Though most cases are mild or asymptomatic, some people are at a higher risk of severe coronavirus disease (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and those with underlying health conditions or weakened immune systems are vulnerable and should take extra precautions to prevent infection.
A new study by researchers in the UK found that older people living with relatives are at an increased risk of severe COVID-19 and death. They also revealed that living in a multi-generational household, where extended family members live, was tied to increased COVID-19 mortality.
Ethnic minorities and COVID-19
People of ethnic minority background in the United Kingdom and the United States have been disproportionately affected by COVID-19. Those of Black and South Asian groups are particularly vulnerable.
Many past studies have tackled why these people are at a higher risk of dying from COVID-19. One important driver of ethnic inequalities may be the differences in household structure between ethnic groups.
The number of people in a household may significantly affect the risk of contracting the virus. Living in multi-generational households is tied to increased social capital, which can benefit health. On the contrary, it also increases the risk of potential viral transmission. For older adults, who are at an elevated risk of having severe complications if infected, living with younger people may increase exposure to infection.
In the study published on the preprint medRxiv* server, the researchers explored the relationship between household composition and COVID-19 mortality risk among older adults who are more than 65 years old and residing in the UK.
The team focused on multi-generational households, wherein elderly individuals were living with younger adults or dependent children. They checked how the tendency to live with younger people in the household varies across ethnic groups and how this contributes to a raised risk of COVID-19-related death.
What the study found
The study highlights how household composition may contribute to higher mortality due to COVID-19. For instance, in the White population, the younger family members will be independent come the right age.
Meanwhile, in Black and South Asian ethnicities, the culture reflects close family ties, wherein family members more often live with each other in one household.
Household composition by ethnic group for people in England aged ≥65 years, stratified by sex.
The study included all usual residents of England aged 65 years old or over in 2020, who had been enumerated in private households at the 2011 census. The researchers included those who entered the UK in the year before the census was performed. Overall, there were more than 10 million older adults as of March 2, 2020.
The team has found that living in a multi-generational household was tied to an increased risk of COVID-19 death. The team also said that it contributes to between 10 percent and 15 percent of the elevated risk of death among older females from South Asian backgrounds, but very little for South Asian males or people in other ethnic groups.
The increased risk is likely driven by living with younger adults, who are at a higher risk of infection than the elderly, due to work. Younger people go out of the household to attend schools or work; hence, they have a higher risk of being infected.
Also, older people living by themselves are at a higher risk of dying from COVID-19 than those living with another older adult. During the pandemic, older people living alone were more likely to be cared for by caregivers, including informal helpers, than those who live with another adult. Also, they are more likely to go out to purchase food and basic needs.
“Older adults living with younger people are at increased risk of COVID-19 mortality, and this is a notable contributing factor to the excess risk experienced by older South Asian females compared to White females,” the team concluded.
“Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent,” they added.
The researchers recommended that effective isolation and improved ventilation within homes can help reduce the transmission risk within the household. Further, they suggest more studies to explain the difference in COVID-19-related death between ethnic groups.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
- Nafilyan, V., Islam, N., Ayoubkhani, D., Gilles, C., et al. (2020). Ethnicity, Household Composition and COVID-19 Mortality: A National Linked Data Study. medRxiv preprint. doi: https://doi.org/10.1101/2020.11.27.20238147, https://www.medrxiv.org/content/10.1101/2020.11.27.20238147v1