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?:abstract
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Objectives:To address the generalisability of COVID-19\'s outcomes to the well-defined but diverse communities of a single City area. Design: An observational study of COVID-19 outcomes using quality-assured and integrated data from a single UK hospital contextualised to its feeder population and its associated factors (comorbidities, ethnicity, age, deprivation). Setting/Participants: Single city hospital with a feeder population of 228,632 adults in Wolverhampton\'s city area. Main Outcome Measures: Hospital admissions and mortality. Results: 5558 patients admitted, 686 died (556 in hospital); 930 were COVID-19 admissions (CA),of which 270 were hospital COVID deaths, 47 non-COVID deaths, 36 deaths post-discharge; 4628 non-COVID-19 admissions (NCA), 239 in-hospital deaths (2 COVID), 94 deaths post-discharge. 223,074 adults not admitted, 407 died. Age, gender, multi-morbidity and Black ethnicity (OR 2.1 [95% CI 1.5-3.2] p<0.001, absolute excess risk of <1/1,000) were associated with COVID-19 admission and mortality. The South Asian cohort had lower CA and NCA, lower mortality (CA (0.5 [0.3-0.8], p<0.01), NCA (0.4 [0.3-0.6] p<0.001), community deaths (0.5 [0.3-0.7] p<0.001). Despite many common risk factors for CA and NCA, ethnic groups had different admission rates, and within-groups differing association of risk factors. Deprivation impacted only in White ethnicity, in the oldest age bracket and in a lesser (not most) deprived quintile. Conclusions: Wolverhampton\'s results, reflecting high ethnic diversity and deprivation, are similar to other studies for Black ethnicity, age and comorbidity risk in COVID-19 but strikingly different in South Asians and for deprivation. Sequentially considering population and then hospital based NCA and CA outcomes, we present a complete single health-economy picture. Risk factors may differ within ethnic groups; our data may be more representative of communities with high BAME populations, highlighting the need for locally focussed public health strategies. We emphasise the need for a more comprehensible and nuanced conveyance of risk.
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