There’s also lots of evidence that coronavirus presents higher risks for black, Asian and minority ethnic (BAME) people, who make up 17% of the English population, but what can we say about the risk for BAME older people? Emily McCarron and Elizabeth Webb look into the available evidence.
Since the beginning of the coronavirus epidemic in the UK there have been indications that our BAME populations have been more at risk of the worst consequences of coronavirus than the white population. The Office for National Statistics recently revealed that in England and Wales, from the start of the coronavirus epidemic until 15 May 2020, 4,326 BAME people died from coronavirus, and that almost three quarters (73.5%) of those people were aged 65+.
Most BAME populations are younger on average than the white population, and when this is taken into account, the chances of BAME people dying of COVID-19 have been shown to be even higher. By 15 May 2020, 256 black males and 120 black females of every 100,000 died of COVID-19, compared to 87 white males and 52 white females.
But what has caused these greater losses among BAME communities? The evidence suggests that it’s due to BAME people having greater chances of catching coronavirus and greater chances of the worst outcomes once they have caught it. How might this impact upon BAME older people in particular?
Is there a greater chance of BAME older people catching coronavirus?
Most of the evidence of greater risk from coronavirus for BAME people has focussed on risks for working age people, in particular the greater chances BAME people have of being in a key worker occupation. However, as most of the people who go on to sadly die of coronavirus are older, the majority of BAME people who have died will not have been working. What might the risks be that are specific to older people?
Having family members in key worker roles
Although most of the BAME older people who have been severely affected by coronavirus are pensioners, they are more likely than white older people to have family who are in key worker roles: 20% of the people working in the jobs that put them at highest risk of catching coronavirus are BAME, compared to 11% of people who work overall.
For instance, 28% of doctors, 19% of nurses and 28% of dentists are BAME, as well as 19% of care workers, 19% of bus and coach drivers and 44% of taxi drivers [1]. The younger family members of BAME older people are more likely to have been doing the essential work outside of their homes that puts them at greater risk of catching coronavirus.
Living with more people, in multigenerational households
New evidence from the Office for National Statistics (ONS) suggests that people living in households with fewer other people may have been less likely to catch coronavirus than people living in larger households [2]. While the majority of older people in the UK either live alone or with a partner, older people from most BAME groups are more likely than white older people to live in larger, multigenerational households.
For instance, less than 2% of white people aged 70+ live in multigenerational households, while 56% of Bangladeshi, 35% of Pakistani, 13% of Indian, 11% of Black African and 6% of Black Caribbean people aged 70+ do [3]. Living in a multigenerational household means older people are more likely to be living with someone who is going out to work, and so at higher risk of catching coronavirus.
Living in overcrowded housing
BAME older people are also more likely to live in overcrowded households than white older people: about 37 in every 1,000 older BAME households is overcrowded, compared to 2 in every 1,000 older white British households [4]. This may mean that these BAME older people were more likely to have been living in a household where a person with coronavirus symptoms would have been unable to self-isolate to prevent the spread of the virus to other household members.
Living in densely populated, urban areas most affected by coronavirus
The areas of England that were initially the hardest hit by coronavirus outbreaks – London and the cities of the West Midlands and the North West – are also places where higher proportions of BAME people live.
For instance, 36% of Asian people and 58% of black people who live in the UK live in London, and 97% of Asian and 98% of black people, compared to 79% of white people, live in urban areas [5]. Living in the densely populated urban areas where the first outbreaks happened has put BAME older people at higher risk of catching coronavirus.
Is there a greater chance of the worst outcomes for BAME people?
As well as being more likely to have been at risk of catching the virus than white older people, the available evidence suggests that BAME older people are also more likely, once they’ve caught the virus, to die from it.
The Intensive Care National Audit and Research Centre (ICNARC) collects information on people in hospitals across England, Wales and Northern Ireland who are seriously ill with coronavirus. They have found that 34% of people who have been admitted to critical care in the UK with coronavirus were BAME. The chances were much higher for BAME people than expected: if BAME and white people had the same chances of being admitted to critical care, only 22% of those admitted would have been BAME. They also found that BAME people were more likely to die in critical care: 39% of white people died compared to 45% of Asian people and 42% of black people. [6]
These differences must at least partly be due to the inequalities in health we see across the population. BAME people are more likely to have some of the underlying conditions, including obesity, diabetes and heart disease, which increase the chances of the worst outcomes from coronavirus. These health inequalities, which are exacerbated by coronavirus, are due to experiences of social and economic inequalities, and racism, across BAME people’s life courses.
Care homes
During the coronavirus epidemic there has been a significant loss of life for care home residents. As of 12 June 2020, 19,394 care home residents had died of coronavirus. The Care Quality Commission has found that, during the peak of the epidemic, higher proportions of deaths among black (54%) [7] and Asian (49%) than white (44%) people in care homes were attributed to coronavirus [8]. However, because the information the CQC has is limited, it is not possible to get a full picture of the ethnic inequalities in risk of coronavirus for care home residents. The true impact may in fact be much larger.
Is this the full picture?
Despite not telling the full story, the evidence available so far shows clearly that BAME older people are at higher risk of catching coronavirus than white older people, and suggests that they are at greater risk of dying from it once they have caught it. At the same time as the Black Lives Matter movement has drawn attention to racism both in the UK and around the world, the coronavirus epidemic has revealed the structural racism and health inequalities facing BAME older people. Age UK is committed to tackling the inequalities and exclusion experienced by many BAME older people, and promoting equality and inclusion of older people from diverse backgrounds in all areas of our work.