The Relationship Between Ethnicity and Socioeconomic Deprivation as Determinants of Health: A Systematic Review

Abstract

Background: Ethnicity and Socioeconomic Status (SES) are well known social determinants of health. However, the impact of the intersection between ethnicity and SES on health remains poorly understood, with many studies examining these factors separately. Methods: We conducted a systematic review using MEDLINE (PubMed), EMBASE, and The Cochrane Library databases. Studies were eligible if they compared outcomes defined by mortality, attendance, readmission, or hospital length of stay, for any acute or chronic illness, according to one or more measures of both ethnicity and SES in adult patients (≥18 years of age) attending primary care or admitted to hospital. Results: Nine studies met eligibility criteria. There was significant heterogeneity in cohort demographics, key variables, and outcome measures. Therefore, qualitative analysis was used. Definitions and categories of ethnicity were inconsistent, using race, country of origin, and sociocultural characteristics. Definitions of SES varied, with studies using between one and seven metrics. Different sub-categories were often used, even when the same metric was utilised. Primary outcomes were mortality (n=7) or admissions-related (n=2). Approaches varied between studies, regarding cause, time periods, and end points. Of those looking at mortality, four reported seeing an interaction between ethnicity and SES groups on outcomes.