Differences in ill health and in socioeconomic inequalities in health by ethnic groups: a cross-sectional study using 2011 Scottish census

Mirjam Allik,Denise Brown,Ruth Dundas,Alastair H Leyland

doi:10.1080/13557858.2019.1643009

Abstract

ABSTRACT Objectives: We compare rates of ill health and socioeconomic inequalities in health by ethnic groups in Scotland by age. We focus on ethnic differences in socioeconomic inequalities in health. There is little evidence of how socioeconomic inequalities in health vary by ethnicity, especially in Scotland, where health inequalities are high compared to other European countries. Design: A cross-sectional study using the 2011 Scottish Census (population 5.3 million) was conducted. Directly standardized rates were calculated for two self-rated health outcomes (poor general health and limiting long-term illness) separately by ethnicity, age and small-area deprivation. Slope and relative indices of inequality were calculated to measure socioeconomic inequalities in health. Results: The results show that the White Scottish population tend to have worse health and higher socioeconomic inequalities in health than many other ethnic groups, while White Polish and Chinese people tend to have better health and low socioeconomic inequalities in health. These results are more salient for ages 30–44. The Pakistani population has high rates of poor health similar to the White Scottish for ages 15–44, but at ages 45 and above Pakistani people have the highest rates of poor self-rated health. Compared to other ethnicities, Pakistani people are also more likely to experience poor health in the least deprived areas, particularly at ages 45 and above. Conclusions: There are statistically significant and substantial differences in poor self-rated health and in socioeconomic inequalities in health between ethnicities. Rates of ill health vary between ethnic groups at any age. The better health of the younger minority population should not be taken as evidence of better health outcomes in later life. Since socioeconomic gradients in health vary by ethnicity, policy interventions for health improvement in Scotland that focus only on deprived areas may inadvertently exclude minority populations.

Highlights

There is growing international interest from both academics and policy makers in the relationship between health and ethnicity (Kim et al 2013; Disney et al 2017)
While we find that some minority ethnic groups have better self-rated health (SRH) and lower socioeconomic inequalities in health compared to the White Scottish majority, this often applies only to younger age groups and at older ages this can be the reverse
Our study has examined ethnic differences in ill health and in socioeconomic inequalities in health, an increasingly important public health focus

Summary

Introduction

There is growing international interest from both academics and policy makers in the relationship between health and ethnicity (Kim et al 2013; Disney et al 2017). This partly reflects increasing trends in migration; according to the United Nations (United Nations 2017) the per cent of migrants from total population in high-income countries rose from 9.6% in 2000 to 14% in 2017. There is a growing understanding that for sustainable development inequalities have to be reduced, and vital information should be collected and analysed by different population groups, such as gender, ethnicity, age, disability, income and so forth (United Nations 2015). Efforts have been made to improve data collection, such as increasing completeness of coding ethnicity on hospitalization records (ISD Scotland 2017a) and including ethnicity on mortality records in Scotland (Christie 2012)

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