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Deprivation factors should be included in Covid admission risk scores

Deprivation factors should be included in Covid admission risk scores

Patients from ethnic minority groups who are living in the areas of highest deprivation are more likely to be hospitalised with Covid yet this is not included in current tools used to assess risk on admission, researchers warn.

A study of Covid patients admitted to four hospitals in the Midlands found that patients from ethnic minority groups were younger had higher multi-morbidity and were more likely to have a range of deprivation factors not included in current risk scores.

Not taking account of these factors on admission may lead to patients being inappropriately triaged and clinicians being ‘falsely reassured’ about the severity of presentation of risk of deterioration, the researchers conclude in BMJ Open.

The detailed analysis of 3,600 patients hospitalised with Covid found a range of deprivation measures including household overcrowding, air pollution, housing quality and adult skills were associated with multi-lobar pneumonia on presentation and intensive care admission.

Yet these factors, which predominantly affect ethnic minority groups are not included in several tools used to calculate a patients’ risk on admission, the researchers from the University of Birmingham said.

They pointed out that the community-based QCOVID tool for predicting hospital admission does at least incorporate a deprivation score, but that doesn’t take into account air pollution, housing quality, or adult skills data that were all found to be risk factors for more severe disease in their analysis.

More work on this in other urban centres is needed with this level of detail to inform national planning on risk stratification and to minimise health inequalities, they added.

Their data shows that ethnic minority patients were almost 5 times more likely to present to hospital when aged under 65 as white patients and have higher co-morbidity scores.

The proportion of individuals from ethnic minorities hospitalised from the most deprived quintile was far higher when compared for white patients for a range of measures including housing, living environment and education.

Considering multi-ethnic age structures, sex, body mass index, co-morbidity scores, chest X-ray imaging and deprivation subdomains on admission would help clinicians in stratifying high-risk patients, the researchers concluded.

‘Covid-19 admission clinical risk stratification tools need to be developed to account for risk factors to which ethnic minorities are predominantly exposed.

‘This will enable the early identification of patients at risk of deterioration and ensure triage to an appropriate level of care.’

The Covid risk algorithm published last year identified a black, Asian and minority ethnic (BAME) background as one of the top risk factors for Covid-19, alongside being male and aged over 70.

Figures from the Office for National Statistics show that ethnic minority groups account for 34% of critically ill patients with Covid despite constituting 14% of the UK population.

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