a paradoxical long-term survival benefit. ” Matthew Tabinor, MRCP, of the Department of Kidney Medicine, University Hospitals of Birmingham NHS Trust and colleagues wrote. “Since BAME patients tend to be socio-economically disadvantaged, multimorbid and frail, it therefore remains unclear whether a relationship between mortality and BAME status in ESKD patients with COVID-19 is independent of these factors.”

For the study, researchers identified 191 patients with ESKD who tested positive for COVID-19 between March and April 2020 (84% were on hemodialysis, 5% were on peritoneal dialysis, and 11% were recipients of a kidney transplant).

Of the total study population, 67% were from BAME groups and 60% lived in areas classified as the most disadvantaged 20% in the UK (77% of these patients were from BAME groups).

Overall mortality was determined for a follow-up period of 4 to 12 weeks, with an overall mortality rate of 29%.

Ethnicity as a “risk factor” for COVID-19 mortality

The results showed that patients in BAME groups were more likely to experience mortality after adjusting for age, deprivation, comorbidities and frailty (HR = 2.37); this remained the case even when the investigators only considered dialysis patients (HR = 2.14).

In addition, the results of a sensitivity analysis that compared results between white patients and black and South Asian patients (who the researchers found made up more than 90% of the BAME group) indicated that South Asian or black ethnic backgrounds were consistently present resulted in higher mortality (HRs of 2.52 and 2.43, respectively).

“Our study shows that ethnicity in ESKD patients with COVID-19 continues to be associated with all-cause mortality despite adapting to socioeconomic deprivation, as measured by [index of multiple deprivation] IMD – a pattern that was replicated in the sensitivity analysis in patients from South Asian (Indian subcontinent) and black ethnicities, ”wrote Tabinor and colleagues. “… Common socio-cultural factors not measured in the IMD estimate may explain our observation, including the prevalence of multigenerational housing; differing health views on seeking professional help during the pandemic; the impact of social stigmatization related to COVID-19 within different BAME communities and lower health literacy.

This shows the complexity of studying ethnicity-mortality relationships in COVID-19 and the critical need for cultural literacy in developing health guidelines in preparing for a pandemic in the future.

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Race and medicine

Race and medicine

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