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Increased risk of COVID-19 outcomes among minority ethnic groups within Scotland

July 2023: Research published in the Journal of Epidemiology and Health has showed White Gypsy/Traveller and Pakistani groups have a higher risk of severe COVID-19 illness in Scotland.

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

Amele, S; Kibuchi, E; McCabe, R; Katikireddi, S.V; et. al

Journal of Epidemiology & Community Health

Published on: 31 July 2023

Available online at: http://dx.doi.org/10.1136/jech-2023-220501

Summary in plain English


Ethnic minority groups have been more affected by the spread of coronavirus (SARS-CoV-2) across the UK than White British people.

In the past, limited data about ethnicity in Scotland has led to:

  • A broad lack of representation in health data studies
  • Underestimation of the impact of health conditions on people from ethnic minorities
  • A reduced ability to identify important health outcomes for these groups.

New research on how severe COVID-19 affects minority groups can help shape future policy. Here, ‘severe COVID-19' describes a person being admitted to hospital with, or dying from the disease.

Why did we carry out this work?

We wanted to understand how the risk of SARS-CoV-2 infection and severe COVID-19 differed by ethnic groups in Scotland. We analysed health records across the four waves of the COVID-19 pandemic to understand inequalities (or differences) in case numbers by ethnicity. This helps to create more effective and supportive interventions for those who need it the most. 

What data did we use?

We used categorised ethnicity data from the 2011 Scottish Census and the EAVE II study, which contains COVID-19 health records for Scotland. We also used primary care, testing, vaccination, hospitalisation, and mortality data. The COVID-19 testing data was taken from the Electronic Communication of Surveillance in Scotland (ECOSS), morbidity and mortality data from Scottish Morbidity Record (SMR) and National Records of Scotland. This data was linked together using the Community Health Index (CHI), a unique numeric identifier used by NHS Scotland.

We included people who live in Scotland and are at least 16 years old. We used relevant records from over 4.3 million people from 1 March 2020 – 17 April 2022. Based on the 2011 Scottish Census, all ethnic groups were classified into five main and sixteen sub-categories as shown below:

  • White: White Scottish, White Other British, White Irish, White Gypsy/Traveller, White Polish, Other White
  • Mixed or multiple ethnic groups: Hereafter as Mixed
  • Asian: Pakistani, Pakistani Scottish or Pakistani British (Pakistani), Indian, Indian Scottish or Indian British (Indian), Bangladeshi, Bangladeshi Scottish or Bangladeshi British (Bangladeshi), Chinese, Chinese Scottish or Chinese British (Chinese), Other Asian.
  • Black: African, African Scottish or African British (African), Caribbean, Caribbean Scottish, Caribbean British (Caribbean).
  • Other ethnic groups: Hereafter, as Other. Arab, Arab Scottish or Arab British (Arab), and Other disaggregated.

Statistical analysis was used to estimate risk for people with different ethnic backgrounds. Characteristics such as, age, sex and health board (a regulatory organisation) were considered. To identify patterns, our main outcomes were differences in the risk of COVID-19 hospitalisation or death.

What did we find?

Overall pattern

We found the risk of COVID-19 hospitalisation or death was higher in certain ethnic minority groups and the level of risk changed across waves of infection.

Risk of severe COVID-19 at different stages

  • The risk was higher for White Gypsy/Traveller and Pakistani groups compared with White Scottish.
  • Risk after confirmed infection was higher for White Gypsy/Traveller, Pakistani and African ethnic groups in comparison to White Scottish.
  • No difference was found across all ethnic groups after hospitalisation for COVID-related deaths
  • Ethnic minority groups had a higher risk of hospitalisation or deaths in the first three waves compared to the fourth.

Wider impact

The increased risk of COVID-19 related outcomes for people from ethnic minority groups matches findings from previous studies in England, using linked Census data. These inequalities are not present following those who were in hospital. Rather, from confirmed infections from the community. This suggests hospital treatment is not a significant contributor to ethnic inequalities.

Why is this important?

This study shows that in Scotland, people’s ethnicity has an impact their COVID-19 health outcome. It demonstrates that ethnicity should be considered as a factor in future COVID-19 policy. This research is one of the few studies using sub-categories of ethnicity data to identify COVID-19 risk patterns.

Certain risks can be missed when looking at larger groups of people rather than smaller ones. For example, this study identified Pakistani or White/Traveller people experience higher risks of COVID-19 outcomes. Factors such as, chronic conditions, lower socio-economic and racism impact these groups and lead to higher health risks

We used self-reported ethnicity data that contributed to nationwide coverage. However, as we collected our data based on the 2011 census, we were unable to include those who may have emigrated or transferred to another GP. Therefore, future research is needed to understand which factors play a role in contributing to ethnic differences in COVID-19 outcomes. These findings can inform policy to create tailored strategies that address ethnic inequalities.


This summary was written by EAVE II's PPI Officer Anna Crawford, and reviewed by Patient Advisory Group members David W, Sandra J and Tamara J. The summary was also checked by team members directly involved in the study.

Find out more about the EAVE II PAG