High COVID Burden Among South Asians in Greater Toronto Area

Fran Lowry

July 13, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Among the South Asian community in the greater Toronto area of Ontario, Canada, the burden of SARS-CoV-2 infection has been high, according to a new study.

By the third wave of the COVID-19 pandemic in Ontario, 23.6% of a sample of South Asian individuals living in the Peel Region had serologic evidence of prior SARS-CoV-2 infection.

Dr Gita Wahi

"The media had widely reported that South Asian communities were at higher risk of COVID-19, so it was important to gather data to build the evidence base and to understand what factors accounted for the higher infection rate," co-investigator Gita Wahi, MD, PhD, associate professor of pediatrics, McMaster University, Hamilton, Ontario, told Medscape Medical News.

Nearly one third of these individuals were essential workers, and 19% reported living in multigenerational households.

The findings were published online July 5 in CMAJ Open.

Cross-Sectional Analysis

The investigators conducted a cross-sectional analysis of 916 South Asian people from April 14 to July 28, 2021. The participants were enrolled in the COVID CommUNITY study, a prospective cohort study focused on South Asian adults living in the provinces of Ontario and British Columbia.

Seropositivity was determined from dried blood spot sampling.

All participants were encouraged to complete a questionnaire online via an emailed link. The questionnaire asked about type of employment, health history, prior SARS-CoV-2 infection, perception of risk for SARS-CoV-2 infection, and primary and trusted sources of COVID-19 information.

Persons were considered essential workers if they were healthcare workers; employees in a food manufacturing or distribution center who could not work from home; retail employees working in a store, either in an essential retail setting or in a nonessential retail setting; and grocery, food bank, nonclinical pharmacy, restaurant, liquor, wholesale, and general goods workers.

Of the 916 participants for whom dried blood spot samples were analyzed, 693 (75.5%) completed the questionnaire online or by telephone.

Relevant Sociodemographic Factors

The mean age of the participants was 41.5 years, and 49.2% (n = 451) were women.

Most (91.7%, n = 830) participants lived in the Peel Region, and most (82%, n = 742) were from Brampton. About two thirds of the participants (65.4%, n = 469) were born in Canada or had lived in Canada for more than 10 years.

Overall, 228 participants (32.9%) worked in essential jobs, and 125 participants (19.1%) said they lived in a multigenerational household.

Among patients who answered questions about risk perception, 89% said that COVID-19 posed a major threat to the South Asian community because of their location, work or profession, lifestyle, or housing situation.

Participants' top-ranked sources of health information included healthcare providers and public health bodies (63.2%, n = 370), traditional media sources, such as TV news channels and newspapers (45.1%, n = 264), social media (33.5%, n = 196), and friends, family, or co-workers (29.1%, n = 170).

Overall, the seropositivity rate for previous SARS-CoV-2 infection was 23.6% (95% CI, 20.8% to 26.4%).

Adjusted seropositivity was higher among participants who were male, were older, had less education, were living in multigenerational households, had lower income, and who were from the city of Brampton.

"It is the sociodemographic factors, or social determinants of health, which place South Asians from the Peel Region at higher risk of COVID-19, compared to the general population," said Wahi.

"One third of participants in this study were essential workers through the pandemic, and 20% lived in multigenerational households. These factors, along with lower socioeconomic status, are the primary determinants of the higher seropositivity rates in Peel's South Asian community, instead of any innately biological cause," Wahi noted.

"COVID-19 exposed the inequities in terms of healthcare access," she added. "Understanding the factors that rendered any community a hot spot for COVID-19 will not only help us manage future pandemics, but the insights can also inform Canada's ongoing efforts to achieve more equitable health outcomes," Wahi said.

Reducing Exposure Risk

"Throughout the pandemic, we have seen that demographic groups such as racialized people or people who live in low-income neighborhoods have experienced much higher burden and worse outcomes from COVID-19 infection," Fahad Razak, MD, assistant professor of health policy, management, and evaluation at the University of Toronto, told Medscape Medical News. Razak did not participate in the research.

Dr Fahad Razak

"This important study explores what factors may have contributed to this increased risk by focusing on one particularly high-risk group: South Asians in the greater Toronto area. It shows that South Asians had much higher rates of SARS-CoV-2 infection due to risk factors that range from workplace exposures, such as being essential workers or in high-risk workplaces, to community risk factors, such as multigenerational housing," said Razak.

"Immigrant groups such as South Asians are overrepresented in many of the jobs considered to be essential work, including food preparation, delivery services, transport, and healthcare support, often in workplaces where low pay and lack of benefits and protections produce especially high-risk environments for infection spread," he added.

"This study gives public health experts and government a range of critical areas to focus on as we enter future waves of infection, and it highlights targets to try and reduce exposure risk and spread within high-risk communities."

The study was funded by the COVID-19 Immunity Task Force via funds from the Public Health Agency of Canada. Wahi and Razak reported no relevant financial relationships.

CMAJ Open. Published online July 5, 2022. Full text

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