Journal of the Royal Society of Medicine

To examine time-trends in ethnic differences in UK medical specialty destinations at two key career points: entry into specialty training (CT/ST1) and awarding Certificate of Completion of Training (CCT).

Repeated cross-sectional analysis using General Medical Council (GMC) secondary data; CT/ST1: 12 specialties, 2012-2022; CCT: 11 specialties, 2007–2021.

Postgraduate specialty training groups within the UK National Health Service.

Doctors with a UK Primary Medical Qualification (CT/ST1: 64,995; CCT: 62,380), categorised as White, Asian and other ethnic groups using GMC data.

The ethnic distribution across specialties was examined using chi-squared tests. The temporal trend was evaluated with ordinary least squares regression of the effect size. Trends in over- and under-representation of ethnic groups within specialties were identified using Kendall’s tau-b correlations.

White doctors comprised the majority proportion (67.1% CT/ST1; 70.3% CCT), followed by Asian (23.4% CT/ST1; 22.6% CCT) and other ethnicities (9.5% CT/ST1; 7.1% CCT). Ethnic differences were statistically significant for all years except CCT in 2007, with larger effect sizes at CT/ST1. Effect sizes increased over time at both levels (CT/ST1 p = 0.041; CCT p = 0.024). Asian doctors were over-represented in Ophthalmology at both levels and Radiology at CT/ST1, and White doctors over-represented in Acute Care at CT/ST1 and Emergency Medicine at CCT.

Persistent ethnic differences exist in UK medical specialty destinations. Systemic factors may therefore influence specialty choice, selection processes and progression to CCT. Future research should explore the underlying causes of ethnic differences between specialties to assess if biases affect career progression.

Risk of death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has fallen during the pandemic, largely due to immunity from vaccination. In England, the timing and extent of this reduction varied due to staggered eligibility during the primary vaccination campaign, based on age and clinical risk group. Duration of protection is less well understood. Our objective was to estimate the case fatality risk (CFR) by vaccination status and time since last dose during a period of widespread community testing, to better understand the impact of coronavirus disease 2019 (COVID-19) vaccination and duration of protection.

SARS-CoV-2 cases diagnosed between May 2020 and February 2022 were linked to vaccine records from the National Immunisation Management System. CFR was calculated as the proportion of cases that died of COVID-19 per the death certificate, aggregated by week of specimen and stratified by 10-year age band and vaccination status.

England, UK.

A total of 10,616,148 SARS-CoV-2 cases, aged ≥18 years, recorded by England’s laboratory reporting system.

Case fatality risk of COVID-19, stratified by age band and vaccination status.

Overall, a reduction in CFR was observed for all age bands, with a clear temporal link to when the age group became eligible for primary vaccination and then the first booster. CFR increased with age (0.3% 50–59 years; 1.2% 60–69; 4.7% 70–79; 16.3% 80+) and was highest in the unvaccinated – albeit a reduction was observed over time. The highest CFR was seen in the unvaccinated 80+ group prior to vaccination rollout (30.6%). CFR was consistently lowest in vaccinated populations within 6 months of last dose, yet increased after over 6 months elapsed since last dose, across all age bands.

COVID-19 CFR reduced after vaccination, with the lowest CFR seen across all age bands when vaccinated up to 6 months prior to specimen date. This provides some evidence for continued booster doses in older age groups.