Ethnic inequalities in age-related patterns of multiple long-term conditions in England: analysis of primary care and nationally representative survey data

Abstract

Background Having multiple long-term conditions has been associated with a higher treatment burden, reduced quality of life and a higher risk of mortality. Epidemiological evidence suggests that people from minoritised ethnic groups have a higher prevalence of multiple long-term conditions (MLTCs) but questions remain regarding the patterning of MLTCs by age, how this varies for different ethnic group populations, and across conceptualisations of MLTCs (for example, MLTCs with and without mental health conditions). The aim of this study is to examine ethnic inequalities in age-related patterns of MLTCs, and combinations of physical and mental health conditions. Methods We analysed data from the English GP Patient Survey (GPPS) 2015-2017, and Clinical Practice Research Datalink (CPRD) Aurum from 2016, to give us insight into self-reported and primary care recorded long-term conditions in people aged 18 years and above. We described the association between two or more long-term conditions and age using multilevel regression models adjusting for sex and area-level deprivation with patients nested within GP practices. Similar analyses were repeated for MLTCs that included a mental health condition. Findings For both self-reported and primary care recorded LTCs, people from most minoritised ethnic groups had a lower prevalence of MLTCs at younger ages compared to their white counterparts. We observed ethnic inequalities from middle age onwards such that in later life, Pakistani, Indian, Black Caribbean and people of Other ethnicity were at an increased risk of having MLTCs compared to white British people. These trends remained after adjusting for area-level deprivation. Compared to white British people, Gypsy and Irish Travellers had higher levels of MLTCs across the age groups, and Chinese people had lower levels. Pakistani and Bangladeshi people aged 50-74 years were more likely than white British people to report two or more LTCs that included a mental health condition. People from other minoritised ethnic groups were less likely to report this compared to white British people. Conclusion We find clear evidence of ethnic inequalities in MLTCs. It is imperative for health systems to recognise and respond to the higher prevalence of MLTCs that develop by middle age for many minoritised ethnic group people. The lower prevalence of MLTCs that include a mental health condition among some minoritised ethnic group people may be an underestimation due to underdiagnosis and/or inadequate care in primary care and requires further scrutiny.

Explanatory factors for Ethnic inequalities in Multimorbidity; findings from pooled Health Survey for England 2011-2018

“…General multimorbidity varied with age among ethnic groups, with the risk being greater among the British White population aged under 40, and greater among ethnic minorities (Pakistani and Bangladeshi) aged 40 and over. Age-related differences in patterns of multimorbidity by ethnicity, was also found in a recent study,(22). This correlates well with the increased risk of cardiovascular multimorbidity among Pakistani and Bangladeshi adults aged 40 and over; however, differences between other ethnic groups and greater risk of cardiovascular multimorbidity but not general multimorbidity suggest the general white population has higher prevalence of non-cardiovascular longstanding conditions and/or there are ethnic differences in reporting or in being diagnosed.…”

A comparative study of model-centric and data-centric approaches in the development of cardiovascular disease risk prediction models in the UK Biobank

“…Two recent studies based on CPRD show that compared with other ethnic groups, people of Chinese ethnicity have the lowest mean number of EHR-determined long-term conditions and lowest prevalence of complex multimorbidity across all age groups. 33 , 34 Our study suggests the predictive value of diagnosed and self-reported conditions within the Chinese ethnicity is lower than others ethnic groups. A possible explanation to this might be lower diagnoses of medical conditions in this subpopulation.…”

Ethnic differences in multimorbidity after accounting for social-economic factors, findings from The Health Survey for England

“…Similar age-related differences in patterns of multimorbidity by ethnicity were also found in a recent study, where a lower prevalence of multiple long-term conditions was found among younger ethnic groups compared with the White majority, based on data from primary care records. 22 A greater risk of cardiovascular multimorbidity, but not general multimorbidity, among ethnic groups suggests a higher prevalence of non-cardiovascular longstanding conditions among the White population and/or variations in reporting or in being diagnosed among ethnic groups. Chinese and Asian Indian adults were less likely to report having multimorbidity in the USA according to a study by Zhang et al; however, they were more likely to have a combination of high cholesterol and hypertension, risk factors for CVD consistent with our study.…”