Underrepresented groups with ESKD twice as likely to die from COVID-19 vs white patients
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A study of patients with end-stage kidney disease and COVID-19 revealed those who were from historically underrepresented groups had more than double the mortality rate of their white counterparts.
The study, which included patients receiving care at a single renal center in the United Kingdom, showed the associations between race/ethnicity and mortality remained after investigators adjusted for age, socioeconomic deprivation, comorbidities and frailty.
Link between race/ethnicity, mortality
“Ethnicity is emerging as a risk factor for mortality in COVID-19 in different populations, but the reasons behind this association remain unclear. This is germane to the ESKD population, given the prevalence of Black, Asian and minority ethnicity (BAME) patients is twice that of the U.K. population and given a recent systematic review demonstrat[ing] ESKD patients from some ethnic minorities have a paradoxical long-term survival advantage,” Matthew Tabinor, MRCP, of the department of renal medicine, University Hospitals of Birmingham NHS Trust, and colleagues wrote. “Given BAME patients are more likely to be socioeconomically deprived, multimorbid, and frail, it therefore remains unclear whether any association 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 receiving hemodialysis, 5% were receiving peritoneal dialysis and 11% were kidney transplant recipients).
Of the total study population, 67% were from BAME groups and 60% lived in areas classified as being in the most deprived 20% in the United Kingdom (77% of these patients were from BAME groups).
All-cause mortality was determined for 4 to 12 weeks of follow-up, with an overall case fatality rate of 29%.
Ethnicity as a ‘risk factor’ for COVID-19 mortality
Findings indicated patients in BAME groups were more likely to experience mortality after adjustment for age, deprivation, comorbidities and frailty (HR = 2.37); this remained true when investigators only considered patients receiving dialysis (HR = 2.14).
Further, results of a sensitivity analysis that compared outcomes between white patients and Black and South Asian patients (which, the researchers noted, made up more than 90% of the BAME group) suggested that being from a South Asian or Black ethnic background consistently led to higher mortality (HRs of 2.52 and 2.43, respectively).
“Our study demonstrates that ethnicity remains associated with all-cause mortality in ESKD patients with COVID-19 despite adjustment for socioeconomic deprivation when measured by [index of multiple deprivation] IMD — a pattern replicated in patients from South Asian (Indian subcontinent) and Black ethnicities in sensitivity analysis,” Tabinor and colleagues wrote. “ ... Shared sociocultural factors, not measured during IMD estimation, may explain our observation, including the prevalence of multi-generational housing; different health beliefs about seeking professional help during the pandemic; the effect of social stigmas associated with COVID-19 within different BAME communities and lower levels of health literacy.
This demonstrates the complexity of investigating associations between ethnicity and mortality in COVID-19 and the critical need for cultural competence when developing healthcare guidance in future pandemic preparation.”
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