The enduring effects of racism on health: Understanding direct and indirect effects over time

Stopforth, Sarah; Kapadia, Dharmi; Nazroo, James; Bécares, Laia

doi:10.1016/j.ssmph.2022.101217

Cited by 14 publications

(12 citation statements)

References 42 publications

(63 reference statements)

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“…Support with management of MLTCs is required to slow or even halt the progression of MLTCs, thereby, improving the quality of life and well-being for those with MLTCs across different ethnic group populations. At the same time, continued efforts are required across government, public, private sector bodies and the third sector to tackle structural, institutional and interpersonal racism, the fundamental causes of ethnic inequalities in health 68, 83, 84 .…”

Section: Discussionmentioning

confidence: 99%

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

Hayanga

Saunders

Bécares

2022

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hayanga

Saunders

Bécares

2022

Preprint

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“…Racism and racial discrimination have strong implications for the economic, social and health outcomes of ethnic minority people, producing and maintaining ethnic inequalities over time. The chapters that follow provide evidence of ethnic inequalities across these outcomes, and although their methodological approach precludes us from making explicit empirical links from the ethnic inequalities reported in those chapters to the racism and racial discrimination we report here, other studies have clearly documented the fundamental role of racism and racial discrimination in leading to ethnic inequalities (Williams, 1996;Karlsen and Nazroo, 2002b;Landrine et al, 2006;Brondolo et al, 2009;Williams and Mohammed, 2009;Wallace et al, 2016;Stopforth et al, 2022). As policy and practice efforts are targeted towards recovering from the pandemic, commitment and action to eliminate racism and racial discrimination are paramount in addressing ethnic inequities in the UK.…”

Section: Discussionmentioning

confidence: 99%

Racism and Ethnic Inequality in a Time of Crisis

2023

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ePUB and EPDF available Open Access under CC-BY-NC-ND licence. This book illustrates life through the COVID-19 pandemic for ethnic minorities in Britain. Drawing from the Evidence for Equality National Survey (EVENS), the book presents new evidence of ethnic inequalities and sheds new light on underlying racisms, opening them up to debate as crucial social concerns. Written by leading international experts in the field, this is a must-read for anyone interested in contemporary ethnic inequalities and racism from academics and policy makers to voluntary and community sector organisations.

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“…Area-level deprivation and multimorbidity are inextricably linked and many, but not all, minoritised ethnic group people have poorer health outcomes that stem from socioeconomic inequities driven by structural, institutional and interpersonal racism and discrimination. 24-26 Recent studies also suggest that some minoritised ethnic groups have a higher prevalence of complex multimorbidity. 27 which increases the likelihood of polypharmacy.…”

Section: Discussionmentioning

confidence: 99%

Ethnic inequities in the patterns of Personalised Care Adjustments for ‘Informed Dissent’ and ‘Patient Unsuitable’: A retrospective study using Clinical Practice Research Datalink

Hayanga

Ashworth

Hughes

et al. 2022

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Objectives To examine patterns of PCA reporting for Informed Dissent and Patient Unsuitable, how they vary by ethnic group, and whether ethnic inequities can be explained by socio-demographic factors or comorbidities. Design A retrospective study using routinely collected electronic health records. Setting Individual patient data from Clinical Practice Research Datalink collected from UK general practice. Participants Patients with at least one of the 12 Quality and Outcomes Framework (QOF) conditions which had PCA coding options from a random sample of 690,00 patients aged 18+ years on the 1st of Jan 2016. Main outcomes measures The associations between ethnicity and two PCA reasons (Informed Dissent and Patient Unsuitable) were examined using logistic regressions after adjustment for age, sex, multiple QOF conditions and area-level deprivation. Results The association between ethnicity and the two PCA reasons were in opposite directions. After accounting for age, gender, multiple QOF conditions and area-level deprivation, people of Bangladeshi [OR: 0.69, 95% CI: 0.55 to 0.87], Black African [OR: 0.70, 95% CI: 0.61 to 0.81] , Black Caribbean, OR: 0.67, 95% CI: 0.58 to 0.76], Indian [OR: 0.74, 95% CI: 0.66 to 0.83], mixed [OR: 0.86, 95% CI: 0.74 to 0.99], other Asian [OR: 0.74 95% CI: 0.64 to 0.86] and other ethnicity [OR: 0.66, 95% CI: 0.55 to 0.80] were less likely to have a PCA record for Informed Dissent than people of white ethnicity. Only people of Indian ethnicity were significantly less likely than people of white ethnicity to have a PCA record for Patient Unsuitable in fully adjusted models [OR: 0.80, 95% CI: 0.67 to 0.94]. We found ethnic inequities in PCA reporting for Patient Unsuitable among people of Black Caribbean, Black other, Pakistani, and other ethnicity, but these attenuated after adjusting for multiple QOF conditions and/or area level deprivation. Conclusion Study findings counter the narratives that suggest that people from minoritised ethnic groups often refuse medical intervention. They illuminate the complex relationship between Informed Dissent and (dis)empowerment which requires further scrutiny. They also show ethnic inequalities in PCA reporting for Patient Unsuitable that are linked to clinical and social complexity and should be tackled to improve health outcomes for all.

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The enduring effects of racism on health: Understanding direct and indirect effects over time

Cited by 14 publications

References 42 publications

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

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

Racism and Ethnic Inequality in a Time of Crisis

Ethnic inequities in the patterns of Personalised Care Adjustments for ‘Informed Dissent’ and ‘Patient Unsuitable’: A retrospective study using Clinical Practice Research Datalink

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