QResearch reveals ethnic minority children more likely to test positive for COVID-19

21 Jun 2021

Ethnic minority children in England are more likely to test positive for COVID-19 than white children, with Asian children more likely to be admitted to hospital with the illness, according to research by the University of Oxford using QResearch – a not-for-profit initiative between the university and EMIS.

Ethnic minority children in England are more likely to test positive for COVID-19 than white children, with Asian children more likely to be admitted to hospital with the illness, according to research by the University of Oxford using QResearch – a not-for-profit initiative between the university and EMIS.

The observational analysis of 2.6 million healthcare records - the largest population study of COVID-19 in children to date - suggests a link between ethnicity and COVID-19, with important implications for global public health strategies to combat the virus, such as access to tests.

In the study, published in JAMA Paediatrics, the research team from the Universities of Oxford, Leicester, Nottingham, Cambridge and Southampton analysed a nationally-representative sample of children’s electronic healthcare records from the QResearch database to understand whether the established link between ethnicity and COVID-19 in adults was similar in children.

Overall, 410,726 (15.9% of the total cohort) children in the analysis were tested for SARS-CoV-2, with 26,322 (6.4% of children tested) receiving a positive test and 343 (0.01% of the total cohort) admitted to hospital. COVID-19 testing in children varied across race and ethnicities - 17.1% of white children in the study were tested for SARS-CoV-2 compared with 13.6% of Asian children, 12.9% of children from mixed/other ethnicities, and 8.3% of Black children.

Compared with white children, the odds of a positive test were higher in children from Asian (1.8 times more likely), Black (1.12 times more likely) and mixed/other ethnicity (1.14 times more likely) backgrounds.

Asian children were 1.62 times more likely to be admitted to hospital with confirmed COVID-19 than white children, while hospital stays in Black, mixed race and children from other ethnicities were around 36 hours longer than in white children. There was one death from COVID-19 in the study cohort.

Co-author Professor Julia Hippisley-Cox, lead of the Primary Care Epidemiology Group at Oxford University’s Nuffield Department of Primary Care Health Sciences, said “While children are at a substantially lower risk from COVID-19 compared with adults, this study suggests that race and ethnicity play an important role in outcomes for COVID-19 across all age groups. Our findings reinforce the need for ethnicity-tailored approaches to diagnosing and managing COVID-19 in community settings, so those families at most risk of severe illness are better informed and have greater access to tests.”

“We’re delighted to support the research programme to enable fast and meaningful analysis on Covid-19. I’d like to thank all of the GP practices using EMIS systems that have opted in to the QResearch programme to enable ground-breaking research like this.”

Dr Shaun O’Hanlon, chief medical officer, EMIS Group

Dr Shaun O’Hanlon, Chief Medical Officer, EMIS Group, said: “Building up evidence of trends and patterns through research means collectively as a healthcare industry we are better placed to make decisions that positively impact patient outcomes on a large scale.”

The observed unequal testing across different races and ethnicities in this study supports similar findings from the US, providing a clearer picture of inequity in healthcare access across the two nations. The researchers accounted for key demographic factors such as age, sex, geography, deprivation, household size and underlying health conditions. They caution that because the study was observational, certain biases could not be ruled out, which should be considered before drawing any further conclusions.

Data for the analysis was obtained between January and November 2020 from QResearch, a database of anonymised health records from 1,300 GP practices across England and linked to COVID-19 test results and hospital admissions data. The research was funded by the Medical Research Council.

Oxford University researchers also used QResearch to create a model to predict which factors would place patients at higher risk if they caught coronavirus. QCovid works out a patient’s risk of hospitalisation and death. This information became invaluable when prioritising patient groups for vaccinations. As a result of this model, in February 2021, 1.5 million people were added to the Shielded Patient List, ensuring the most vulnerable were prioritised for the vaccine. The research that created the QCovid algorithm was published in the BMJ.