Ethnic inequalities in health is equivalent of being 20 years older

Health-related quality of life in older age was worse for minority ethnic groups than the White British group, according to a new study that found the health disparities were equivalent to being 20 years older.

The study published in The Lancet Public Health journal is the first detailed analysis of health inequalities among older adults in England from a broad range of ethnic groups. It found that in 15 out of 17 minority ethnic groups, there was evidence of wide ethnic inequalities in health-related quality of life and five determinants of health for older adults in England.

The researchers 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.

The study used surveys taken by patients over 55-years-old registered at GP practices across England from July 2014 to April 2017. The authors analysed how ethnicity was associated with five self-reported aspects of daily life impacted by the health of participants: mobility, self-care, ability to engage in daily activities, pain or discomfort, and anxiety or depression. These five areas were combined to give an overall ‘health-related quality of life’ score for each ethnic group, which ranged from 1 (perfect health) to -5.94 (poorest health). Health-related quality of life was then compared across ethnic groups.

Underlying causes of ethnic health disparities

They did a further analysis to understand what the underlying causes of the ethnic disparities might be, estimating the association between ethnicity and five factors known to impact health.

The survey asked if participants had one or more of 14 long-term health conditions, received high quality healthcare, received enough support from local services (such as social care and support groups) and were confident in managing their own health. The authors also considered level of deprivation in participants’ residential area.

Out of the 1,394,361 survey respondents included in the analysis, 11% (152,710) self-identified as belonging to a minority ethnic group. The patterning of disadvantage observed between groups varied by sex.

In five of those groups – Bangladeshi, Pakistani, Arab, and Gypsy or Irish Traveller – the difference compared with the White British group is equivalent to, or greater than, the health impacts of being 20 years older.

Lead author on the study, Dr Ruth Watkinson, University of Manchester, UK, says “The disproportionate number of deaths due to Covid-19 in minority ethnic groups has highlighted ethnic inequalities in health among older adults in England. Our study adds detail to evidence of these inequities and their drivers before the pandemic. Now, we need decisive policy action to improve equity of socioeconomic opportunity and transformation of health and local services to ensure they meet the needs of all people in the multi-ethnic English population.”

The two ethnic groups who were healthier than White British people were Chinese (men and women), and Black African (men only). However, this only applied across all age groups for Chinese men, whereas for Chinese women and Black African men further analyses suggested they were only healthier in the younger age groups (55-64 years for Black African men, and 55-74 years for Chinese women).

When looking at the association between ethnicity and factors that could cause poor health outcomes, the study suggested inequalities in health were accompanied by increased long-term health conditions (particularly diabetes), poor experiences of primary care, insufficient support from local services, low confidence in managing their own health, and high local social deprivation.

The authors emphasise that social deprivation, although more common in ethnic minority groups, could not fully explain the health disparities they observed, and suggest that other factors are also at play, such as structural and institutional racism in health care and local service provision.

Ethnicity must not impact the quality of healthcare they receive

The Royal College of GPs, said the research was concerning especially as the Covid-19 pandemic has shone a light on the health inequalities faced by members of Black, Asian and minority ethnic communities in society, and this study adds to that evidence base.

Professor Martin Marshall, Chair of the RCGP, said: “Someone’s ethnicity must not impact the quality of healthcare they receive. When it is shown to, it must be addressed, and the College is committed to supporting ongoing efforts in this regard.

“Throughout the pandemic, the College has kept abreast of Covid-related issues impacting on BAME communities, and we’ve made significant efforts – such as lobbying for recommendations in the Fenton report to be implemented, and calling for rationale as to why ethnicity has not been included as prioritisation criteria for vaccination – to address these issues. We are currently calling for culturally competent communications tailored to local communities in order to address the projected low uptake of the Covid vaccine within black, Asian and minority ethnic communities.

“This study is incredibly important, because it’s through good research that we are able to improve and progress. More research needs to be undertaken, so that we can understand the specific difficulties that individual ethnic minority groups experience, being careful not to take a ‘one size fits all’ approach to addressing them. It’s also important that general practice has the resources, workforce and support required to continue to deliver high-quality care to all of our patients, regardless of their ethnicity or background.”