Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)

Paul Henery; Eleftheria Vasileiou; Kirsten J. Hainey; Duncan Buchanan; Ewen Harrison; Alastair H. Leyland; Thomas Alexis; Chris Robertson; Utkarsh Agrawal; Lewis Ritchie; Sarah Jane Stock; Colin McCowan; Annemarie Docherty; Steven Kerr; James Marple; Rachael Wood; Emily Moore; Colin R. Simpson; Aziz Sheikh; Srinivasa Vittal Katikireddi

doi:10.1136/bmjopen-2021-048852

Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)

Paul Henery, Eleftheria Vasileiou, Kirsten J. Hainey, Duncan Buchanan, Ewen Harrison, Alastair H. Leyland, Thomas Alexis, Chris Robertson, Utkarsh Agrawal, Lewis Ritchie, Sarah Jane Stock, Colin McCowan, Annemarie Docherty, Steven Kerr, James Marple, Rachael Wood, Emily Moore, Colin R. Simpson, Aziz Sheikh, Srinivasa Vittal Katikireddi^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland. The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.

Original language	English
Article number	e048852
Journal	BMJ Open
Volume	11
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2021-048852
Publication status	Published - 10 Aug 2021

Bibliographical note

Funding Information:
Funding This study is being funded by the UKRI Centre on the Dynamics of Ethnicity 4 (ES/W000849/1). PH, SVK, AHL and KJH are funded by the Medical Research Council (MC_UU_00022/2) and Scottish Government Chief Scientist Office (SPHSU17). SVK is funded by a NRS Senior Clinical Fellowship (SCAF/15/02). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE-The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK; with additional support from the Scottish Government DG Health and Social Care.

Funding Information:
Competing interests SVK is co-chair of the Scottish Government’s Expert Reference Group on Ethnicity and COVID-19 and a member of the UK Government’s Scientific Advisory Group on Emergencies (SAGE) subgroup on ethnicity and COVID-19. AS is a member of the Scottish Government’s Chief Medical Officer’s COVID-19 Advisory Group, the Scottish Government’s Expert Reference Group on ethnicity and COVID-19 and the UK Government’s Subgroup on Risk Stratification of the New and Emerging Respiratory Virus Threats Group (NERVTAG). LR acts as a medical advisor to Scottish Government on primary care and public health, including vaccination issues. CRS reports grants from the UK National Institute for Health Research, Medical Research Council and New Zealand Health Research Council and The Ministry of Business, Innovation and Employment.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Keywords

COVID-19
epidemiology
protocols & guidelines
public health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2021-048852

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Final published version, 893 KBLicence: CC BY

Cite this

Henery, P., Vasileiou, E., Hainey, K. J., Buchanan, D., Harrison, E., Leyland, A. H., Alexis, T., Robertson, C., Agrawal, U., Ritchie, L., Stock, S. J., McCowan, C., Docherty, A., Kerr, S., Marple, J., Wood, R., Moore, E., Simpson, C. R., Sheikh, A., & Katikireddi, S. V. (2021). Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II). BMJ Open, 11(8), Article e048852. https://doi.org/10.1136/bmjopen-2021-048852

Henery, P, Vasileiou, E, Hainey, KJ, Buchanan, D, Harrison, E, Leyland, AH, Alexis, T, Robertson, C, Agrawal, U, Ritchie, L, Stock, SJ, McCowan, C, Docherty, A, Kerr, S, Marple, J, Wood, R, Moore, E, Simpson, CR, Sheikh, A & Katikireddi, SV 2021, 'Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)', BMJ Open, vol. 11, no. 8, e048852. https://doi.org/10.1136/bmjopen-2021-048852

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title = "Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)",

abstract = "Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland. The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.",

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author = "Paul Henery and Eleftheria Vasileiou and Hainey, {Kirsten J.} and Duncan Buchanan and Ewen Harrison and Leyland, {Alastair H.} and Thomas Alexis and Chris Robertson and Utkarsh Agrawal and Lewis Ritchie and Stock, {Sarah Jane} and Colin McCowan and Annemarie Docherty and Steven Kerr and James Marple and Rachael Wood and Emily Moore and Simpson, {Colin R.} and Aziz Sheikh and Katikireddi, {Srinivasa Vittal}",

note = "Funding Information: Funding This study is being funded by the UKRI Centre on the Dynamics of Ethnicity 4 (ES/W000849/1). PH, SVK, AHL and KJH are funded by the Medical Research Council (MC_UU_00022/2) and Scottish Government Chief Scientist Office (SPHSU17). SVK is funded by a NRS Senior Clinical Fellowship (SCAF/15/02). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE-The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK; with additional support from the Scottish Government DG Health and Social Care. Funding Information: Competing interests SVK is co-chair of the Scottish Government{\textquoteright}s Expert Reference Group on Ethnicity and COVID-19 and a member of the UK Government{\textquoteright}s Scientific Advisory Group on Emergencies (SAGE) subgroup on ethnicity and COVID-19. AS is a member of the Scottish Government{\textquoteright}s Chief Medical Officer{\textquoteright}s COVID-19 Advisory Group, the Scottish Government{\textquoteright}s Expert Reference Group on ethnicity and COVID-19 and the UK Government{\textquoteright}s Subgroup on Risk Stratification of the New and Emerging Respiratory Virus Threats Group (NERVTAG). LR acts as a medical advisor to Scottish Government on primary care and public health, including vaccination issues. CRS reports grants from the UK National Institute for Health Research, Medical Research Council and New Zealand Health Research Council and The Ministry of Business, Innovation and Employment. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.",

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AU - Henery, Paul

AU - Vasileiou, Eleftheria

AU - Hainey, Kirsten J.

AU - Buchanan, Duncan

AU - Harrison, Ewen

AU - Leyland, Alastair H.

AU - Alexis, Thomas

AU - Robertson, Chris

AU - Agrawal, Utkarsh

AU - Ritchie, Lewis

AU - Stock, Sarah Jane

AU - McCowan, Colin

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AU - Kerr, Steven

AU - Marple, James

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AU - Moore, Emily

AU - Simpson, Colin R.

AU - Sheikh, Aziz

AU - Katikireddi, Srinivasa Vittal

N1 - Funding Information: Funding This study is being funded by the UKRI Centre on the Dynamics of Ethnicity 4 (ES/W000849/1). PH, SVK, AHL and KJH are funded by the Medical Research Council (MC_UU_00022/2) and Scottish Government Chief Scientist Office (SPHSU17). SVK is funded by a NRS Senior Clinical Fellowship (SCAF/15/02). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE-The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK; with additional support from the Scottish Government DG Health and Social Care. Funding Information: Competing interests SVK is co-chair of the Scottish Government’s Expert Reference Group on Ethnicity and COVID-19 and a member of the UK Government’s Scientific Advisory Group on Emergencies (SAGE) subgroup on ethnicity and COVID-19. AS is a member of the Scottish Government’s Chief Medical Officer’s COVID-19 Advisory Group, the Scottish Government’s Expert Reference Group on ethnicity and COVID-19 and the UK Government’s Subgroup on Risk Stratification of the New and Emerging Respiratory Virus Threats Group (NERVTAG). LR acts as a medical advisor to Scottish Government on primary care and public health, including vaccination issues. CRS reports grants from the UK National Institute for Health Research, Medical Research Council and New Zealand Health Research Council and The Ministry of Business, Innovation and Employment. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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N2 - Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland. The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.

AB - Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland. The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.

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Ethnic and social inequalities in COVID-19 outcomes in Scotland: Protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II)

Abstract

Bibliographical note

Keywords

UN SDGs

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