Ethnic inequalities in hospital admissions in England: an observational study

Abstract

Background Ethnic inequalities in health are well-known and partly explained by social determinants such as poorer living and working conditions, health behaviours, discrimination, social exclusion, and healthcare accessibility factors. Inequalities are known both for self-reported health and for diseases such as diabetes, cardiovascular diseases, respiratory diseases, and non-specific chest pains. Most studies however concern individual diseases or self-reported health and do not provide an overview that can detect gaps in existing knowledge. The aim of this study is thus to identify ethnic inequalities in inpatient hospital admission for all major disease categories in England. Methods Observational study of the inpatient hospital admission database in England enhanced with ethnicity coding of participants’ surnames. The primary diagnosis was coded to Level 1 of the Global Burden of Disease groups. For each year, only the first admission for each condition for each participant was included. If a participant was readmitted within two days only the first admission was counted. Admission risk for all major disease groups for each ethnic group relative to the White British group were calculated using logistic regression adjusting for age and area deprivation. Results 40,928,105 admissions were identified between April 2009 and March 2014. Ethnic inequalities were found in cardiovascular diseases, respiratory diseases, chest pain, and diabetes in line with previous studies. Additional inequalities were found in nutritional deficiencies, endocrine disorders, and sense organ diseases. Conclusions The results of this study were consistent with known inequalities, but also found previously unreported disparities in nutritional deficiencies, endocrine disorders, and sense organ diseases. Further studies would be required to map out the relevant care pathways for ethnic minorities and establish whether preventive measures can be strengthened.

Ethnicity and prognosis following a cardiovascular event in people with and without type 2 diabetes: Observational analysis in over 5 million subjects in England

“…Identifying the precise pattern of interrelated causes underpinning our (and previous) findings is difficult, given the complex interplay between numerous biological, environmental, demographic, social, and healthcare related factors which have been suggested to explain ethnic differences in health outcomes [37,38]. However, as our data were obtained from admitted patients, it is worth noting that ethnic inequalities exist in hospital admission in England: investigating around 41 million hospitalisations between 2009 and 2014, Petersen et al showed large variations among ethnic groups in the age-and deprivation-adjusted overall and cause-specific number of admissions, particularly for CVDand diabetes-related hospitalisation [39]; therefore, information on CVD and type 2 diabetes from hospital data may reflect inequalities in the access to healthcare services rather than the population burden of these two conditions [40,41]. A further element to consider is the variable proportion of migrants among ethnics group [16]: as there is evidence that people who migrate to UK are generally healthier than UK-born population [42][43][44], variations in these proportions may contribute to the lower mortality rates in some ethnic groups.…”

Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020

“…Other studies have shown that even when admission rates are adjusted for age and deprivation, discrepancies in admission rates across ethnic groups remain [13]. This supports that ethnic inequalities in health are driven by factors other than deprivation, including overall health and health-seeking behaviours alongside discrimination and marginalisation [13][14][15]. Addressing socioeconomic determinants of health is necessary but not sufficient to eliminate ethnic inequalities [42].…”

“…Alongside an overall increased burden of disease, evidence suggests ethnic minorities may experience increased barriers to healthcare access and less effective healthcare provision [13][14][15]. It was found that ethnic minority groups may have less disease monitoring and slower intensification of therapy for certain chronic conditions [15].…”

“…Generally, they were less satisfied with the care they received [14] and reported a lower quality of care compared to White groups [14]. Worryingly, ethnic minority groups are also shown to wait longer for a medical appointment and longer to be referred to a specialist for certain conditions, including cancer [13]. Language barriers, less knowledge of available services, and discrimination may all be contributory factors [37].…”

Ethnic inequalities in patient satisfaction with primary health care in the UK: evidence from recent General Practitioner Patient Surveys (GPPS)

“…It is well established that ethnic minorities are more vulnerable to a variety of long - term health problems. For instance, South Asians are at a higher risk of diabetes, coronary heart disease, asthma, gastrointestinal diseases while Black ethnic groups are at a higher risk of hypertension and diabetes [1]. Therefore, it is plausible that ethnic minorities dealing with a variety of health issues may exhibit their frustrations subconsciously on their patient satisfaction scores, consistently scoring negatively in comparison to the ethnic majority.…”