Health Inequalities in Primary Care: Ethnicity, Antibiotic Resistance and Respiratory Health

Problem

A recent study has found that people from ethnic minority backgrounds are likely to have a greater level of antibiotic resistant gut microbiota compared to white ethnicities. This study aims to quantify associations between ethnicity and health outcomes related to respiratory infections, and exacerbations of chronic respiratory illnesses (including asthma and COPD). People from minority ethnic groups tend to be associated with poorer health outcomes. Although there is evidence that quantifies the association between ethnicity and various respiratory health outcomes, there is currently no evidence regarding how antibiotic resistance contributes to this. Therefore, this research aims to understand these relationships between ethnicity, antibiotic resistance and respiratory health.

Approach

To investigate differences between demographic groups in health service use and antibiotic prescribing, data will be obtained from the BNSSG system-wide dataset (SWD), an anonymised individual patient level dataset encompassing Primary and Secondary care patient data across the BNSSG Integrated Care Board region. This study will investigate associations between ethnicity and health outcomes related to respiratory infections including antibiotic prescriptions for different diagnoses, GP and emergency department attendance, and hospital admissions.To explore experiences of ethnic minority patients and GPs who provide primary care to ethnically diverse communities, qualitative interviews with up to 20 doctors and up to 30 patients will be conducted . Interviews will ask about: experiences of primary care consultations for respiratory conditions; explore any problems with accessing or giving healthcare; investigate reasons for any inequalities that are identified by the quantitative analysis; and obtain views on how to reduce inequalities for this group.To ensure public involvement in the research, a recruitment strategy was developed (with public input) to from an advisory group of people with African and Asian heritage with no restrictions on age or gender. This group will meet regularly to advise on the research including: interpretation of the quantitative analysis findings; development of qualitative study recruitment strategy and interview topic guide; integration of mixed methods study findings and strategies for disseminating the results.

Findings

The application to access the Bristol, North Somerset, and South Gloucestershire (BNSSG) system-wide dataset (SWD) has been submitted and is being reviewed. The public advisory board recruitment resources have been disseminated and recruitment is in progress.

Consequences

This study will be one of the first of its kind to measure health outcomes related to respiratory infections in different ethnic groups using a unique dataset combining both primary and secondary care interactions at the individual patient-level. This data will allow us to determine whether antibiotic prescribing in different ethnic groups is associated with poorer respiratory infection outcomes. It will identify possible reasons for increased antibiotic resistance in ethnic minorities, which will enable the development of interventions and identify healthcare service improvements to reduce this disparity.