The effect of COVID-19 on vulnerable populations in the US and UK: an international scoping review

Context: Comparing the Covid-19 related experiences of vulnerable groups can help to improve public health.?The United States and the United Kingdom are both characterized by underfunded public health in the context of racist systems. We reviewed differences in Covid-19 outcomes between groups in the US and UK and compared intergroup differences between the two countries. Methods: The scoping review analyzed articles published in English during the Covid-19 pandemic focusing on the US or the UK. Using Scopus and PubMed, research articles were chosen based on titles, abstracts, and relevance to the research question. Certain demographic groups known to be differentially affected by Covid-19 were chosen a priori for inclusion. Data was extracted by the first author and reviewed by senior authors. 63 studies met the inclusion criteria. Results: Two studies compared the US and UK. One found that minority status is an important social determinant of health (SDOH) of Covid-19 related health outcomes in both countries, likely through association with other SDOH. Another found that the risk of confirmed infection was higher in African-Americans, Hispanic Americans, and Asian Americans in the US and in African-Caribbean/Black-Africans, South-Asians, and Mixed-race people in the UK, compared with their respective White peers. Asian ethnicity is subject to different definitions in the US and the UK. Individual articles focusing on either the US or the UK also found that, in both countries, essential workers were impacted; those with disabilities were more often affected by Covid-19 related comorbidities in both countries. In addition, in both the US and the UK, people living in multigenerational families were more susceptible to Covid-19. Misclassification of causes of morbidity and mortality was noted in both countries. Discussion and conclusion: A limited literature indicates that, in both the US and UK, non-White populations were more affected by the Covid-19 pandemic, possibly due to association of SDOH with racist systems. Racial definitions differ between these countries and this needs further research. In both countries, data focused on LGBTQ+ groups and people with disabilities is lacking.