Estimated inequities in COVID-19 infection fatality rates by ethnicity for Aotearoa New Zealand

There is limited evidence as to how COVID-19 infection fatality rates (IFR) may vary by ethnicity. We combine demographic and health data for ethnic groupings in Aotearoa New Zealand with international data on IFR for different age groups to estimate inequities in IFR by ethnicity. We find that, if age is the dominant factor determining IFR, estimated IFR for M[a]ori is around 50% higher than non-M[a]ori. If underlying health conditions are more important than age per se, then estimated IFR for M[a]ori is more than 2.5 times that of New Zealand European, and estimated IFR for Pasifika is almost double that of New Zealand European. IFRs for M[a]ori and Pasifika are likely to be increased above these estimates by racism within the healthcare system and other inequities not reflected in official data. IFR does not account for differences among ethnicities in COVID-19 incidence, which could be higher in M[a]ori and Pasifika as a result of crowded housing and higher inter- generational contact rates. These factors should be included in future disease incidence modelling. The communities at the highest risk will be those with elderly populations, and M[a]ori and Pasifika communities, where the compounded effects of underlying health conditions, socioeconomic disadvantage, and structural racism result in imbricated risk of contracting COVID-19, becoming unwell, and death.