Explanatory factors for Ethnic inequalities in Multimorbidity; findings from pooled Health Survey for England 2011-2018
Authors: Fat Linda Ng , Mindell Jennifer S , Manikam Logan , Scholes Shaun 
Published: October 2022

Background

Social-economic factors and health behaviours may be driving variation in ethnic health inequalities in multimorbidity including among distinct ethnic groups.

Methods

Using the cross-sectional nationally-representative Health Surveys for England 2011-2018 (N=54,438, aged 16+), we carried out multivariable logistic regression on the odds of having general multimorbidity (≥2 longstanding conditions) by ethnicity (British White (reference group), White Irish, Other White, Indian, Pakistani, Bangladeshi, Chinese, African, Caribbean, White Mixed, Other Mixed, Other), adjusting for age, sex, education, area-deprivation, smoking status, and survey year. This was repeated for cardiovascular multimorbidity (N=37,148, aged 40+: having ≥2 of the following: doctor-diagnosed diabetes or hypertension, heart attack or stroke) and multiple cardiometabolic risk biomarkers (HbA1c ≥6.5%, raised blood pressure, total cholesterol ≥5mmol/L).

Results

20% of adults had general multimorbidity. In fully-adjusted models, compared with the White British majority, Other White (Odds Ratio (OR)=0.63 (95% confidence interval=(0.53-0.74)), Chinese (OR=0.58 (0.36-0.93)), and African adults (OR=0.54 (0.42-0.69)), had lower odds of general multimorbidity. Among adults aged 40+, Pakistani (OR=1.27 (0.97-1.66) p=0.080) and Bangladeshi (OR=1.75 (1.16-2.65)) had increased odds, and African adults had decreased odds (OR=0.63 (0.47-0.83)) of general multimorbidity. Risk of cardiovascular multimorbidity was higher among Indian (OR=3.31 (2.56-4.28)), Pakistani (OR=3.48 (2.52-4.80)), Bangladeshi (OR=3.67 (1.98-6.78)), African (OR=1.61 (1.05-2.47)), Caribbean (OR=2.18 (1.59-2.99)) and White Mixed (OR=1.98 (1.14-3.44)) adults. Indian adults were also at risk of having multiple cardiometabolic risk biomarkers.

Conclusion

Ethnic inequalities in multimorbidity are independent of socioeconomic factors. Ethnic minority groups are particularly at risk of cardiovascular multimorbidity, which may be exacerbated by poorer management of cardiometabolic risk factors.

What is already known on this topic

Studies have found ethnic inequalities in multimorbidity among broad ethnic groups; however, it is not known whether lower socioeconomic status or health behaviours are driving this inequality in England, nor whether there are differences between distinct ethnic groups.

What this study adds

Ethnic inequalities in multimorbidity in a nationally-representative sample in England vary between older and younger adults, distinct ethnic groups, and are independent of socioeconomic status, smoking and obesity.

African, Caribbean, Bangladeshi, Indian, Pakistani and White mixed adults aged 40 and over had higher risk of self-reported cardiovascular multimorbidity compared with British White adults. Indian adults were also at risk of multiple uncontrolled cardiometabolic risk biomarkers.

African, Chinese, Other White and Indian adults (<40 years) had lower risk of general multimorbidity compared with the British White majority, suggesting a healthy migrant effect or differences in interpretation of chronic conditions.

How this study might affect research, practice or policy

Further research is needed to explore whether underdiagnosis and/or poorer management of cardiometabolic risk factors among ethnic groups may be driving factors behind inequalities in self-reported cardiovascular multimorbidity.