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

Problem

During the COVID-19 pandemic, we witnessed how the virus and the measures adopted to arrest its spread disproportionately impacted people from minoritised ethnic groups. Pre-existing long-term conditions were a key driver of these observed inequalities. Indicative evidence suggests that minoritised ethnic group people have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the white majority population. While there is evidence on ethnicity and single 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. A better understanding of ethnic inequalities in MLTCs is needed to inform recovery efforts from the COVID19 pandemic. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, and 2) summarise the prevalence estimates of MLTCs across ethnic groups.

Approach

We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. In order to address the second objective, we included only studies that counted more than two long‐term conditions as they are more likely to give insight into individuals severe disease and therefore, complex medical needs and greater usage of healthcare. Two reviewers, B.H and L.B. screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis.

Findings

Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts

Consequences

Because the number/types of health conditions varied between studies and some ethnic populations were aggregated, the findings may not accurately reflect the true level of inequality. Thus, our conclusions can only be tentative. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development of MLTCs in different ethnic groups.