Wide ethnic minority health inequalities in England — GP Patient Survey data

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England’s most extensive ever study of ethnic minority health in the over-55s has revealed substantial inequalities across most groups, compared with white British people. The University of Manchester study showed people from some ethnic minority groups – particularly those belonging to Asian groups – were more likely to report poor experiences at their GP surgery.

That suggests, say the authors, unfairness within the National Health Service (NHS) services may be exacerbating health inequalities for some ethnic minority groups.

It found that the average health of 60-year-olds belonging to Gypsy or Irish Traveller, Bangladeshi, Pakistani, and Arab groups was similar to that of a typical 80 year old.

People from almost all ethnic groups studied were much more likely to report insufficient support from local services to manage their health conditions and to say they lacked self-confidence in managing their health.

The study used the England-wide GP Patient Survey to analyse responses from almost 1.4m adults aged over 55 surveyed between 2015 and 2017. The sample included over 150,000 people who self-identified as belonging to an ethnic minority group – the largest ever sample.

The GP Patient Survey contains information on day-to-day difficulties and factors that can determine overall health.

Other key findings included:
Inequalities tended to be wider for older women
Older people from ethnic minority groups were more likely to report suffering from some common long-term conditions like diabetes and from having 2 or more conditions
Older Bangladeshi women were around 3 times more likely to report poor experiences than compared to older White British women

Lead author Dr Ruth Watkinson from The University of Manchester said: “We found that people from some ethnic minority groups – particularly Asian groups – were more likely to report poor experiences at their GP surgery.

“This suggests the NHS as an institution is failing people from some ethnic groups. Policy action is needed to transform healthcare and wider support services to make sure they meet the needs of all individuals in England’s multi-ethnic population fairly.

“But policy makers also need to address the structural racism that makes it harder for people belonging to ethnic minority groups to access socioeconomic opportunities because poverty is a major cause of poor health.

Co-author Dr Alex Turner, also from The University of Manchester added: “Researchers haven’t been able to research the health outcomes of people over 55 in ethnic minority groups, because they aren’t included in sufficient numbers in most datasets.

“And much official data doesn’t distinguish between groups, which can mask inequalities

“But this study allowed us analyse results for all 18 of the UK census ethnic groups separately, allowing us to see differences between them.

“However more research to better understand exactly what drives these health inequalities. There needs to be more data collection with much better inclusion of people from ethnic minority groups in longitudinal studies.”

 

Study details
Ethnic inequalities in health-related quality of life among older adults in England: secondary analysis of a national cross-sectional survey

Ruth Elizabeth Watkinson, Matt Sutton, Alex James Turner

Published in The Lancet Public Health on 28 January 2021

Abstract
Background
The population of older adults (ie, those aged ≥55 years) in England is becoming increasingly ethnically diverse. Previous reports indicate that ethnic inequalities in health exist among older adults, but information is limited by the paucity of data from small minority ethnic groups. This study aimed to analyse inequalities in health-related quality of life (HRQoL) and five determinants of health in older adults across all ethnic groups in England.
Methods
In this cross-sectional study, we analysed data from five waves (July 1, 2014, to April 7, 2017) of the nationally representative English General Practice Patient Survey (GPPS). Study participants were adults aged 55 years or older who were registered with general practices in England. We used regression models (age-adjusted and stratified by gender) to estimate the association between ethnicity and HRQoL, measured by use of the EQ-5D-5L index and its domains (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression). We also estimated associations between ethnicity and five determinants of health (presence of long-term conditions or multimorbidity, experience of primary care, degree of support from local services, patient self-confidence in managing own health, and degree of area-level social deprivation). We examined robustness to differential handling of missing data, alternative EQ-5D-5L value sets, and differences in area-level social deprivation.
Findings
There were 1 416 793 GPPS respondents aged 55 years and older. 1 394 361 (98·4%) respondents had complete data on ethnicity and gender and were included in our analysis. Of these, 152 710 (11·0%) self-identified as belonging to minority ethnic groups. HRQoL was worse for men or women, or both, in 15 (88·2%) of 17 minority ethnic groups than the White British ethnic group. In both men and women, inequalities were widest for Gypsy or Irish Traveller (linear regression coefficient −0·192 [95% CI −0·318 to −0·066] in men; −0·264 [–0·354 to −0·173] in women), Bangladeshi (−0·111 [–0·136 to −0·087] in men; −0·209 [–0·235 to −0·184] in women), Pakistani (−0·084 [–0·096 to −0·073] in men; −0·206 [–0·219 to −0·193] in women), and Arab (−0·061 [–0·086 to −0·035] in men; −0·145 [–0·180 to −0·110] in women) ethnic groups, with magnitudes generally greater for women than men. Differentials tended to be widest for the self-care EQ-5D-5L domain. Ethnic inequalities in HRQoL were accompanied by increased prevalence of long-term conditions or multimorbidity, poor experiences of primary care, insufficient support from local services, low patient self-confidence in managing their own health, and high area-level social deprivation, compared with the White British group.
Interpretation
We found evidence of wide ethnic inequalities in HRQoL and five determinants of health for older adults in England. Outcomes varied between minority ethnic groups, highlighting heterogeneity in the direction and magnitude of associations. We recommend further research to understand the drivers of inequalities, together with policy changes to improve equity of socioeconomic opportunity and access to services for older adults from minority ethnic groups.
Funding
University of Manchester and National Institute for Health Research.

 

 

The Lancet Public Health study (Open access)

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