New clinical risk management tools are needed to prevent COVID-19
deaths, say experts

Date:
August 13, 2021
Source:
University of Birmingham
Summary:
A new study exposes the dire need for new clinical risk management
tools to help hospital healthcare workers prevent the deaths and
intensive care admissions of Black, Asian and minority ethnic
(BAME) COVID-19 patients with pneumonia, say researchers.



FULL STORY ==========================================================================
A new study exposes the dire need for new clinical risk management tools
to help hospital healthcare workers prevent the deaths and intensive care admissions of Black, Asian and minority ethnic (BAME) COVID-19 patients
with pneumonia, say researchers.


==========================================================================
The call for healthcare policy change comes after a new study led by
the University of Birmingham has revealed ethnic minority COVID-19
patients from areas with the highest levels of household overcrowding,
air pollution, poor housing quality and adult skills deprivation
are more likely to be admitted to hospital suffering pneumonia and
requiring intensive care. Indian, Pakistani, African, Caribbean,
Chinese, Bangladeshi and mixed ethnicity patients were all more likely
than Caucasians to be admitted from an area with at least one form
of deprivation.

The first of its kind study of 3,671 patients with COVID-19 admitted to
four Midland hospitals provides new important and detailed insights into
the stark contrasts between ethnic minorities and Caucasians.

It found 81.5% of ethnic minority COVID-19 patients were more likely to
be admitted to hospital from regions of highest air pollution deprivation compared with 46.9% of Caucasians. 81.7% of hospitalised ethnic minority COVID-19 patients were more likely to be admitted from regions of highest household overcrowding deprivation compared with 50.2% of Caucasians.

Crucially, the study found that existing tools used by medics to
predict or measure risk and manage the care of COVID-19 patients with
pneumonia are insufficient, and can result in underscoring of ethnic
minority patients. This is particularly due to the fact that often
they do not take into consideration that ethnic minority patients
are at greater risk of serious illness with COVID-19 at a younger age
than Caucasians. The study found of those patients hospitalised, ethnic minorities , including Indian, Pakistani, African, Chinese, Bangladeshi
and any other non-Caucasian ethnic group were under the age of 65,
while Caucasians were older than 65.

Existing scoring also does not take into account important risk factors
that ethnic minority patients are much more exposed or vulnerable to,
including suffering multiple pre-existing underlying health conditions, obesity, and deprivation, such as living in overcrowded households or
areas of high pollution.

The researchers say underscoring can potentially lead to inappropriate
levels of care as clinicians are left falsely reassured regarding the
severity of illness and risk of a patient's deterioration.

The results showed ethnic minority patients with pneumonia and low
CURB65 scores -- a tool used by clinicians to predict severity of
pneumonia -- had higher mortality than Caucasians (22.6% vs 9.4%
respectively). Africans were at highest risk (38.5%), followed by
Caribbean (26.7%), Indian (23.1%), and Pakistani (21.2%) patients.

The research was supported by the National Institute for Health Research
(NIHR) and its publication comes following the gripping BBC 1 documentary
"Why is COVID killing people of colour?" which was released earlier this
year where the lead author, Dr Marina Soltan, was interviewed by David
Harewood following a previous study she led showing that patients with
chronic conditions such as hypertension or kidney disease are nearly
twice as likely to die from COVID-19 and that many patients with these conditions come from deprived areas.

Lead author Dr Marina Soltan, a NIHR Academic Clinical Fellow in
Respiratory Medicine at the University of Birmingham and the NHS England
Health Inequalities Improvement Policy and Delivery Lead for Data and
Research, said: "The COVID-19 pandemic has shone a harsh light on health inequalities. This study demonstrates an urgent need for the development
of novel clinical risk stratification tools, ensuring they reflect
risk factors to which ethnic minorities are predominantly predisposed."
"This work has implications for how we train healthcare professionals
to recognise multi-ethnic risk factors and public health implications
for how to narrow the gap on health inequalities.

"Meanwhile, partnership with both government and industry is beneficial
to prevent the rise in the number of patients with multiple chronic
illnesses and reduce inequalities, ensuring everyone has access to
suitable housing, employment and education opportunities, regardless." ========================================================================== Story Source: Materials provided by University_of_Birmingham. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Marina A Soltan, Justin Varney, Benjamin Sutton, Colin R Melville,
Sebastian T Lugg, Dhruv Parekh, Will Carroll, Davinder P Dosanjh,
David R Thickett. COVID-19 admission risk tools should include
multiethnic age structures, multimorbidity and deprivation metrics
for air pollution, household overcrowding, housing quality and adult
skills. BMJ Open Respiratory Research, 2021; 8 (1): e000951 DOI:
10.1136/bmjresp-2021- 000951 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210813151939.htm

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