Black and Asian people may be more likely to die of Covid-19 in England and Wales because many of them live in polluted areas, according to an official report.
The Office for National Statistics (ONS) today said it found a seven per cent increase in the risk of dying of coronavirus in England’s most polluted areas.
But this increase seemed to disappear when experts took people’s race into account, prompting the government agency to admit the link was ‘inconclusive’.
The findings suggest ethnic minority people are more likely to die from the disease because they live in polluted cities.
But the ONS warned toxic air is not necessarily worsening the risk from the virus because London and other pollution-hit areas were the first to be hit, meaning death rates would inevitably be higher.
However, the ONS today acknowledged that air pollution is ‘one of many factors’ that could be driving disproportionate outcomes for black, Asian and minority ethnic (BAME) people. And scientists today said it was ‘very plausible that higher exposure to air pollution will be a contributory factor’.
Numerous reports have found that BAME people in Britain face a higher risk than white people of dying if they catch coronavirus.
The reasons for this remain unclear but may include the fact minority ethnic people are more likely to be poorer and therefore in worse health, and more likely to work in public-facing jobs where they are more likely to catch the illness.
The ONS report said 35 per cent of people who died of Covid-19 up to June had a lung or heart disease — which can be caused by pollution — before they caught the virus.
The report, the first of its kind published by the ONS, said the effect of pollution on risk of coronavirus death appeared to be smaller than previous research had suggested.
The statistical analysis grouped areas across the country according to levels of deprivation, population density and average exposure to PM2.5 over five years to account for regional differences in infection rates.
It included 46,471 deaths of people in England between March 7 and June 12, using a model that also took into account factors such as pre-existing health conditions and smoking rates. It also looked at ethnicity.
It estimated that there was a seven per cent increase in Covid-19 death risk for people who inhaled an extra one microgram per cubic metre of particulate matter over 10 years.
Particulate matter is pollution made up on tiny particles that are produced by car exhausts, friction between tyres and roads, and construction work.
The World Health Organization said no amount of PM2.5 – the smallest type of particulate matter – is considered safe, but said countries should try to keep levels below 10 micrograms per cubic metre.
Currently, the UK follows EU guidelines which are looser and suggest pollution be limited to 25ug/m3. In London the average was between 12 and 20ug/m3 in 2016.
PM2.5 infiltrates the blood stream and lungs, irritating cells and disrupting DNA, and cause serious damage to the body if absorbed regularly over long periods of time.
The ONS report found that at the peak of Britain’s epidemic, death rates were higher in more polluted areas, typically inner London and Birmingham.
But this was also because of other factors, such as numbers of confirmed cases and the number of people living in poverty.
As the outbreak spread further outside of cities, the link between pollution and deaths became weaker, the report showed.
As the more polluted — and more populated — areas had higher deaths, so too did the black, Asian and ethnic minority community.
Greater proportions of non-white people live in polluted inner city areas than white people, who are more likely to live outside of town and city centres.
The ONS report noted that pollution may contribute to the deaths of BAME people, or that BAME people may be at risk of dying because of other reasons, which made deaths higher in the polluted areas they happened to live in.
‘A range of structural differences are resulting in higher Covid-19 death rates among people of Black, Asian and Minority Ethnicity (BAME),’ the report said.
‘Air pollution exposure could be a contributing factor if it causes Covid-19 deaths, with the BAME population more likely than those of White ethnicity to live in inner city areas (that are more polluted).
‘Ultimately, our analysis is inconclusive.
‘Without controlling for ethnicity, we find long-term exposure to fine particulate matter (PM2.5) could increase the risk of contracting and dying from Covid-19 by up to 7 per cent.
‘However, when controlling for ethnicity, air pollution exposure has no statistically significant impact on Covid-19 deaths.
‘As air pollution is just one of many factors that could be driving disproportionate outcomes for minority ethnic groups, the increased risk of dying from Covid-19 (found when ethnicity is not controlled for) is likely to be an overestimate of the true effect.’
Professor Alastair Lewis, an atmospheric chemistry expert at the University of York, said: ‘The study shows that some of the early associations made between exposure to air pollution and an increased risk of Covid-19 mortality were artificially enhanced because the disease initially spread in large cities.
‘As Covid-19 became more evenly distributed through the UK over time the effect of air pollution on mortality became less pronounced.
‘The ONS analysis shows that long-term exposure to air pollution does still potentially increase the risk of mortality from Covid-19’.
He added: ‘Ethnic minority communities have been some of the most affected by Covid-19 and it is very plausible that higher exposure to air pollution will be a contributory factor.’
The ONS report comes after a paper published by Public Health England in June found that BAME Brits had a noticeably higher risk of dying if they caught Covid-19.
The PHE report revealed Britons of Bangladeshi ethnicity have around twice the risk of white Brits of dying with the coronavirus.
And it showed black people, as well as those of Chinese, Indian, Pakistani, other Asian, or Caribbean backgrounds had between a 10 and 50 per cent higher risk of death. The analysis did not take into account higher rates of long-term health conditions among these people, which experts say probably account for some of the differences.
Evidence compiled in the report also revealed that age is the single biggest risk factor that determines how likely people are to die with the virus – those over the age of 80 are 70 times more likely to be killed than under-40s.
And health conditions which appeared often on people’s death certificates were heart disease, diabetes – understood to be type 2 diabetes, high blood pressure and dementia. More than one in five victims had diabetes, the data showed, which was a significantly higher rate than in people who died of other causes.
Poorer, more deprived people faced a higher risk of dying and men working in lower-paid jobs – such as security guards, bus drivers and construction workers – also had worse chances of survival if they contracted the virus.
Health chiefs launched a probe to investigate the disproportionate impact of Covid-19 on BAME Brits in April, prompted by a wave of evidence that showed white people were less likely to die from the disease.
Mr Hancock admitted that the report has ‘exposed huge disparities in the health of our nation’ and his counterpart in the Labour Party, Shadow Health Secretary Jonathan Ashworth, noted: ‘Covid thrives on inequalities’.
Doctors still don’t know exactly what is increasing non-white people’s risk of death, but PHE’s report adds to a growing body of evidence proving the link exists.
One paper presented to government advisers in SAGE suggested that higher-than-average rates of type 2 diabetes among black and south Asian people may be to blame – the condition is known to increase risk of Covid-19 death.
The highest diagnosis rates per 100,000 population were in black people (486 females and 649 males), the PHE review found. The lowest were in white people (220 in females and 224 in males).
Compared to previous years, death from all causes was almost four times higher than expected among black males, almost three times higher in Asian males and almost two times higher in white males.
Among females, deaths were almost three times higher in this period in black, mixed and other females, and 2.4 times higher in Asian females compared with 1.6 times in white females.
The highest death rates of confirmed cases per 100,000 population were among people in ‘other’ ethnic groups (234 females and 427 males) followed by people of black ethnic groups (119 females and 257 males) and Asian ethnic groups (78 females and 163 males).
In comparison, the death rates of confirmed cases in white people was 36 per 100,000 females and 70 per 100,000 males.