In July, Dr Elizabeth Webb discussed the evidence that BAME older people were at an increased risk of dying from coronavirus during the first wave. As a second wave of coronavirus deaths begins, Dr Webb takes a look at the most up to date evidence to focus on Black older people – the group evidence suggests has been most disproportionately affected by deaths from coronavirus.
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Recent evidence
Last week, the Office for National Statistics (ONS) published an updated analysis of the data on coronavirus deaths. The ONS have estimated that up to 28 July, 1,510 Black people had died of coronavirus in England and Wales, and that almost 3 in 4 (73%) of those people were aged 65 and older. More than 1 in every 40 deaths involving coronavirus during this period was of a person who was Black African (1.7%) or Black Caribbean (1%).
These statistics alone don’t fully help us to understand the risk of dying from coronavirus for Black people compared to other ethnic groups. Black people make up a minority of the population of England and Wales – around 1 in every 30 people at the last Census – so we would expect them to only experience a minority of the deaths. Further, Black people in England and Wales have a younger average age, 30 years old according to the last Census – compared to the overall average of 39 years. As age is such an important risk factor for dying from coronavirus, we would expect this to mean the average Black person would be at lower risk.
In order to examine this, the ONS have calculated the ‘age standardised’ rates of death for each ethnic group – analysis that takes into account the different age distributions in each ethnic group. The ONS have estimated that up to 28 July:
- for every 100,000 Black African men there were 288 coronavirus deaths
- for Black Caribbean men it was 270 in 100,000
- for Black African and Black Caribbean women, the equivalent statistics were 115 and 129 in 100,000
- Black African and Caribbean men and women had a much higher risk of dying from coronavirus than White men and women, whose age-standardised rates of death were 107 and 66 in 100,000 respectively.
How do these increased risks come about? Have Black African and Black Caribbean men and women been at higher risk of catching coronavirus? Are Black African and Black Caribbean men and women at higher risk of dying from coronavirus once they catch it? Or, as we suggested in a previous article on the topic, are the ethnic inequalities we’ve seen in coronavirus deaths a combination of both the risk of catching coronavirus and risk of dying from it?
Risk of catching coronavirus
The idea that Black African and Black Caribbean people may be at higher risk of catching coronavirus is reflected in the numbers of people who are testing positive for the virus. Public Health England data shows that, for much of the pandemic, there have been larger numbers of new cases of coronavirus for every 100,000 Black people than for every 100,000 White people in England.
For example, in the week ending 3 April, just after the UK was put into lockdown, there were 78 new cases of coronavirus for every 100,000 Black people, compared to 41 new cases for every 100,000 White people. Looking at the average across the whole pandemic period, a Black person has had a 40% higher risk of testing positive than a White person.
The REACT study, which has tested 100,000 randomly selected members of the public in England for coronavirus antibodies, has found that Black people were more than 3 times more likely to test positive than White people. They estimate that 17% of Black people compared to 5% of White people had had coronavirus before the end of June.
Going into hospital with coronavirus
Public Health England has shown that 7.8% of people who were hospitalised with coronavirus were Black. Furthermore, 11.9% of people whose health was poor enough to need to be admitted to intensive care or a high dependency unit were Black. This suggests that Black people who went into hospital with coronavirus needed a higher level of care, perhaps because their symptoms were more severe.
Dying from coronavirus
The chances of dying from coronavirus have been more than twice as high for Black people than for White people, even after taking into account differences in the size and age of these populations in England and Wales. The ONS found that the risk to Black African men was 3.8 times that of White men, and Black Caribbean men’s risk was 2.8 times that of White men. For women, the risk among Black Africans was 2.9 times and the risk among Black Caribbeans was 2.2 times that of White women.
The ONS did some further statistical analysis, to try to address the questions of whether the ethnic inequalities in risk of dying from coronavirus were due to where people live, their level of socioeconomic advantage, or their health and disability. All of these factors vary by ethnicity and could potentially be linked to differences in the chances of catching coronavirus, and also the chances of having worse outcomes once people have caught it.
The ONS found that, even after ethnic differences in these factors had been taken into account, they could still see a higher risk of having died of coronavirus among Black African and Caribbean men and women. Black African men and women still had greater than double the chances of having died from coronavirus compared to White men and women.
Structural inequalities
The factors that lead to increased risks of both catching and dying from coronavirus for Black people are driven by the structural racism and resultant inequalities that Black people in the UK experience across their lives. Structural racism impacts upon people’s chances of being in a job or having employment conditions which put them at risk of contracting coronavirus, of having other health conditions, or of living in an area or in circumstances that put them at risk. Furthermore, it can impact upon the health care people seek and are offered. It is through our understanding of how structural racism impacts upon coronavirus risk that we can reduce the impact of its second wave on the communities that have suffered the most already.