Background

The population of older adults (ie, those aged ≥55 years) in England is becoming increasingly ethnically diverse. Previous reports indicate that ethnic inequalities in health exist among older adults, but information is limited by the paucity of data from small minority ethnic groups. This study aimed to analyse inequalities in health-related quality of life (HRQoL) and five determinants of health in older adults across all ethnic groups in England.

Methods

In this cross-sectional study, we analysed data from five waves (July 1, 2014, to April 7, 2017) of the nationally representative English General Practice Patient Survey (GPPS). Study participants were adults aged 55 years or older who were registered with general practices in England. We used regression models (age-adjusted and stratified by gender) to estimate the association between ethnicity and HRQoL, measured by use of the EQ-5D-5L index and its domains (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression). We also estimated associations between ethnicity and five determinants of health (presence of long-term conditions or multimorbidity, experience of primary care, degree of support from local services, patient self-confidence in managing own health, and degree of area-level social deprivation). We examined robustness to differential handling of missing data, alternative EQ-5D-5L value sets, and differences in area-level social deprivation.

Findings

There were 1 416 793 GPPS respondents aged 55 years and older. 1 394 361 (98·4%) respondents had complete data on ethnicity and gender and were included in our analysis. Of these, 152 710 (11·0%) self-identified as belonging to minority ethnic groups. HRQoL was worse for men or women, or both, in 15 (88·2%) of 17 minority ethnic groups than the White British ethnic group. In both men and women, inequalities were widest for Gypsy or Irish Traveller (linear regression coefficient −0·192 [95% CI −0·318 to −0·066] in men; −0·264 [–0·354 to −0·173] in women), Bangladeshi (−0·111 [–0·136 to −0·087] in men; −0·209 [–0·235 to −0·184] in women), Pakistani (−0·084 [–0·096 to −0·073] in men; −0·206 [–0·219 to −0·193] in women), and Arab (−0·061 [–0·086 to −0·035] in men; −0·145 [–0·180 to −0·110] in women) ethnic groups, with magnitudes generally greater for women than men. Differentials tended to be widest for the self-care EQ-5D-5L domain. Ethnic inequalities in HRQoL were accompanied by increased prevalence of long-term conditions or multimorbidity, poor experiences of primary care, insufficient support from local services, low patient self-confidence in managing their own health, and high area-level social deprivation, compared with the White British group.

Interpretation

We found evidence of wide ethnic inequalities in HRQoL and five determinants of health for older adults in England. Outcomes varied between minority ethnic groups, highlighting heterogeneity in the direction and magnitude of associations. We recommend further research to understand the drivers of inequalities, together with policy changes to improve equity of socioeconomic opportunity and access to services for older adults from minority ethnic groups.

Funding

University of Manchester and National Institute for Health Research.

中文翻译：

---

英格兰老年人健康相关生活质量中的种族不平等：国家横断面调查的次要分析

背景

英格兰的老年人口（即年龄≥55岁的人口）正变得越来越多样化。先前的报告表明，老年人中存在种族不平等的健康状况，但是由于少数少数民族的数据匮乏，信息受到限制。这项研究旨在分析与健康有关的生活质量（HRQoL）中的不平等现象，以及英格兰所有族裔中老年人的五个健康决定因素。

方法

在这项横断面研究中，我们分析了全国代表性的英国全科患者调查（GPPS）的五次浪潮（2014年7月1日至2017年4月7日）中的数据。研究参与者是55岁以上的成年人，他们已经在英格兰进行了常规注册。我们使用回归模型（按年龄调整和按性别分层）来估计种族和HRQoL之间的关联，该关联通过使用EQ-5D-5L指数及其域（活动性，自我护理，日常活动，疼痛或不适，和焦虑或抑郁）。我们还估算了种族与五个健康决定因素之间的关联（长期状况或多发病，存在初级保健的经验，当地服务的支持程度，患者对自己健康管理的自信心以及区域一级的社会剥夺程度） ）。

发现

55岁及以上的年龄在1416793 GPPS的受访者中。1 394 361（98·4％）的受访者拥有完整的种族和性别数据，并包括在我们的分析中。在这些人中，有152,710（11·0％）人自称是少数民族。在17个少数族裔中，有15个（88·2％）的男性或女性，或两者兼有的HRQoL比白人英国族裔更差。在男性和女性中，吉普赛人或爱尔兰旅行者的不平等最广泛（男性线性回归系数−0·192 [95％CI −0·318至−0·066]； − 0·264 [–0·354至-女用[0·173]），孟加拉国（男用-0·111 [–0·136至-0·087]；女用-0·209 [–0·235至-0·184]），巴基斯坦（-男性为0·084 [–0·096至-0·073]；女性为−0·206 [–0·219至-0·193]）和阿拉伯语（−0·061 [–0·086至-男性； 0·035]；女性）-0·145 [–0·180至-0·110]民族，女性的身材通常要比男性高。自我护理EQ-5D-5L域的差异往往最广。与之相比，HRQoL中的种族不平等伴随着长期状况或多发病的患病率增加，初级保健的经验不足，当地服务的支持不足，患者对自己的健康管理的自信心低下以及区域性社会剥夺程度高白英集团。

解释

我们发现证据表明，英格兰的HRQoL中存在着广泛的种族不平等现象，并且是老年人健康状况的五个决定因素。少数族裔群体的结局各不相同，突出了结社方向和程度的异质性。我们建议进行进一步的研究，以了解不平等的驱动因素，以及旨在改善社会经济机会公平性和少数族裔老年人获得服务机会的政策变化。

资金

曼彻斯特大学和国家卫生研究所。