England's ethnic minorities '20 years older' because of poorer health

Disproportionate death toll for non-white citizens during Covid prompted study into health disparities

Bangladeshi, Pakistani, Arab, and Gypsy or Irish Traveller cohorts suffer the worst health outcomes comparitively. EPA

People over the age of 55 in 15 out of 17 minority ethnic groups in England are likely to be in worse health than white Britons, a new study published in The Lancet suggests.

Researchers found the difference in the health of some Bangladeshi, Pakistani, Arab, Roma and Irish Traveller groups was the equivalent of them being 20 years older.

They found women over 55 in the groups to be even more disadvantaged than men.

"The disproportionate number of deaths as a result of Covid-19 in minority ethnic groups has highlighted ethnic inequalities in health among older adults in England," said lead study author Dr Ruth Watkinson, from the University of Manchester.

“Our study adds detail to evidence of these inequities and their drivers before the pandemic.

"Now, we need decisive policy action to improve equity of socioeconomic opportunity and transformation of health and local services to ensure they meet the needs of all people in the multi-ethnic English population.”

How the study was conducted

The study used surveys taken from patients over 55 years old who were registered at GP practices throughout England, from July 2014 to April 2017.

The authors analysed five self-reported aspects of daily life affected by health: mobility; self-care, such as washing and dressing; ability to engage in daily activities such as working, studying, housework, spending time with family; pain or discomfort; and anxiety or depression.

These five areas were combined to give an overall “health-related quality of life” score for each ethnic group, which ranged from 1 for perfect health to minus 5.94, for poorest health.

Health-related quality of life was then compared across ethnic groups.

To ascertain reasons for the disparities, the researchers then conducted further analysis focused on the association between ethnicity and five factors known to affect health, such as quality of health care received and level of support from local services.

The minority ethnic outliers

The two ethnic groups found to be healthier than white British people were Chinese men and women, and black African men.

But superior health across all age groups was found only in Chinese men. Chinese women and black African men were healthier only in the younger age groups.

The study suggested inequalities in health were accompanied by increased long-term health conditions, particularly diabetes, poor experiences of primary care, insufficient support from local services, low confidence in managing their own health and high local social deprivation.

The authors emphasised that social deprivation, although more common in ethnic minority groups, could not fully explain the health disparities they observed.

They suggested that other factors were also at play, such as structural and institutional racism in health care and local service provision.

Limits of study do not diminish conclusions

Although the large sample size and relatively high survey response rate among older adults allowed the authors to analyse outcomes for smaller ethnic groups, estimates for some ethnic groups were still imprecise because of limited numbers.

The authors noted that some bias may have been introduced by those who chose not to respond to the survey, and by the survey being taken from patients registered at a GP surgery, possibly excluding vulnerable adults or those without a fixed residence.

And the data used was recorded in 10-year age groups, so the authors were unable to ensure exact like-for-like age comparisons.

This may have made some ethnic groups appear healthier.

“Although constrained by the availability of granular data, the report reinforces the need to consider the intersectional influences of sex and ethnicity on inequalities in healthy ageing,” lead author Prof Seeromanie Harding wrote.