Evidence for ethnic inequalities in mortality related to COVID-19 infections: findings from an ecological analysis of England

Objectives In the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area. Design Ecological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution. Setting Local authorities in England. Results For every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5 center dot 12, 95% CI (4 center dot 00 to 6 center dot 24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4 center dot 42, 95% CI (2 center dot 24 to 6 center dot 60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas. This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people. Conclusions We find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.