COVID-19 ethnic inequalities in mental health and multimorbidities: protocol for the COVEIMM study.

PURPOSE: The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI). METHODS: This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations. RESULTS: 81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities. CONCLUSION: The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.

Minority status and mental distress: a comparison of group density effects.

BACKGROUND: It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality. METHOD: Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels. RESULTS: Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07-1.67], and attempted suicide (OR 1.84 95% CI 1.19-2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91-5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03-1.71). We found no evidence for an association with common mental disorders. CONCLUSIONS: The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.

Active school transport and fast food intake: Are there racial and ethnic differences?

OBJECTIVES: To investigate whether active school transport was associated with fast food consumption, and to examine differences across racial/ethnic groups. METHODS: Adolescent data (n=3194) from the 2009 California Health Interview Survey were analyzed with logistic regression models to examine the association between active school transport (AST) and fast food intake across racial/ethnic groups. RESULTS: In the overall sample, AST during 1-2days in the past week was associated with greater likelihood of fast food intake (OR: 1.58; 95% CI: 1.03-2.43), compared with zero days of AST, controlling for demographic and other factors. The association between AST and fast food intake differed significantly by race/ethnicity (p<0.01). Among Latino adolescents, greater frequency of AST was significantly associated with greater likelihood of fast food intake (1-2days OR, 2.37, 95%CI: 1.05-5.35; 3-4days OR, 2.78, 95% CI: 1.04-7.43; 5days OR, 2.20, 95%CI: 1.23-3.93). Among White and Asian adolescents, there was a curvilinear pattern: relative to adolescents who reported zero days of AST, those who did AST 1-2days/week had greater likelihood of fast food intake, but AST of 3-4days and 5days/week was associated respectively, with higher and lower likelihood of fast food intake among both groups. CONCLUSIONS: AST appears to be a risk factor for fast food intake, and may expose some ethnic groups more than others to increased opportunity to purchase and consume fast food. Programs and policies to promote AST among adolescents should incorporate efforts to encourage healthy eating and discourage concentration of fast food outlets near schools.

Objective and perceived ethnic density and health: findings from a United Kingdom general population survey.

Studies indicate an ethnic density effect, whereby an increasing proportion of persons of the same ethnicity as oneself (co-ethnics) in one's area of residence is associated with reduced risk of morbidity among ethnic minorities, though evidence is mixed. Measures of ethnic density are commonly taken from small-area census data using predefined categories of ethnicity. In a United Kingdom study, the authors compared these measures with perceived ethnic density, based on self-reported proportion of co-ethnics in the area. Using 2005 Home Office Citizenship Survey data linked to the 2001 United Kingdom Census, they found moderate-sized correlations between perceived and measured ethnic density which varied across ethnic groups (r = 0.34-0.65). Perceived ethnic density underestimated measured levels for whites and overestimated measured levels for ethnic minorities. Compared with participants in areas where less than half of residents were co-ethnics, those reporting a perceived ethnic density of more than half tended to have less limiting long-term illness (for all ethnic minorities combined, odds ratio = 0.81, 95% confidence interval: 0.63, 1.04) after adjustment for age, sex, socioeconomic position, ethnicity, area deprivation, and measured ethnic density. After adjustment for perceived ethnic density, there was no evidence of a protective association for measured ethnic density, except for Caribbeans. Perceived ethnic density may reflect individual experiences of frequency and intensity of contact with co-ethnics, which may explain why it was more consistently related to lower morbidity risk.