Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study.

BACKGROUND: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census. METHODS: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group. RESULTS: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL. CONCLUSIONS: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths: analysis of 2 years of a record linked national cohort study in Scotland.

BACKGROUND: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland. METHODS: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time. FINDINGS: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave. INTERPRETATION: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities.

The impact of COVID-19 on different population subgroups: ethnic, gender and age-related disadvantage.

Against a background of stalling UK life expectancy, the COVID-19 pandemic is a major crisis for public health with impacts differing markedly by ethnicity, gender, and age. Direct health impacts include mortality and long-term harms among survivors. Social disruption and lockdown measures arising from uncontrolled infection have destabilised healthcare and other essential services. The economic crisis resulting from the pandemic is already triggering job losses, which will in turn have their own adverse health effects. These myriad impacts of the pandemic are not affecting everyone equally. Ethnic minorities, men and older people have disproportionately suffered from COVID-19, including their risk of mortality. However, some indirect impacts - including those on mental health and employment - are more likely to affect women and younger people. The health consequences of the pandemic will affect the lives of people in the UK for decades.

Psychological distress among people with probable COVID-19 infection: analysis of the UK Household Longitudinal Study.

Studies exploring the longer-term effects of experiencing coronavirus disease-2019 (COVID-19) on mental health are lacking. We explored the relationship between reporting probable COVID-19 symptoms in April 2020 and psychological distress (measured using the General Health Questionnaire) 1, 2, 3, 5 and 7 months later. Data were taken from the UK Household Longitudinal Study, a nationally representative household panel survey of UK adults. Elevated levels of psychological distress were found up to 7 months after probable COVID-19, compared with participants with no likely infection. Associations were stronger among younger age groups and men. Further research into the psychological sequalae of COVID-19 is urgently needed.

Ethnic and social inequalities in COVID-19 outcomes in Scotland: protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II).

INTRODUCTION: Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland.The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. METHODS AND ANALYSIS: We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. ETHICS AND DISSEMINATION: Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.

Reconciling diverse mammalian pigmentation patterns with a fundamental mathematical model.

Bands of colour extending laterally from the dorsal to ventral trunk are a common feature of mouse chimeras. These stripes were originally taken as evidence of the directed dorsoventral migration of melanoblasts (the embryonic precursors of melanocytes) as they colonize the developing skin. Depigmented 'belly spots' in mice with mutations in the receptor tyrosine kinase Kit are thought to represent a failure of this colonization, either due to impaired migration or proliferation. Tracing of single melanoblast clones, however, has revealed a diffuse distribution with high levels of axial mixing--hard to reconcile with directed migration. Here we construct an agent-based stochastic model calibrated by experimental measurements to investigate the formation of diffuse clones, chimeric stripes and belly spots. Our observations indicate that melanoblast colonization likely proceeds through a process of undirected migration, proliferation and tissue expansion, and that reduced proliferation is the cause of the belly spots in Kit mutants.

An emerging model of maternity care: smartphone, midwife, doctor?

BACKGROUND: Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. AIM: To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. METHODS: The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. FINDINGS: iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. DISCUSSION: The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care.