Associations between multiple long-term conditions and mortality in diverse ethnic groups

Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and Findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Cox regression models were used to estimate mortality by number of long-term conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional long-term condition at baseline was associated with increased mortality. This association differed across ethnic groups. Compared with 50-year-olds of white ethnicity with no conditions, the mortality rate was higher for white 50-year-olds with two conditions (HR 1.77) or four conditions (HR 3.13). Corresponding figures were higher for 50-year-olds of Black Caribbean ethnicity with two conditions (HR=2.22) or four conditions (HR 4.54). The direction of the interaction of number of conditions with ethnicity showed higher mortality associated with long-term conditions in nine out of ten minoritised ethnic groups, attaining statistical significance in four (Pakistani, Black African, Black Caribbean and Black other ethnic groups). Conclusions The raised mortality rate associated with having multiple conditions is greater in minoritised ethnic groups compared with white people. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.

Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records

ObjectivesSickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables.DesignLongitudinal study of health records.SettingPrimary care and secondary mental health care in the borough of Lambeth, South London. Forty-five GP practices in Lambeth and the local secondary mental healthcare trust.ParticipantsThe analytical sample included 293 933 working age adults (16–60 years) registered at a Lambeth GP practice between 1 January 2014 and 30 April 2016.Primary and secondary outcome measuresThree indicators of mental healthcare in the year after first fit note were antidepressant prescription, contact with Improving Access to Psychological Therapy (IAPT) services and contact with secondary mental health services.Results75% of people with an identified mental health condition at first fit note had an indicator of mental healthcare in the following year. Black Caribbean and Black African groups presenting with mental disorders were less likely to have a mental healthcare indicator compared with White British groups.ConclusionsThe majority of those with an identified mental health need receive some treatment in the year following a fit note; however, our results suggest Black African and Black Caribbean groups with an identified mental healthcare need have less complete access compared to the White British group.

Exploring the racial habitus through John’s story: On race, class and adaptation

This article puts Pierre Bourdieu’s conceptual tool habitus to work alongside Sara Ahmed’s theory of racialization to conceptualize a racial habitus that is durable but not totally determining. The racial habitus is applied to the narrative account of John, a Black-Caribbean man from North East London, who finds himself a ‘fish out of water’ within a racist society, which confronts him with the reality that he must actively acquire new dispositions, sensibilities and cultural capital, in order to survive. This article explores the cost of this adaptation for people such as John and the uneven processes that enabled his constrained adaptation. It is argued that people such as John are forced to ‘carve’ themselves out against the backdrop of dominant racist discourse in complex and creative ways that highlight the constrained but non-essential nature of racial subjectivities. In doing so, this article argues against perceptions that Pierre Bourdieu is a structural determinist through offering empirically-driven insights that highlight his oft-ignored complex positions on agency.

Sociodemographic inequality in COVID-19 vaccination coverage among elderly adults in England: a national linked data study

ObjectiveTo examine inequalities in COVID-19 vaccination rates among elderly adults in England.DesignCohort study.SettingPeople living in private households and communal establishments in England.Participants6 655 672 adults aged ≥70 years (mean 78.8 years, 55.2% women) who were alive on 15 March 2021.Main outcome measuresHaving received the first dose of a vaccine against COVID-19 by 15 March 2021. We calculated vaccination rates and estimated unadjusted and adjusted ORs using logistic regression models.ResultsBy 15 March 2021, 93.2% of people living in England aged 70 years and over had received at least one dose of a COVID-19 vaccine. While vaccination rates differed across all factors considered apart from sex, the greatest disparities were seen between ethnic and religious groups. The lowest rates were in people of black African and black Caribbean ethnic backgrounds, where only 67.2% and 73.8% had received a vaccine, with adjusted odds of not being vaccinated at 5.01 (95% CI 4.86 to 5.16) and 4.85 (4.75 to 4.96) times greater than the white British group. The proportion of individuals self-identifying as Muslim and Buddhist who had received a vaccine was 79.1% and 84.1%, respectively. Older age, greater area deprivation, less advantaged socioeconomic position (proxied by living in a rented home), being disabled and living either alone or in a multigenerational household were also associated with higher odds of not having received the vaccine.ConclusionResearch is now urgently needed to understand why disparities exist in these groups and how they can best be addressed through public health policy and community engagement.

Racialized Immigrants In Canada’s Changing Labour Market: An Investigation Of The Effects Of Precarious Work On Black Caribbean Women

This research undertakes an examination of the employment opportunities and experiences of black Caribbean women in Canada, particularly within the context of the growing trend towards precarious jobs—casual, part-time and low paying—in the restructured Canadian labour market. The specific purview of this study is the labour history and employment experience of a representative group of black Caribbean women who work as Personal Support Workers in nursing homes across the Greater Toronto Area. A main concern of the study is to understand the ways in which precarious work affects these women’s settlement and integration experiences, particularly their ability to gain economic independence; this, in turn, affects a number of variables related to their, and others, perception regarding their status and place in Canada. By focusing on the case of Personal Support Workers, the study aims to shed light not only on the employment experiences of black Caribbean women in this sector but also to examine more closely the policies and employment practices that create labour market “niches” or labour “segregation” along racial and gender lines.

Racialized Immigrants In Canada’s Changing Labour Market: An Investigation Of The Effects Of Precarious Work On Black Caribbean Women

This research undertakes an examination of the employment opportunities and experiences of black Caribbean women in Canada, particularly within the context of the growing trend towards precarious jobs—casual, part-time and low paying—in the restructured Canadian labour market. The specific purview of this study is the labour history and employment experience of a representative group of black Caribbean women who work as Personal Support Workers in nursing homes across the Greater Toronto Area. A main concern of the study is to understand the ways in which precarious work affects these women’s settlement and integration experiences, particularly their ability to gain economic independence; this, in turn, affects a number of variables related to their, and others, perception regarding their status and place in Canada. By focusing on the case of Personal Support Workers, the study aims to shed light not only on the employment experiences of black Caribbean women in this sector but also to examine more closely the policies and employment practices that create labour market “niches” or labour “segregation” along racial and gender lines.