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Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020.
Toal, C M; Fowler, A J; Pearse, R M; Puthucheary, Z; Prowle, J R; Wan, Y I.
Affiliation
  • Toal CM; William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK. connor.toal@nhs.net.
  • Fowler AJ; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK. connor.toal@nhs.net.
  • Pearse RM; William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
  • Puthucheary Z; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK.
  • Prowle JR; William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK.
  • Wan YI; Acute Critical Care Research Unit, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK.
J Racial Ethn Health Disparities ; 10(6): 2872-2881, 2023 12.
Article in En | MEDLINE | ID: mdl-36471147
BACKGROUND AND AIM: The COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic. DESIGN: This was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020. METHODS: The primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals. RESULTS: Age-standardised admission rates were higher in Asian (RR 1.40 [1.38-1.41] in 2019) and Black (RR 1.37 [1.37-1.38]) and lower in Mixed groups (RR 0.91 [0.90-0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and 'other' ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories. CONCLUSIONS: This study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ethnicity / Pandemics Type of study: Prognostic_studies Aspects: Determinantes_sociais_saude / Equity_inequality Limits: Humans Country/Region as subject: Europa Language: En Journal: J Racial Ethn Health Disparities Year: 2023 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ethnicity / Pandemics Type of study: Prognostic_studies Aspects: Determinantes_sociais_saude / Equity_inequality Limits: Humans Country/Region as subject: Europa Language: En Journal: J Racial Ethn Health Disparities Year: 2023 Document type: Article Country of publication: