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Original research
Ethnic variation in outcome of people hospitalised during the first COVID-19 epidemic wave in Wales (UK): an analysis of national surveillance data using Onomap, a name-based ethnicity classification tool
  1. Daniel Rh Thomas1,2,
  2. Oghogho Orife1,
  3. Amy Plimmer1,
  4. Christopher Williams1,
  5. George Karani2,
  6. Meirion R Evans1,
  7. Paul Longley3,
  8. Janusz Janiec4,
  9. Roiyah Saltus5,
  10. Ananda Giri Shankar6
  1. 1Public Health Wales, Communicable Disease Surveillance Centre, Cardiff, UK
  2. 2Cardiff Metropolitan University School of Health Sciences, Cardiff, UK
  3. 3University College London, London, UK
  4. 4Narodowy Instytut Zdrowia Publicznego, Warszawa, Poland
  5. 5University of South Wales, Pontypridd, UK
  6. 6Public Health Wales, Health Protection Division, Cardiff, UK
  1. Correspondence to Professor Daniel Rh Thomas; Daniel.Thomas{at}


Objective To identify ethnic differences in proportion positive for SARS-CoV-2, and proportion hospitalised, proportion admitted to intensive care and proportion died in hospital with COVID-19 during the first epidemic wave in Wales.

Design Descriptive analysis of 76 503 SARS-CoV-2 tests carried out in Wales to 31 May 2020. Cohort study of 4046 individuals hospitalised with confirmed COVID-19 between 1 March and 31 May. In both analyses, ethnicity was assigned using a name-based classifier.

Setting Wales (UK).

Primary and secondary outcomes Admission to an intensive care unit following hospitalisation with a positive SARS-CoV-2 PCR test. Death within 28 days of a positive SARS-CoV-2 PCR test.

Results Using a name-based ethnicity classifier, we found a higher proportion of black, Asian and ethnic minority people tested for SARS-CoV-2 by PCR tested positive, compared with those classified as white. Hospitalised black, Asian and minority ethnic cases were younger (median age 53 compared with 76 years; p<0.01) and more likely to be admitted to intensive care. Bangladeshi (adjusted OR (aOR): 9.80, 95% CI 1.21 to 79.40) and ‘white – other than British or Irish’ (aOR: 1.99, 95% CI 1.15 to 3.44) ethnic groups were most likely to be admitted to intensive care unit. In Wales, older age (aOR for over 70 years: 10.29, 95% CI 6.78 to 15.64) and male gender (aOR: 1.38, 95% CI 1.19 to 1.59), but not ethnicity, were associated with death in hospitalised patients.

Conclusions This study adds to the growing evidence that ethnic minorities are disproportionately affected by COVID-19. During the first COVID-19 epidemic wave in Wales, although ethnic minority populations were less likely to be tested and less likely to be hospitalised, those that did attend hospital were younger and more likely to be admitted to intensive care. Primary, secondary and tertiary COVID-19 prevention should target ethnic minority communities in Wales.

  • COVID-19
  • epidemiology
  • public health

Data availability statement

Data are available on reasonable request. Individual data not available but aggregated data may be made available.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available on reasonable request. Individual data not available but aggregated data may be made available.

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  • Contributors DRT designed the study, contributed to the analysis and wrote the manuscript. OO contributed to the analysis and commented on the manuscript. AP, GK, MRE, JJ and RS commented on the manuscript and contributed to the validation work. PL commented on the methodology, referee comments and results, including use of the names classification tool. CW and AGS commented on the design and analysis and manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Paul Longley is Director of Publicprofiler Ltd.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.