Ethnic inequalities in age-related patterns of multiple long-term conditions in the UK: analysis of primary care and self-reported data

Problem

The COVID-19 pandemic and the measures adopted to arrest its spread have illuminated and magnified existing health and economic inequalities. International and UK data suggest that at the height of the pandemic, minoritised ethnic group people were at increased risk of infection and death from COVID-19. Pre-existing long-term conditions were a key driver underlying these health inequalities and they warrant further investigation to inform recovery efforts. 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 and how this varies for different ethnic group populations. The aim of this study is to describe age-related patterns of MLTCs, and combinations of physical and mental health conditions across different ethnic groups in England.

Approach

We analysed data from Clinical Practice Research Datalink (CPRD) Aurum 2016, and the English GP Patient Survey (GPPS) 2015-2017, to give us insight into both primary care recorded and self-reported long-term conditions. We described the association between total number of LTCs, and age using a multilevel regression model adjusting for sex and deprivation with patients nested within GP practices. Similar analyses were repeated for two or more physical LTCs and two or more LTCs including a mental health condition.

Findings

For both primary care recorded and self-reported LTCs, people from 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 with steeper age-related increases in MLTCs among Bangladeshi, Pakistani, Indian, Black Caribbean and Gypsy or Irish Travellers. These trends were also seen after adjusting for area-level deprivation. These patterns were similar when physical LTCs were considered. Compared to minoritised ethnic group people, people from the white ethnic group were more likely to report 2 or more LTCs that included a mental health condition.

Consequences

This study finds ethnic inequalities in the prevalence of MLTCs from midlife onwards and identifies ethnic group populations that are at a particular risk of MLTCs. The findings raise several questions concerning the underlying processes that lead to these differential health outcomes. Further research is required to identify these processes and inform efforts to address age-related inequalities experienced by people from minoritised ethnic groups compared with their white counterparts