• Tackling racism in UK Health Research (February 2022)

Richard Powell,  Chidi Njoku, Ramyia Elangovan, Ganesh Sathyamoorthy, Josephine Ocloo, Sudhin Thayil, Mala Rao. (BMJ)

This article draws attention to the ways in which the health research process in the UK is subject to ethno-racial biases in numerous ways from beginning to end: White dominated research commissioning; under-representation of ethnic minorities in patient participation and public involvement; and racism in academia, the assessment of research excellence and research dissemination.  The authors make a range of proposals on how these can be addressed.  They conclude: “Stakeholders in the UK must change their structures, systems, and processes to reflect the diversity of the population, optimise innovation, and inform inclusive decision making. They must implement a transformative, anti-racist, equity-based research agenda. By committing to this agenda, we can make substantive and permanent change tackling the structural determinants of health inequalities.” 

• Why asylum seekers deserve better healthcare, and how we can give it to them (January 2022)

Olivia Farrant, Sarah Eisen, Chris van Tulleken,  Allison Ward, Nicky Longley (BMJ)

Many asylum seekers in the UK find themselves in a maze of paperwork that can lead to a total absence of healthcare. In this paper, the authors describe Respond, an integrated model of care designed to meet the complex needs of asylum seekers in temporary accommodation. Based in the London Borough of Camden, it begins with primary care registration. At the initial appointment, families are assessed holistically. Investigations follow a protocol and referrals are made to relevant services as required. Currently being evaluated, this model has the potential to be extended to primary care services across the country - and perhaps other countries. 

• Ethnic differences in life expectancy and mortality from selected causes in England and Wales: 2011 to 2014. (Website - November 2021) 

Office for National Statistics

This article shows that between 2011 and 2014 people of White and Mixed ethnic groups had lower life expectancy at birth than all other ethnic groups, with the Black African group having significantly higher life expectancy than most other groups. It also found the White ethnic group were more likely to die of cancer than their Black or Asian counterparts, while for both sexes, ischaemic heart disease mortality was highest in the Bangladeshi, Pakistani and Indian groups. Further research is required to investigate the reasons for the differences. These results reveal important patterns in life expectancy and mortality by ethnic group which are complex, but consistent with most previous studies.

• Mortality from leading causes of death by ethnic group, England and Wales: 2012 to 2019 (Website - November 2021)  

Office for National Statistics 

This article presents experimental statistics on ethnic differences in leading causes of death in England and Wales, using death registrations linked to self-reported ethnicity from the 2011 Census. The White ethnic group accounted for more than 95% of registered deaths in each of the three-year rolling periods, between 2012 to 2019

In the latest period, 2017 to 2019, the White group had a statistically significantly higher age-standardised mortality rate (ASMR) from all-causes than any other ethnic group and had higher ASMRs than most other ethnic groups for many leading causes of death including dementia and Alzheimer’s disease and a range of common cancer.

Looking at the most common causes of death, ischaemic heart disease featured for all ethnic groups, and the highest ASMRs across time have been in the Bangladeshi, Pakistani and Indian ethnic groups. The White, Mixed, and Black Caribbean ethnic groups had the highest dementia and Alzheimer’s disease ASMRs. 

Lung cancer ASMRs were highest among male Bangladeshi, Mixed, and White ethnic groups, and in female White and Mixed ethnic groups. While not one of the most common causes of death, suicide ASMRs in males were higher in White and Mixed ethnic groups than in other groups, and in females the rate for the Mixed ethnic group was higher than other groups. 

The results reveal important patterns in causes of death between ethnic groups that are complex but consistent with most previous studies; further research is required to investigate the reasons for the differences, with potential explanations including past migration patterns, socio-economic composition of the groups, health-related behaviours, and clinical and biological factors.

• Life expectancy by ethnic group in England: a complex picture of disparities emerges from latest ONS analysis (November 2021)

Raghib Ali, Veena Raleigh, Azeem Majeed, Kamlesh Khunti, British Medical Journal

This BMJ Editorial comments on the above two reports 

• Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff (June 2021)

Charlotte Woodhead and 16 colleagues - Ethnicity & Health, DOI: 10.1080/13557858.2021.1936464

This qualitative study explores in detail the range of attitudes towards COVID-19 vaccination in a sample of 25 clinical and management staff of differing ethnic backgrounds, seeking explanations for why some are much more hesitant about accepting the vaccine than others. (A summary of the study for non-professional readership can be found HERE ).

• Ethnic differences in SARS-CoV-2 infection and COVID-19- related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform (May 2021)

Mathur R et al, Lancet

This large study found that some minority ethnic populations in England have excess risks of testing positive for SARS-CoV-2 and of adverse COVID-19 outcomes compared with the White population, even after accounting for differences in sociodemographic, clinical, and household characteristics. Causes are likely to be multifactorial, and delineating the exact mechanisms is crucial. Tackling ethnic inequalities will require action across many fronts, including reducing structural inequalities, addressing barriers to equitable care, and improving uptake of testing and vaccination.

• Ethnic disparities in the major causes of mortality and their risk factors - a rapid review. A submission to the Commission on Race and Ethnic Disparities (April 2021)

Raghib Ali, Avirup Chowdhury, Nita Forouhi, Nick Wareham. MRC Epidemiology Unit, University of Cambridge.

This report provides much of the detail that contributed to the Health Chapter of the Commission report. It draws heavily on work carried out by the Office of National Statistics (ONS) and the Scottish Health and Ethnicity Linkage Study. It examines the relationships between health, ethnicity and socio-economic circumstances, and demonstrates that, as the analysis by ethnic group and by disease or health condition becomes more detailed e.g. from South Asian to Indian, Pakistani and Bangladeshi or from overall mortality to heart disease and cancer types, so a more complex picture of advantage and disadvantage emerges. 

• Commission on Race and Ethnic Disparities: The  Report (March 2021)

This wide-ranging report from 10 Government-appointed commissioners, all but one of whom has an ethnic minority background, has generated huge controversy. While acknowledging that racism and ethnic inequalities persist, it argues that considerable progress has been made in recent decades. In particular, it demonstrates the complexity of the variations in health, with some ethnic minorities faring better than the White majority in overall life-expectancy and pointing out, for example, that the White majority has the highest death rates due to 9 of the 11 most common forms of cancer.

• Mitigating ethnic disparities in covid-19 and beyond (January 2021)

Razai M, Kankam HKN, Majeed A, Esmail A, Williams D. ,British Medical Journal

The authors argue that although socioeconomic status partly explains ethnic disparities seen with covid-19, cultural and structural racism also adversely affect health.

• Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases (January 2021)

Laurence Gruer and 10 colleagues, Journal of Public Health

This is the last analysis from Phase 4 of the Scottish Health and Ethnicity Linkage Study (SHELS). It examines rates of hospitalisations and deaths related to all infections and 15 different infection categories. It also looks at ethnic differences for serological diagnoses of HIV, HBV and HBC. The study demonstrates very varied, and sometimes enormous, ethnic differences, pointing to a complex mix of causative factors. The paper also provides a useful context for the recent findings of  higher rates of morbidity and mortality due to COVID-19 among some ethnic minorities in the UK.

• Raising ethnicity recording in NHS Lothian from 3% to 90% in 3 years: processes and analysis of data from Accidents and Emergencies (December 2020)

Emma M. Davidson, Anne Douglas, Nazmy Villarroel, Katy Dimmock, Dermot Gorman, Raj S. Bhopal.

Journal of Public Health

This article describes how the National Health Service in Lothian (the region in Scotland, UK, that includes Edinburgh) succeeded in increasing the recording of the ethnicity of patients attending hospital from 3% to 90% in three years. The focus is on attendances for Accidents and Emergencies.  This is an impressive achievement. However, another recent article from Scotland (below December 2019) shows that even if ethnicity recording rates are relatively high, they may not be enough to enable reliable comparisons between ethnic groups to be made.

• Black people, racism and human rights (November 2020)

• Improving Data and Evidence On Ethnic Inequalities In Health: Initial Advice And Recommendations From The Expert Reference Group On Ethnicity And COVID-19 (September 2020)

• Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland (August 2020)

Christine Campbell, Anne Douglas, Linda Williams, Geneviève Cezard, David H Brewster, Duncan Buchanan, Kathryn Robb, Greig Stanners, David Weller, Robert JC Steele, Markus Steiner, Raj Bhopal. (BMJ Open)

This study found important variations in uptake of bowel cancer screening by ethnic group and religion in Scotland, for both sexes, that require further research and targeted interventions.

• Beyond the data: Understanding the impact of COVID-19 on BAME groups (June 2020)

• Disparities in the risk and outcomes of COVID-19 (June 2020)

• The challenge of using routinely collected data to compare hospital admission rates by ethnic group: a demonstration project in Scotland (December 2019)

S. Knox, RS. Bhopal, CS. Thomson, A. Millard, A. Fraser, L. Gruer, D. Buchanan

Journal of Public Health

This article analyses in-patient rates by ethnicity in Scottish Hospitals in 2013.  It reports that the completeness of ethnicity coding on hospital admission records was 76%, a marked improvement since 2010. However, the validity of admission rates based on these data was variable across ethnic groups and further improvements are required to support monitoring of inequality.