Quantifying the association between COVID-19, ethnicity and mortality: A cohort study across three UK national databases

目的：早期证据表明，黑人、亚洲人和少数民族（BAME）群体中COVID-19疾病的严重程度有所增加。在英国或国际范围内，量化BAME组内差异或检查这些与可改变的风险因素相关的基于人群的队列的证据有限。目的：在英国成年人的一个大样本和代表性样本中，按种族描述COVID-19确诊病例的流行情况，并量化按COVID-19感染分层的种族和死亡率与可改变的临床和社会风险因素（血压、HbA1c水平、总胆固醇、体重指数、吸烟状况、合并症、药物使用、住所和家庭成员）之间的关系。方法：对英格兰三个大型国家初级保健数据库登记的成年人进行队列研究，代表英国人口的40%以上。参与者的社会人口学、剥夺、临床和住所特征将被总结和比较更高层次的种族群体（白人、黑人、亚洲人和其他混血）及其亚群体。例如，根据2011年的人口普查，亚洲子群体包括巴基斯坦人、印度人、孟加拉国人或中国人，而黑人子群体包括非洲人或加勒比人。全因死亡率和COVID-19死亡率的风险比和95%置信区间，经潜在混杂因素调整后，将使用Cox比例风险回归计算。含义：我们的研究结果可以为英国各种族群体之间和内部的COVID-19模式和相关死亡率提供快速证据。这有可能为有针对性的缓解公共卫生战略提供信息，并可能改变出现感染的高危患者的临床阈值。

Purpose: Early evidence suggests increased severity of COVID-19 disease amongst Black, Asian and Ethnic minority (BAME) groups. There is limited evidence from population-based cohorts at scale across the UK or internationally that quantify within BAME group differences, or examine these in relation to modifiable risk factors.Aim: To describe the prevalence of confirmed COVID-19 cases by ethnic group in a large and representative sample of UK adults, and to quantify the association between ethnicity and mortality stratified by COVID-19 infection and modifiable clinical and social risk factors (blood pressure, HbA1c level, total cholesterol, Body Mass Index, smoking status, co-morbidities, medication use, domicile and household number).Methods: A cohort study of adults registered across three large national primary care databases in England, representing over 40% of the UK population. Participant sociodemographic, deprivation, clinical and domicile characteristics will be summarised and compared by higher level ethnic group (White, Black, Asian and Mixed Other) and their subgroups. For example, the Asian subgroup includes Pakistani, Indian, Bangladeshi or Chinese while the Black subgroup includes African or Carribean, as per the 2011 census. Hazard ratios and 95% confidence intervals for all-cause mortality and COVID-19 mortality, adjusted for potentially confounding factors will be calculated using Cox's proportional hazard regression. Implication: Our findings could provide rapid evidence on patterns of COVID-19 and associated mortality across and within ethnic groups in the UK. This has the potential to inform targeted mitigation public health strategies, and could alter clinical thresholds for at-risk patients presenting with the infection.