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

Abstract

ABSTRACTBackgroundHaving 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.MethodsWe 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.FindingsFor 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.ConclusionWe 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.