Health inequalities in risk of SARS-CoV-2 infection in England’s second wave: 1 population-based cross-sectional analysis from the REACT-1 study
File(s)
Published version
Author(s)
Wang, Haowei
Riley, Steven
Elliott, Paul
Type
Journal Article
Abstract
Objectives
The rapid spread of SARS-CoV-2 infection caused high levels of hospitalisation and deaths in late 2020 and early 2021 during the second wave in England. COVID-19 disease during this period was associated with marked health inequalities across ethnic and sociodemographic subgroups. In this paper, we aim to investigate and quantify inequalities in the risk of SARS-CoV-2 infection across ethnic and sociodemographic subgroups during a
key period before widespread vaccination, thereby identifying the populations that bore a disproportionate burden of risk.
Methods
We analysed risk factors for test-positivity for SARS-CoV-2, based on self-administered throat and nose swabs in the community during rounds 5 to 10 of the REal-time Assessment of Community Transmission-1 (REACT-1) study between 18 September 2020 and 30 March 2021.
Results
Compared to the White ethnicity, people of Asian and the Black ethnicity had a higher risk of infection during rounds 5 to 10, with odds of 1.46 (1.27, 1.69) and 1.35 (1.11, 1.64) respectively, adjusted for demographic factors including age, sex, region, key work status, ethnicity and deprivation. Among ethnic subgroups, the highest and the second-highest odds were found in Bangladeshi and Pakistan participants at 3.29 (2.23, 4.86) and 2.15 (1.73, 2.68) respectively when compared to the White British participants. People in larger (compared to smaller) households had higher odds of infection. Health care workers with direct patient contact and care home workers showed higher odds of infection compared to
other essential/key workers. Additionally, the odds of infection among participants in public facing activities or settings were greater than among those not working in those activities or settings.
Conclusion
Our findings highlight the differences in the risk of SARS-CoV-2 infection in a global-north population during a period when the risk of infection was high, and there were substantial levels of social mixing. Planning for future waves of severe respiratory pathogens should
include policies to reduce inequality in the risk of infection by ethnicity, household size, and occupational activity in order to reduce inequality in disease.
The rapid spread of SARS-CoV-2 infection caused high levels of hospitalisation and deaths in late 2020 and early 2021 during the second wave in England. COVID-19 disease during this period was associated with marked health inequalities across ethnic and sociodemographic subgroups. In this paper, we aim to investigate and quantify inequalities in the risk of SARS-CoV-2 infection across ethnic and sociodemographic subgroups during a
key period before widespread vaccination, thereby identifying the populations that bore a disproportionate burden of risk.
Methods
We analysed risk factors for test-positivity for SARS-CoV-2, based on self-administered throat and nose swabs in the community during rounds 5 to 10 of the REal-time Assessment of Community Transmission-1 (REACT-1) study between 18 September 2020 and 30 March 2021.
Results
Compared to the White ethnicity, people of Asian and the Black ethnicity had a higher risk of infection during rounds 5 to 10, with odds of 1.46 (1.27, 1.69) and 1.35 (1.11, 1.64) respectively, adjusted for demographic factors including age, sex, region, key work status, ethnicity and deprivation. Among ethnic subgroups, the highest and the second-highest odds were found in Bangladeshi and Pakistan participants at 3.29 (2.23, 4.86) and 2.15 (1.73, 2.68) respectively when compared to the White British participants. People in larger (compared to smaller) households had higher odds of infection. Health care workers with direct patient contact and care home workers showed higher odds of infection compared to
other essential/key workers. Additionally, the odds of infection among participants in public facing activities or settings were greater than among those not working in those activities or settings.
Conclusion
Our findings highlight the differences in the risk of SARS-CoV-2 infection in a global-north population during a period when the risk of infection was high, and there were substantial levels of social mixing. Planning for future waves of severe respiratory pathogens should
include policies to reduce inequality in the risk of infection by ethnicity, household size, and occupational activity in order to reduce inequality in disease.
Date Issued
2026-01-01
Date Acceptance
2025-11-11
Citation
BMJ Public Health, 2026, 4 (1)
ISSN
2753-4294
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Public Health
Volume
4
Issue
1
Copyright Statement
Copyright © The Author(s). This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1136/bmjph-2025-002596
Publication Status
Published
Article Number
002596
Date Publish Online
2026-01-05