Researchers in the UK have reported on a protocol for a longitudinal study investigating the risk of adverse physical and mental health outcomes associated with coronavirus disease 2019 (COVID-19) among healthcare workers of various ethnic groups.
This study aims to address emerging evidence and growing concern that healthcare workers (health workers) from ethnic minority groups appear to be at greater risk of adverse COVID-19 outcomes than white health workers.
The protocol describes the UK-REACH longitudinal cohort study (UK Research Study on Ethnicity and COVID-19 in Healthcare workers).
Katherine Woolf of University College London Medical School and colleagues said the questionnaire data would be collected from UK healthcare workers and auxiliary workers at baseline, and then 4 months and 8 months from baseline. With consent, data will be linked to health care records and participants will be followed up for up to 25 years.
Multivariate analysis will be used to model changes over time and to understand the absolute and relative risks faced by different ethnic groups.
The results will be disseminated via reports to the government and papers which will be uploaded to preprint servers and submitted to peer-reviewed journals.
Preprint reports of this protocol are available at medRxiv* server, while papers undergo peer review.
Study flow chart
Health care workers and ethnic groups appear to be at particular risk
Since the COVID-19 outbreak first began in Wuhan, China, at the end of 2019, the pandemic has resulted in significant morbidity and mortality, with the death toll now reaching more than 2.52 million globally.
Health care workers and ethnic minority groups were among the groups identified to be at increased risk of infection with the causative agent – severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2).
Emerging evidence also suggests that healthcare workers from ethnic minority groups are at increased risk of adverse physical and mental health outcomes related to COVID-19, including anxiety, depression, and post-traumatic stress.
“There is concern that healthcare workers from ethnic minority groups are at risk of contracting SARS-CoV-2 and adverse COVID-19 outcomes compared to white healthcare workers,” Woolf and colleagues wrote.
However, to date, there has been no large-scale analysis of these outcomes and risks among health workers or adjunct workers in UK health care settings where data is stratified by ethnicity, the team said.
UK-REACH Work package 2 timeline from 4 February 2021.Dates displayed at bottom from October 2019 to July 2021. The COVID-19 outbreak began in the UK in January 2020 with daily hospital admissions due to COVID-19 shown with an under orange line for Wave one and Wave two. Vaccination starts in December 2020 and is shown by a green line for daily vaccinations. Locks are indicated by a horizontal red bar, the first national locks begin on 23 March 2020, the second on 5 November, and the third on 5 January 2021. Locks differ somewhat in timing between England, Wales, Scotland and Northern Ireland. Tiered local restrictions are in place across the UK between locks, shown in yellow. Questionnaire 1 Work package 2 began to be distributed on December 4 onwards and distributed until the end of March 2021. Questionnaire 1 asked about current events and working conditions, as well as retrospectives on pre-Covid incidents and working conditions in 2019, about the initial response to Covid in the months first year 2021, and about events during the first national lockdown. Questionnaire 2 will be distributed four months after registration for Questionnaire 1 and will therefore be distributed between April and June 2021. Questionnaire 2 asks about current working conditions, and changes in other aspects of the participants’ lives listed in Questionnaire 1, including the main measures of physical and mental health. With consent, the questionnaire data will be linked to the electronic health care record data.
More on the UK-REACH longitudinal study
To address this, the UK-REACH longitudinal study will rapidly examine differences in COVID-19 diagnosis, clinical outcomes, professional roles, and well-being among ethnic minority groups and white healthcare workers (aged 16 years or over) living in all four Great Britain.
This study will provide information on short-term outcomes to produce fast actionable outcomes and also enable future research on the effects of COVID-19 on healthcare workers in the medium and long term.
Three waves of questionnaires
Between December 2020 and January 2021, participants received basic questionnaires on demographics, job roles, physical and mental health, workplace location, residence, interactions with COVID-19 patients, social and living conditions, and discrimination and harassment. The baseline questionnaire also gathered some retrospective information on experiences and attitudes to work before and at the start of the pandemic.
Participants were then given the option of filling out two further follow-up questionnaires, one approximately 4 months from baseline and one approximately 8 months from baseline. The questionnaire will include the same results as the basic questionnaire, as well as new items that become relevant as the pandemic progresses.
Participants will be asked for consent to follow up for 25 years, during which time serial questionnaire data will be collected and periodically linked to health care records. Information will also be drawn from the COVID-19-related log and the participant’s “symptom study” website or app.
Analysis and results
Univariate analysis will be used to assess the relationship between ethnicity and primary outcomes – clinical COVID-19 outcomes and physical and mental health.
This will be followed by a multivariable analysis to examine the relationship between ethnicity and key outcomes after controlling for confounding variables.
Follow-up data will be used in a stratified model to assess changes over time by ethnic groups, thereby facilitating an understanding of absolute and relative risk among different ethnic groups.
“The results will be disseminated with reports to the government and papers uploaded to preprint servers and sent to peer-reviewed journals,” Woolf and colleagues said.
* Important Notice
medRxiv publishes preliminary scientific reports that are not peer reviewed and, therefore, should not be construed as conclusions, guidelines for health-related clinical / behavioral practice, or are treated as defined information.
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