Ethnic inequalities in primary care experiences for people with multiple long-term conditions: Evidence from the general practice patient survey.

Objectives: To examine the relationship between ethnicity and experiences of primary care for people with multiple long-term conditions (MLTCs) and assess the relative importance of demographic, practice, and area-level factors as influences on primary care experiences across ethnic groups.

Study Design: A retrospective study using 2018-19 GP Patient Survey data linked to General Practice Workforce data and small area data published by the Office for National Statistics.

Methods: We conducted multilevel regression analysis to assess the relationship between ethnicity and experience of accessing primary care and interacting with healthcare professionals.

Mechanisms for Integrating Real Data into Search Game Simulations: An Application to Winter Health Service Pressures and Preventative Policies.

While modelling and simulation are powerful techniques for exploring complex phenomena, if they are not coupled with suitable real-world data any results obtained are likely to require extensive validation. We consider this problem in the context of search game modelling, and suggest that both demographic and behaviour data are used to configure certain model parameters. We show this integration in practice by using a combined dataset of over 150,000 individuals to configure a specific search game model that captures the environment, population, interventions and individual behaviours relating to winter health service pressures.

The prevalence of common mental disorders across 18 ethnic groups in Britain during the COVID-19 pandemic: Evidence for Equality National Survey (EVENS).

Background: The COVID-19 pandemic negatively impacted mental health in the general population in Britain. Ethnic minority people suffered disproportionately, in terms of health and economic outcomes, which may contribute to poorer mental health. We compare the prevalence of depression and anxiety across 18 ethnic groups in Britain during the COVID-19 pandemic.

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

Little is known about the patterning of multiple long-term conditions (MLTCs) by age, ethnicity and across conceptualisations of MLTCs (e.g. MLTCs with/without mental health conditions [MHCs]).

Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study.

Background: The association of COVID-19 with death in people with severe mental illness (SMI), and associations with multimorbidity and ethnicity, are unclear.

Aims: To determine all-cause mortality in people with SMI following COVID-19 infection, and assess whether excess mortality is affected by multimorbidity or ethnicity.

Method: This was a retrospective cohort study using primary care data from the Clinical Practice Research Database, from February 2020 to April 2021.

Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study.

Background: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census.

Methods: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group.

Ethnic inequalities in positive SARS-CoV-2 tests, infection prognosis, COVID-19 hospitalisations and deaths: analysis of 2 years of a record linked national cohort study in Scotland.

Background: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland.

Methods: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020.

Ethnic inequities in the patterns of personalized care adjustments for 'informed dissent' and 'patient unsuitable': a retrospective study using Clinical Practice Research Datalink.

Background: In England, general practitioners voluntarily take part in the Quality and Outcomes Framework, which is a program that seeks to improve care by rewarding good practice. They can make personalized care adjustments (PCAs), e.g.

The influence of a hostile environment on a syndemic of depression, stress and chronic limiting illness among LGBTQ+ people during the COVID-19 pandemic.

Lesbian, Gay, Bisexual, Transgender, Queer, Questioning (LGBTQ+) are at greater risk of poorer COVID-19 prognosis due to higher levels of chronic disease and a greater impact on mental health from pandemic mitigation strategies due to worse pre-pandemic mental health. We examine how a hostile social system contributes to LGBTQ+ people's negative health experiences during the pandemic through adopting a syndemic framework and using data from The Queerantine Study, a cross-sectional, web-based survey (n = 515). Identification of a health syndemic is based on depressive symptoms, perceived stress and limiting long-term illness.

Maternal racism experience and cultural identity in relation to offspring telomere length.

Racism is a determinant of individual and offspring health. Accelerated telomere shortening, an indicator of cellular aging, is a potential mechanism through which parental experience of racism could affect offspring. Here we longitudinally evaluated the relationship between maternal lifetime experience of an ethnically-motivated verbal or physical attack, as reported in pregnancy, with offspring telomere length in 4.

Pathways to ethnic inequalities in COVID-19 health outcomes in the United Kingdom: A systematic map.

Background: Marked ethnic inequalities in COVID-19 infection and its consequences have been documented. The aim of this paper is to identify the range and nature of evidence on potential pathways which lead to ethnic inequalities in COVID-19 related health outcomes in the United Kingdom (UK).

Methods: We searched six bibliographic and five grey literature databases from 1 December 2019 to 23 February 2022 for research on pathways to ethnic inequalities in COVID-19 health outcomes in the UK.

Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants.

Background: COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group.

Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis.

Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs.

Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems.

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population.

Continuity of care in diverse ethnic groups: a general practice record study in England.

Background: GPs and patients value continuity of care. Ethnic differences in continuity could contribute to inequalities in experience and outcomes.

Aim: To describe relational continuity of care in general practice by ethnicity and long-term conditions.

The enduring effects of racism on health: Understanding direct and indirect effects over time.

Experiences of racism and racial discrimination are associated with poorer mental and physical health outcomes for people from minoritised ethnic groups. One mechanism by which racism leads to poor health is through reduced socio-economic resources, but the evidence documenting the direct and indirect effects of racism on health via socio-economic inequality over time is under-developed. The central aims of this paper are to better understand how racism affects health over time, by age, and via the key mechanism of socio-economic inequality.

Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study.

Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy.

COVID-19 ethnic inequalities in mental health and multimorbidities: protocol for the COVEIMM study.

Purpose: The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI).

Methods: This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD).

Inequalities in mental health, self-rated health, and social support among sexual minority young adults during the COVID-19 pandemic: analyses from the UK Millennium Cohort Study.

Purpose: Young adults who self-identify as a sexual minority may have been particularly harmed by the consequences of lockdown, closure of educational institutions, and social distancing measures as they are likely to have been confined in households that may not be supportive of their sexual orientation. We examine inequalities in the mental health and self-rated health of sexual minority young adults, compared to their heterosexual peers, at the height of lockdown restrictions in the UK.

Methods: We analysed data from singletons who participated in waves 6, 7, and the wave 1 COVID-19 survey (n = 2211) of the Millennium Cohort Study, a nationally representative longitudinal study of infants born in the UK between September 2000 and January 2002.

Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis.

Indicative evidence suggests that the prevalence of multiple long-term conditions (i.e., conditions that cannot be cured but can be managed with medication and other treatments) may be higher in people from minoritised ethnic groups when compared to people from the White majority population.

Explaining ethnic variations in adolescent mental health: a secondary analysis of the Millennium Cohort Study.

Purpose: The relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study.

Methods: Parental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixed n = 492, Indian n = 275, Pakistani n = 496, Bangladeshi n = 221, Black Caribbean n = 102, Black African n = 187, Other Ethnic Group n = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use).

Discrimination as a predictor of poor mental health among LGBTQ+ people during the COVID-19 pandemic: cross-sectional analysis of the online Queerantine study.

Objectives: To assess the mental health and experiences of discrimination among lesbian, gay, bisexual, transgender, queer (LGBTQ) people at the start of the COVID-19 pandemic.

Design: Data come from a cross-sectional online survey targeted at LGBTQ+ people, which collected data on mental health, experiences of discrimination and a number of other pandemic-related experiences. To examine the association between sexual orientation and gender and mental health and experiences of discrimination, we conducted regression analyses that adjusted for a range of sociodemographic variables.

Evidence for ethnic inequalities in mortality related to COVID-19 infections: findings from an ecological analysis of England.

Objectives: In the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.

Design: Ecological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.