Mindell JS, Knott CS, Ng Fat LS, Roth MA, Manor O, Soskolne V, Daoud N. Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England. J Epidemiol Community Health. 2014 Dec;68(12):1133-44.

J Epidemiol Community Health. 2014 Dec;68(12):1133-44. doi: 10.1136/jech-2014-203927. Epub 2014 Aug 5.

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England.

Mindell JS(1), Knott CS(1), Ng Fat LS(1), Roth MA(1), Manor O(2), Soskolne V(3), Daoud N(4).

Author information:
(1)Department of Epidemiology & Public Health, UCL (University College London), London, UK.
(2)School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel.
(3)School of Social Work, Bar-llan University, Ramat-Gan 52900, Israel.
(4)Department of Public Health, Ben Gurion University of the Negev, Beersheba, Israel.

BACKGROUND: The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants.

METHOD: Using HSE 2003-2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28,470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models.

RESULTS: Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96).

CONCLUSIONS: SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.

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PMID: 25096809  [PubMed - indexed for MEDLINE]

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