Abstract
Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access to biologics has been an issue. In this study, data on admissions to hospital of South Asian and White British patients with inflammatory bowel disease between 2015 and 2019 were collected from 12 National Health Service (NHS) trusts in England, three Health Boards in Wales and two Scottish health organizations using Freedom of Information requests. The analyses of data were based on the assumption that inflammatory bowel disease (IBD) has the same prevalence in the South Asian community and the White British community in the UK. Comparisons were made between the proportion of hospitalised patients who were South Asian and the proportion who were White British in the local community using a z statistic. In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK. However, in Coventry, Wolverhampton, Walsall, Acute Pennine Trust in the north-west of England, Barking, Havering and Redbridge and Glasgow, South Asian patients were significantly under-represented, indicating significant issues with access to hospital-based healthcare for inflammatory bowel disease. This study provides evidence of on-going evidence of disparate levels of care for patients from a South Asian background, with inflammatory bowel disease being underserved by a number of NHS Trusts, Health Boards and comparable organisations. When there is on-going failure to achieve the objectives of the NHS of achieving equality in the delivery of care, it is critical to introduce effective policies which will alter the in-built inertia to change within such organisations.
Highlights
In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK
There have been earlier studies that have shown disparate levels of care received by South Asian patients in England [1] and amongst Eastern European and AfroCaribbean patients, compared to those who are White British [2]
The data provided by Buckinghamshire National Health Service (NHS) Healthcare Trust suggested considerably lower admission rates for inflammatory bowel disease and was not consistent with data from all other organisations
Summary
There have been earlier studies that have shown disparate levels of care received by South Asian patients in England [1] and amongst Eastern European and AfroCaribbean patients, compared to those who are White British [2]. Trusts deny the evidence from their own data that such disparate levels of care exist [3]. National organisations, such as the Care Quality Commission and National Health Service (NHS) Improvement, which are tasked with ensuring equitable care, have taken no actions to address issues of disparate levels of care [3].
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