Deprivation ‘likely to play central role’ in ethnic health inequalities

Jemma Crew, PA Social Affairs Correspondent
·4-min read

Deprivation is a central driver of coronavirus disparities among minority ethnic groups, research suggests.

Reducing deprivation could play a “pivotal role” in reducing inequalities in outcomes such as disproportionate Covid-19 infections, hospital admissions and deaths in south Asian and black communities, according to analysis.

Researchers from the University of Leicester modelled a hypothetical scenario where the 50% most deprived of a sample of 407,830 south Asian, black and white individuals were lifted out of material deprivation.

Deprivation was calculated based on unemployment, non-car ownership, non-home ownership and household overcrowding.

The data was taken from the UK Biobank with linked Covid-19 outcomes occurring between March 16 and August 24 last year.

The modelling showed that more than 80% of the excess risk of being infected, developing severe disease and dying with Covid-19 for south Asian and black populations would be eradicated.

In this scenario, these groups would no longer have a meaningfully higher risk than the white group, the researchers found.

By moving the bottom 25% of the sample out of deprivation, 40-50% of additional risk to south Asian and black populations would be alleviated.

The authors said their findings suggest the “central importance of material deprivation in driving ethnic inequalities for Covid-19 outcomes”.

They added: “This further highlights the central role that deprivation is likely to play in driving ethnic health inequalities and the importance of policies working to reduce levels of deprivation within the whole population.”

The findings follow a landmark report from the Commission on Race and Ethnic Disparities, which said that for Covid-19 and many other health conditions, there is a “complex interplay” of socio-economic, behavioural, cultural and in some cases genetic risk factors which lead to disparities.

It said analyses had shown that the increased risk of dying with coronavirus of those from black and south Asian communities was mainly due to an “increased risk of exposure to infection”, through factors such as living in urban areas, occupation and deprivation.

Previous analysis from the Office for National Statistics (ONS) has also found that a large proportion, but not all,  of the difference in the risk of Covid-19 mortality between ethnic groups can be explained by demographic, geographical and socio-economic factors.

A paper in September from the ethnicity sub-group of the Scientific Advisory Group for Emergencies (Sage) said the most important factors in increased risk were likely to be social, such as socio-economic position, housing and occupation.

It added that historical experiences of minority ethnic groups and “long-term discrimination” may lead to a higher proportion working in high-risk occupations, living in crowded housing and with fewer health resources.

Cameron Razieh, lead author and epidemiologist at the University of Leicester, said: “The method of analysis we used in this study upholds that inequalities in health or health behaviours in people living with high deprivation are, in the most part, the result of the high deprivation itself.

“If we take this as truth, then we can conclude that high levels of deprivation are helping drive Covid-19 ethnic disparities.

“Reducing deprivation within the whole population could therefore play a pivotal role in reducing ethnic inequalities in Covid-19 outcomes observed in south Asian and black communities.”

Professor Kamlesh Khunti, joint senior author, added: “Material deprivation is a universal underpinning determinant of health inequalities within and between populations.

“Quantifying the extent to which material deprivation reduces risk is important but even more imperative is to now ask how we can reduce social inequality and increase social mobility.

“There is a rapidly closing window to use research evidence such as this to give those most in need a fighting chance to better manage their health.”

Dr Habib Naqvi, director of the NHS Race and Health Observatory, said: “There are undeniable inequalities that result in damaging outcomes such as increased rates of morbidity and mortality amongst ethnic minority communities.

“Whilst socioeconomic deprivation and increased exposure to frontline occupational roles impact individuals, we must address the structural factors and discrimination that underlie and lead to poorer lifestyles and health.”

The study was supported by the National Institute for Health Research’s Leicester Biomedical Research Centre.

It is published in the European Journal of Public Health.