Gastrointestinal infections and ethnicity in the UK: a systematic review and narrative synthesis

Abstract

Abstract Background Gastrointestinal (GI) infections exert a significant public health burden on healthcare services in the United Kingdom (UK). The literature suggests an association between ethnicity and health; however, we do not know the extent of inequalities in GI infection/disease in the UK. This systematic review aimed to identify studies that ascertain differences in the incidence or prevalence of GI infections between UK ethnic groups and explore possible explanations for heterogeneity observed within the literature. Methods MEDLINE, CINAHL Plus, Web of Science (Science Social Science Citation Index), and grey literature were searched from 1980 to 21st June 2023 for studies reporting an association between ethnicity and GI infections in UK population samples. Two reviewers independently screened the studies and conducted quality appraisals; data extraction was undertaken by one reviewer and verified by another reviewer. A narrative synthesis was undertaken and a harvest plot supported the textual synthesis to investigate potential sources of heterogeneity in effect estimates by GI pathogen and ethnic group. Results The searches identified 10028 studies, of which 16 met the inclusion criteria. 15 out of 47 effect estimates from a total of 16 studies found that GI infection risk was greater in Black and Ethnic Minority Groups, mainly of Asian ethnicity, compared to the majority White population. 13 studies reported a higher risk in ethnic minorities of Asian ethnicity, while one study described a higher risk in the Non-White ethnic group. One single study on STEC reported a higher risk of GI infection in the White population compared to the Non-White population, while another single study on norovirus found no significant difference by ethnic group. Conclusions This systematic review demonstrates that ethnic minority groups in the UK have a higher risk of GI infections than the general or White population. Key messages • There is a clear need to elucidate further the high incidence of GI infections in UK Indian, Pakistani, and Bangladeshi communities. • Tackling ethnic inequalities requires a concerted approach and translating evidence into policy.