Background Ethnic minorities account for 34% of critically ill patients with COVID-19 despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand deterioration risk factors to inform clinical risk tool development. Methods Multicentre cohort study of hospitalised patients with COVID-19 (n=3671) exploring determinants of health, including Index of Multiple Deprivation (IMD) subdomains, as risk factors for presentation, deterioration and mortality by ethnicity. Receiver operator characteristics were plotted for CURB65 and ISARIC4C by ethnicity and area under the curve (AUC) calculated. Results Ethnic minorities were hospitalised with higher Charlson Comorbidity Scores than age, sex and deprivation matched controls and from the most deprived quintile of at least one IMD subdomain: indoor living environment (LE), outdoor LE, adult skills, wider barriers to housing and services. Admission from the most deprived quintile of these deprivation forms was associated with multilobar pneumonia on presentation and ICU admission. AUC did not exceed 0.7 for CURB65 or ISARIC4C among any ethnicity except ISARIC4C among Indian patients (0.83, 95% CI 0.73 to 0.93). Ethnic minorities presenting with pneumonia and low CURB65 (0–1) had higher mortality than White patients (22.6% vs 9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004). Conclusions Ethnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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COVID-19 入学风险工具应包括多种族年龄结构、多发病率和空气污染剥夺指标、家庭过度拥挤、住房质量和成人技能

背景 尽管少数民族占英国人口的 14%，但仍占 COVID-19 危重患者的 34%。在国际上，研究人员呼吁开展研究以了解恶化风险因素，以便为临床风险工具开发提供信息。方法 对 COVID-19 住院患者 (n=3671) 进行多中心队列研究，探索健康的决定因素，包括多重剥夺指数 (IMD) 子域，作为按种族分类的表现、恶化和死亡率的风险因素。通过计算的种族和曲线下面积 (AUC) 绘制 CURB65 和 ISARIC4C 的受试者操作特征。结果 少数民族住院时的 Charlson 合并症评分高于年龄、性别和剥夺匹配的对照组，并且来自至少一个 IMD 子域的最贫困五分之一：室内生活环境 (LE)、室外 LE、成人技能、更广泛的住房和服务障碍。从这些剥夺形式中最贫困的五分之一入院与就诊和入住 ICU 时发生多叶性肺炎有关。除了印度患者中的 ISARIC4C，任何种族的 CURB65 或 ISARIC4C 的 AUC 均不超过 0.7（0.83，95% CI 0.73 至 0.93）。表现出肺炎和低 CURB65 (0-1) 的少数民族的死亡率高于白人患者（22.6% 对 9.4%；p<0.001）；非洲人的风险最高（38.5%；p=0.006），其次是加勒比人（26.7%；p=0.008）、印度人（23.1%；p=0.007）和巴基斯坦人（21.2%；p=0.004）。结论 尽管年龄结构较年轻且不成比例地暴露于未计分的风险因素（包括肥胖和贫困），少数民族仍表现出较高的多发病率。家庭过度拥挤，空气污染、住房质量和成人技能剥夺与就诊和入住 ICU 的多叶性肺炎有关，这些都是死亡风险因素。风险工具需要反映主要影响少数民族的风险。与研究相关的所有数据都包含在文章中或作为补充信息上传。