Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: A systematic review and meta-analysis

Abstract

Background People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. Methods We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020 – 15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. Results Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59–1.99), hospitalisation ratio 1.87 (95% CI = 1.69–2.04), mortality ratio 1.68 (95% CI = 1.52–1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64–0.77), hospitalisation ratio 0.74 (95% CI = 0.65–0.82), mortality ratio 0.82 (95% CI = 0.78–0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63–1.94), hospitalisation ratio 1.32 (95% CI = 1.08–1.55), mortality ratio 0.94 (95% CI = 0.84–1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19–1.67), hospitalisation ratio 1.12 (95% CI = 0.89–1.35), mortality ratio 1.06 (95% CI = 0.89–1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. Conclusions Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.