Neurological and cardiac complications of covid-19 among Chinese and south Asians in Ontario-waves 1,2 and 3: a population-based Canadian study

Background: Although we had previously reported the cardiac and neurologic outcomes of Chinese and South Asian Ontarians in wave 1 of COVID-19, data on subsequent waves of COVID-19 remain unexamined.This is an extension study of this cohort in waves 2 and 3.

Methods: We identified adult Ontarians with a positive COVID-19 polymerase chain reaction test from January 1, 2020 to June 30, 2021, and they were classified as being Chinese or South Asian using a validated surname algorithm; we compared their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models.

Results: Compared to the general population (n . 439,977), the Chinese population (n . 15,208) was older (mean age 44.2 vs 40.6 years, P < 0.001) and the South Asian population (n . 46,333) was younger (39.2 years, P < 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.28-1.61) and more hospitalization or emergency department visits (OR, 1.14; 95% CI, 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR, 1.03; 95% CI, 0.87-1.12) and neurologic complications (OR, 1.23; 95% CI, 0.96-1.58). South Asians had a lower 30-day mortality (OR, 0.88; 95% CI, 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR, 1.17; 95% CI, 1.14-1.20) with a trend toward a lower incidence of cardiac complications (OR, 0.76; 95% CI, 0.67-0.87) and neurologic complications (OR, 0.89; 95% CI, 0.73-1.09). There was also a significant difference in these outcomes between wave 1, 2 and 3, with a greater mortality in all groups in waves 2 and 3.

Conclusions: Ethnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among patients with COVID-19, requiring further studies to understand factors driving these differences.

Dr. Chu graduated from the Faculty of Medicine, University of Toronto in 1978. He subsequently completed his residency training in Internal Medicine and Neurology at University of Toronto obtaining his FRCPC in both specialties. He opened a private Neurological consultative practice in Etobicoke in 1984 with special interests in electromyography and clinical neuromuscular disorders. Other areas of interests include Stroke, Epilepsy, Movement Disorders including Botox injections and Dementia. He is an Assistant Professor of Medicine (Neurology) at the University of Toronto and is an associate staff Neurologist at the Toronto Western Hospital-University Health Network. He is also a consultant Neurologist at the William Osler Health System in Toronto. He was past president of the Chinese Canadian Medical Society of Ontario. In addition, he had published extensively in peer review journals on the Epidemiology of Cerebrovascular Diseases among Chinese Canadians. He was Chairman of the Research Committee, Chinese Canadian Council of the Heart & Stroke Foundation and now the Chinese Canadian Heart and Brain Association (CCHABA). He has been a popular invited visiting Professor giving lectures in Hong Kong, Peoples’ Republic of China, Taiwan and USA. Since 2020, Dr Chu had been leading a team of researchers/clinicians in carrying out population-based research on the epidemiology of COVID-19 and its cardiac and neurological complications among visible minorities in Ontario. His research work is supported by the Ontario Ministry of Health, the Ontario Health Data Platform (OHDP)and the Department of Medicine, University of Toronto and CCHABA.