Representation of Black, Asian and minority ethnic patients in secondary care mental health services: analysis of 7-year access to memory services in Leicester and Leicestershire.

Hari Subramaniam,Andrew Wilson,John Bankart,Elizabeta B Mukaetova-Ladinska

doi:10.1192/bjb.2020.3

Abstract

We aimed to explore access by Black, Asian and minority ethnic (BAME) elders to the memory services in Leicester and Leicestershire, examining any trends over time. We then compared the odds of referral by ethnicity, using observed versus expected referrals for the city of Leicester. We gathered data on a comprehensive county-wide memory clinic used by people with suspected dementia and memory problems from the Trust electronic record system during the period 2011-2017. For Leicester city, we compared referral rates for 2011-2017 and compared observed and expected referral rates with demographics from the UK Census 2011. In Leicester, there was a significant underrepresentation of referrals from the BAME population as compared with the White population in 2011, 2012 and 2013, when compared with population estimates of those aged ≥60 years from the 2011 UK Census Leicester city data. Data for the Black population were too small for comparisons. The odds of being referred to a memory clinic for the White group was double that of the Asian group in 2011 (odds ratio 2.15, 95% CI 1.52-3.02) and nearly 1.5 times in 2012 (odds ratio 1.40, 95% CI 1.01-1.93). This difference did not persist after 2014. However, this differential odds of referral changes when the age difference between the groups is accounted for. After adjusting for age, there were no differences between the two groups in their odds of referral to the memory clinic from 2011 to 2013, but from 2014 to 2017, members of the Asian group had higher odds of being referred. The relationship between BAME and access to memory services is complex. The relative lower prevalence of Asian people among referrals to memory services in Leicester from 2011 to 2013 may partly be explained by the lower ages of the Asian population at referral. The higher prevalence of Asian people in 2014-2017 may be owing to use of denominators from the 2011 UK Census, which are likely to be disproportionately low for this group. Further studies are needed to explore any potential barriers to the access of services by BAME communities.

Highlights

As a part of a National Institute of Health Research (NIHR) study, the findings of which will be reported elsewhere, we identified all referrals to the Leicestershire Partnership National Health Service Trust (LPT) memory clinics where patients suspected of cognitive disorders and dementias would be referred and diagnosed
We found that Asian people represented 22.6% of all the memory service referrals in Leicester city and 1.5% within the county of Leicestershire
The role and the nature of the assessments in memory clinics have perhaps changed over these times, with increasing awareness of the newer concept of minimal cognitive impairment and changes to the assessments of cognitive issues associated with functional illness and/or physical illnesses

Summary

Results

LPT memory services received a total of 15 634 referrals, of which 191 (1.2%) had been entered in error. As the raw referral rate data suggested a lower referral rate among BAME groups compared with the White British population, for Leicester city we compared annual referral rates between 2011 and 2017, based on an estimate of the population at risk, derived from the 2011 UK Census. We obtained this population-at-risk estimate by an age-defined cut-off of 60 years, obtained by stratification of the known population estimates taken from the 2011 UK Census data. To control for the effects of age at presentation, we compared the White ethnicity and Asian ethnicity groups, using age-adjusted logistic regression over the period 2011–2017 (Table 5), with data from each year being analysed separately. The odds of being actively open to the memory clinic were 1.67 (95% CI 1.42–1.96; P < 0.0001) times lower in the Asian population (24% of active cases compared with the 40% of total at-risk Asian population estimates), whereas the odds of being actively open to the memory clinic were 2.72 (95% CI 1.79–4.15; P < 0.0001) times lower for the Black population (among the 2.4% of active cases compared with the 7% of total at-risk Black population estimates)

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Future work