Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants – The Lancet

High-income countries Song Hospital admission; ICU admission USA 1st Mar–10th Aug 20 Respiratory failure, myocardial infarction, stroke, pulmonary hypertension, embolism, thrombosis, acute renal failure N/A 50% 465,565 (White) 182,637 Acosta Mortality USA 1st Mar 20–28th Feb 21 NR Age 88% 63,981 (White) 79,361 Adeji Mortality USA 1st Jul 21–30th Jun 22 NR N/A 81% 207,926 (White) 80,218 Lindsay Seropositivity USA 20th Feb–10th Jul 20 Charlson Comorbidity Index N/A 75% 1,092,652 (White) 269,941 Luo Mortality USA 4th Mar–23rd Jun 20 Cardiovascular disease, obesity, diabetes N/A 25% 7,300,959 (White) 3,321,251 Metra ICU admission USA 20th Jan–30th Sep 20 Hypertension, diabetes, obesity, COPD, cerebral infarction, systemic connective tissue disorders, reduced mobility, pregnancy, neoplasm, nicotine dependence Age, sex, diabetes, hypertension, obesity, homelessness, neoplasms 50% 157,049 (White) 50,376 Zerbo Hospital admission; ICU admission; Mortality USA 1st Nov 20–27th Jul 21 BMI, diabetes, hypertension, renal disease, asthma, heart disease, COPD, pneumonia, cerebral infarction, Alzheimers, Parkinsons, movement disorders, demyelinating disorders, epilepsy Age, comorbidities 75% 1,891,899 (White) 1,300,923 Bennett Hospital admission; Mortality USA 1st Jan 20–7th Dec 20 Diabetes, renal disease, heart failure, chronic pulmonary disease, peripheral vascular disease, stroke, cancer, dementia, myocardial infarction, liver disease, rheumatologic disease, hemiplegia, peptic ulcer disase N/A 69% 1,251,401 (White) 675,298 Chang Infection; Hospital admission USA 1st Jan 20–31st Dec 20 27 conditions N/A 88% 23,769,184 (White) 7,859,910 Egede ICU admission USA 1st Mar 20–10th Jul 20 Comorbidity count N/A 81% 23,788 (White) 7761 Feldman Mortality USA 1st Jan 20–24th Feb 21 NR Age 69% 227,532 (White) 148,593 Ioannou Infection USA 1st Feb 20–31st Mar 21 Charlson Comorbidity Index Age, sex, region, location, BMI, comorbidities 93% 5,887,349 (White) 3,240,324 Jones Seroprevalence USA 1st Jul 20–31st May 21 NR N/A 63% 1,226,745 (White) 216,774 Young Hospital admission USA 1st Jan 20–31st Dec 20 Presence of comorbidities Age, sex, service, rank, education, occupation, region, comorbidities 93% 374,525 (White 622,726 Thomas 1 ICU admission; Mortality UK 1st Mar 20–31st May 20 NR N/A 81% 13,092 (White) 697 Gray Mortality UK 1st Mar 20–31st Mar 21 Charlson Comorbidity Index Age, sex, deprivation, comorbidities 93% 359,160 (White) 15,084 Knight Hospital admission UK 1st Jan 20–7th Dec 20 Number of diagnoses N/A 93% 36,131,134 (White) 8,833,352 Thomas 2 Infection UK 21st Nov 20–22nd Dec 20 NR Age, deprivation, catchment area, smoking status, place of work, key worker 88% 2729 (White British or Irish) 88 Martin Infection UK Dec 20–Mar 21 Diabetes, immunosuppressed Age, sex, migration, religiosity, deprivation, household factors 93% 7583 (White) 8276 Talaei Seroprevalence UK 1st May 20–2nd Nov 20 Arterial disease, asthma, autoimmune disease, cancer, COPD, diabetes, heart disease, hypertension, immunodeficiency, kidney disease, major neurological conditions Age, sex 93% 10,651 (White) 479 Mathur Infection; Hospital admission; ICU admission; Mortality UK 1st Feb 20 to 31st Dec 20 Hypertension, asthma, respiratory disease, heart disease, diabetes, cancer, liver disease, stroke, dementia, neurological disease, kidney disease, immunosuppression Age, sex 100% 10,877,978 (White) 6,410,554 Hippisley Cox Hospital admission; Mortality UK 8th Dec 20–15th Jun 21 Kidney disease, chemotherapy, diabetes, other health conditions Age, sex, BMI, vaccination dose, background infection rate 75% 4,781,050 (White) 903,979 Ward Seropositivity UK 20th Jun 20–13th July 20 NR Age, sex, region 94% 92,737 (White) 6667 Farrell ICU admission; Mortality Ireland 13th Mar 20–1st May 20 Charlson Comorbidity Index Age 69% 208 (White Irish and White Other) 49 Allen Seroprevalence Ireland 19th Apr 21–28th Apr 21 NR N/A 81% 3798 (White Irish) 1287 Chu Hospital admission Canada 1st Jen 20–30th Sep 20 Charlson Comorbidity Index N/A 75% 42,547 (General) 4645 Saeed Seropositivity Canada 9th May 20–21st Jul 20 NR Age, sex, region, deprivation, blood type 81% 52,852 (White) 10,695 Passos-Castilho Hospital admission Canada 1st Jan 20–30th Sep 20 Charlson Comorbidity Index N/A 88% 42,547 (Canadian born) 4645 Islamoska Hospital admission Denmark 1st Feb 20–30th Jun 20 Charlson Comorbidity Index Age, sex 88% 433,539 (Danish) 60,114 Guijarro Infection Spain 1st Jan 20–14th Mar 20 NR Age, sex 100% 131,599 (Spain) 20,419 Ramos-Rincon ICU admission; Mortality Spain 1st Mar 20–31st Dec 21 Charlson Comorbidity Index N/A 81% 20,599 (European) 3354 Rostila Mortality Sweden 31st Jan 20–4th May 20 NR Age, sex 94% 11,232,511 (Sweden) 541,119 Nwaru Hospital admission; ICU admission Sweden 1st Jan 20–28th Feb 21 Hypertension, diabetes, obesity, stroke, pneumonia, COPD, asthma, psychiatric conditions N/A 88% 266,848 (Swedish born) 59,204 Stralin ICU admission; Mortality Sweden 1st Mar 20–30th Sep 20 Hypertension, diabetes, chronic lung disease, cancer, ischaemic disease, neuromuscular disease, stroke, obesity, dementia Age, sex, comorbidities, care dependency, healthcare region 88% 9973 (Sweden) 6243 Gustafsson Hospital admission; Mortality Sweden 4th Apr 20–14th Sep 20 Charlson Comorbidity Index Age, sex, comorbidities, housing, family structure, civil status, region, education, income 100% 52,201 (Sweden) 20,527 Consolazio Infection Italy 20th Feb 20–3rd May 20 NR Age, sex, comorbidities 88% 2,856,202 (Italy) 469,473 Lombardi Seropositivity Italy 27th Apr 20–12th Jun 20 Hypertension, diabetes, cardiac, respiratory, renal chronic diseases Age, sex, occupation, frontline area, BMI, smoking 81% 3869 (Italian) 186 Fabiani Hospital admission; ICU admission; Mortality Italy 20th Feb 20–19th Jul 20 Oncologic, cardiovascular, respiratory, diabetes/metabolic diseases Age, sex, geographical macro-area of diagnosis, level of urbanisation of place of residence, comorbidities, calendar period of diagnosis, random effect due to regional contextual differences 88% 197,206 (Italian) 15,974 Cacciani Hospital admission; ICU admission Italy 22nd Feb 21–2nd Jul 21 NR N/A 88% 45,580 (Italian) 2513 DiGirolamo Mortality Italy 22nd Feb 21–16th Jul 21 NR N/A 81% 34,370,041 (Italian) 4,006,808 Pagani Seroprevalence Italy 23rd Dec 20–19th Feb 21 NR N/A 88% 1572 (Italian) 472 Coyer 1 Hospital admission Netherlands 29th Feb 20–31st May 20 NR Age 88% 386,521 (Ethnic Dutch) 486,534 Collard Mortality Netherlands 18th Feb 20–30th Jan 21 Hypertension, asthma/COPD, chronic kidney disease, diabetes, malignancy, chronic cardiac disase, obesity, BMI N/A 69% 763 (Dutch) 415 Coyer 2 Seropositivity Netherlands 24th Jun 20–9th Oct 20 Diabetes, high blood pressure N/A 88% 503 (Dutch) 1994 Vos Seropositivity Netherlands 31st Mar 20–11th May 20 NR Weighted to population 88% 2306 (Dutch) 331 Indseth Infection; Hospital admission; Mortality Norway 1st Mar 20–18th Oct 20 NR N/A 81% 450,801 (Non-Immigrants) 869,442 Labberton Infection; Hospital admission Norway 15th Jun 20–21st Mar 21 14 medical conditions N/A 100% 53,890 (Norwegian) 28,642 Jefferies Infection New Zealand 2nd Feb 20–13th May 20 NR N/A 69% 1091 (European) 412 Ishii Infection Japan 16th Jul 20 – NR NR N/A 75% 3242 (Japanese) 298 Saidel Odes Infection Israel 8th Sep 20–31st Dec 20 NR Age, sex 81% 6381 (Jewish) 2137 Al Awaidy Hospital admission; Mortality Oman 14th Feb 20–23rd Jul 20 Hypertension, cardiovascular disease, lung disease N/A 75% 40,859 (Omani) 28,523 Al Abri Seropositivity Oman 1st Jul 20–30th Nov 20 Presence of comorbidities Selection bias 81% 11,582 (Omani) 5875 Abu Ruz Mortality United Arab Emirates 1st Mar 20–30th May 20 Diabetes, hypertension, anaemia, vitamin D deficiency, dyslipidaemia, chronic kidney disease, asthma, cancer, COPD N/A 75% 486 (Middle Eastern) 2810 Al Zahmi ICU admission United Arab Emirates 26th Feb 20–31st May 20 Cardiac disease, hypertension, chronic lung disease, asthma, chronic kidney disease, diabetes, cancer, immunosuppression, HIV, medication N/A 75% 73 (Emirati) 4,87 Hamadah ICU admission; Mortality Kuwait 24th Feb 20–20th Apr 20 Diabetes, hypertension, cardiovascular, asthma, cerebrovascular, hepatitis, cancer, hypothyroidism, renal disease, immunodeficiency, recent surgery Age, smoking, comorbidities 88% 294 (Kuwait) 829 Al Kuwari Infection Qatar 18th Feb 20–18th Apr 20 Hypertension, diabetes, cardiovascular disease, lung disease, kidney disease, malignancy, tuberculosis, liver disease, immunodeficiency N/A 88% 497 (Qatari National) 5188 Shaikh ICU admission; Mortality Saudi Arabia 1st May 20–1st Aug 20 Hypertension, obesity, diabetes, cardiovascular disease, respiratory diseases, malignancies, other chronic conditions Age, BMI, comorbidities, ICU admission (for mortality only) 69% 131 (Saudi National) 434 Nasif Mortality Saudi Arabia Nov 20–Jun 21 NR N/A 50% 953 (Saudi National) 1664 Low- and middle-income countries Horta Seropositivity Brazil 14th May 21–24th Jun 20 NR Age, sex 100% 2064 (White) 32,383 Da Silva Infection Brazil 27th Oct 20–11th Dec 20 NR N/A 56% 2945 (White) 3039 Rodrigues Mortality Brazil 22nd Feb 20–10th May 21 Cardiovascular disease, diabetes, haematological disease, down syndrome, obesity, pulmonary disease, liver disease, renal disease, neurological disease N/A 50% 435,144 (White) 405,057 Sansone Mortality Brazil 22nd Feb 20–4th Apr 21 Cardiopathy, haematological disorder, down syndrome, Hepatic disorder, asthma, diabetes, neurological disorder, chronic respiratory disease, immunosuppressive disorder, renal disease, obesity, other comorbidities N/A 88% 309,646 (White) 276,009 Silva ICU admission Brazil 26th Feb 20–9th Oct 20 Obesity, cardiovascular disease Age 50% 73,464 (White) 86,399 Ibarra-Nava ICU admission Mexico 28th Feb 20–3rd Aug 20 Diabetes, COPD, high blood pressure, chronic kidney disease N/A 94% 412,368 (Non-Indigenous) 3487 Servan-Mori Hospital admission; Mortality Mexico 1st Mar 20–28th Feb 21 Diabetes, obesity, hypertension, COPD, asthma, health problems during pregnancy Age, sex, comorbidities, timing of presentation to care, social deprivation 88% 787,856 (Non-Indigenous) 8022 Bojorquez-Chapela Seroprevalence Mexico 1st Nov 20–30th Apr 21 NR N/A 75% 121 (Mexican-born) 227 Dahal Mortality Mexico 19th Feb 20–25th Mar 22 Pneumonia, diabetes, COPD, asthma, other disease, cardiovascular disease, obesity, chronic kidney failure Age, sex 100% 2,151,140 (Non-Indigenous) 21,896 Ramli Infection Malaysia 1st Jan 21–31st Oct 21 Presence of comorbidities N/A 56% 110 (Malay) 10 Utulu Infection Nigeria Nov 20–Dec 20 Hypertension, diabetes N/A 63% 157 (Other) 1337 Cifuentes Mortality Colombia 2nd Mar 20–26th Oct 20 NR Age, sex, area of residence, health insurance, socioeconomic status 81% 971,078 (White) 62,140 Concha Infection Colombia 28th Mar 21–26th Apr 21 NR Sex, village 81% 72 (Colombian) 380 Sultanoglu Mortality Cyprus 9th Mar 20–4th May 20 NR N/A 13% 76 (Native) 32 Sacoto Mortality Ecuador 21st Feb 20–31st Dec 20 Presence of comorbidities N/A 50% 205,718 (Mestizo) 46,047 Kadyrova Infection; Seroprevalence Kazakhstan 1st Apr 21–30th May 21 Presence of comorbidities N/A 38% 55 (Kazakh) 45 Ikram Infection South Africa NR NR N/A 69% 8 (White) 228 Jugwanth Infection South Africa Nov 20–Dec 20 Diabetes, hypertension, HIV, tuberculosis, chronic kidney disease, heart disease, asthma/COPD, liver disease, cancer, pregnancy N/A 44% 275 (White) 255 Stead Infection South Africa 1st Jan 20–14th Mar 20 Diabetes, hypertension, HIV Sex, education, smoking status, profession, COVID-19 exposure, PPE training, public transport use, BMI, diabetes, hypertension, HIV 93% 114 (White) 1181