Ethnic inequalities in health and care among people with multiple conditions A project aiming to build an evidence base on ethnic inequalities in the health and care of people with multiple long-term conditions.

The number of people in the UK who are living with multiple long-term conditions (MLTCs) is rising, and those with MLTCs have reduced quality of life and a higher risk of mortality. There is evidence that people from some minority ethnic groups may be at a greater risk of having MLTCs when compared to people from the white majority population.

There is growing evidence of ethnic inequalities in health care, in particular in relation to access to services. However, to date, there has been little evidence uncovered on ethnic inequalities in the prevalence, health care utilisation and care quality for people with MLTCs.

About the project 

The project team will synthesise existing evidence and use nationally representative data to provide an up-to-date description of how MLTCs vary across ethnic groups in the UK.

They will describe ethnic differences in health care quality (including continuity of care) and outcomes (including quality of life and survival) for people with MLTCs, and will provide evidence on these inequalities for policy makers, practitioners and academia.

A combination of survey data and electronic health record data will be used to understand the level of health care need and the differences in each of these data sources.

The project team will describe and appraise the current evidence, make it accessible to interested parties, and identify the gaps.

Project outputs to date

• A systematic review of studies reporting ethnic variations in health care use and care quality among people with MLTCs was carried out and published in November 2021. There were 14 studies found on aspects of care for people with MLTCs, with five that focused on more than two conditions. From these, there was some evidence of suboptimal disease management in black and South Asian people. The review demonstrated that there is a lack of studies exploring ethnic inequalities in the different dimensions of care quality among people with MLTCs.
• Analysis to find out whether MLTCs and mortality varies across ethnic groups in England was carried out and published in April 2022. It aimed to estimate the mortality risk of having MLTCs, and whether the size of this risk varies across ethnic groups. The analysis revealed that the higher mortality rate associated with having multiple conditions is greater in Pakistani, African, Caribbean and other black ethnic groups compared with white ethnic groups.
• Comparison of quality of primary care for people with MLTCs across ethnic groups is underway. This shows lower levels of continuity of care for Bangladeshi, Pakistani, Black African, Black Caribbean and other Black ethnic groups. Analysis of exclusion from the Quality Outcomes Framework, a pay-for-performance scheme that rewards general practices for delivery of evidence-based standards of care, is underway.
• An event summarising this work and related work funded by the Health Foundation and discussing the implications with policy experts is available to watch here.

Contact details

For further information about this project, please contact Mai Stafford, Senior Analytical Manager at the Health Foundation.