Ethnic inequalities in health-related quality of life among older adults in England: secondary analysis of a national cross-sectional survey
Ethnic inequalities in health-related quality of life among older adults in England: secondary analysis of a national cross-sectional survey
复制标题
DOI：
10.1016/s2468-2667(20)30287-5
复制
发表时间：
2021-02-25
影响因子：
50
通讯作者：
Turner, Alex James
中科院分区：
文献类型：
--
作者：
Watkinson, Ruth Elizabeth;Sutton, Matt;Turner, Alex James
背景英格兰的老年人（即年龄≥ 55岁的人）的种族多样性越来越大。以前的报告表明，老年人在健康方面存在族裔不平等，但由于少数族裔群体的数据很少，资料有限。这项研究的目的是分析在健康相关的生活质量（HRQoL）和五个健康的决定因素在老年人在所有民族在England.Methods的不平等在这个横断面研究中，我们分析了五波（2014年7月1日，2017年4月7日）的全国代表性的英语全科医生患者调查（GPPS）的数据。研究参与者是55岁或以上的成年人，他们在英格兰注册了全科诊所。我们使用回归模型（经年龄调整并按性别分层）估计种族与HRQoL之间的关联，HRQoL通过使用EQ-5D-5L指数及其领域（活动性、自我护理、日常活动、疼痛或不适以及焦虑或抑郁）进行测量。我们还估计了种族与健康的五个决定因素（长期疾病或多重疾病的存在，初级保健的经验，当地服务的支持程度，患者在管理自己的健康方面的自信心，以及地区水平的社会剥夺程度）之间的关联。我们研究了鲁棒性的差异处理缺失的数据，替代EQ-5D-5L值集，并在地区层面的social deprivation.Findings差异有1 416 793 GPPS受访者年龄在55岁及以上。1 394 361名（98.4%）受访者拥有完整的种族和性别数据，并被纳入我们的分析。其中152 710人（11.0%）自认为属于少数族裔。17个少数民族群体中有15个（88.2%）的男性或女性或两者的HRQoL比白色英国民族群体更差。在男子和妇女中，吉普赛人和爱尔兰游民的不平等最严重。（男性线性回归系数为-0.192 [95% CI -0.318至-0.066];女性为-0.264 [-0.354至-0.173]），孟加拉国人（男性-0.111 [-0.136至-0.087];女性-0.209 [-0.235至-0.184]），巴基斯坦人（男性-0.084 [-0.096至-0.073];女性-0.206 [-0.219至-0.193]），阿拉伯（男子为-0.061 [-0.086至-0.035];妇女为-0.145 [-0.180至-0.110]）族裔群体，妇女的幅度一般大于男子。自我护理EQ-5D-5L领域的差异往往最大。在HRQoL的种族不平等的同时，增加患病率的长期条件或多发病，初级保健的经验差，从当地服务的支持不足，病人的自信心低，在管理自己的健康，和高面积级的社会剥夺，与白色英国group.Interpretation相比，我们发现广泛的种族不平等的证据HRQoL和五个决定因素的健康老年人在英格兰。结果各不相同的少数民族群体，突出的异质性的方向和规模的协会。我们建议进一步研究，以了解不平等的驱动因素，以及政策变化，以改善社会经济机会的公平性和少数民族老年人获得服务的机会。版权所有（C）2021作者。爱思唯尔有限公司出版
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 healthrelated 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. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.