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Source: The Lancet 
January 2021

There is a pressing need to understand the health of older adults (ie, those aged ≥55 years) from minority ethnic groups in England.
Although minority ethnic groups in England have young age structures relative to the whole population, historic migration patterns mean that there are substantial and increasing numbers of older people from minority ethnic groups, including settled migrants and British-born individuals.
Estimates of life expectancy and healthy life expectancy at birth are lower for most minority ethnic groups than for White British people in England, with some large inequalities.
For example, compared with their White British counterparts, estimates of disability-free life expectancy are approximately 10 years lower for Bangladeshi men and 12 years lower for Pakistani women.
Estimates from surveys and longitudinal studies indicate higher burdens of long-term conditions and poorer self-rated health among older adults from most minority ethnic groups than those with a White British background. Some studies have provided evidence of an interaction between ethnicity, gender, and age, with disparities often greater for women than men and increasing with age.
This observation could be due to life-course effects, with a cumulative compounding of disadvantage originating from the experience of structural, institutional, and interpersonal racism.
For individuals born abroad, there could have been health disadvantages in their country of birth and periods of vulnerability before, during, and after migration—although, these are far from universal experiences.
Recognising heterogeneity between groups and across outcomes is important for understanding the complexities of ethnic inequalities in health, with differences between some minority ethnic groups greater than those between any given minority ethnic group and the White British ethnic group. However, this heterogeneity is frequently overlooked, with distinct groups aggregated into broader categories because of small sample sizes, despite little or no similarity in health or exposures.
Scarce representation in national datasets, poor recording of ethnicity in general practice, and no ethnicity documentation on death certificates frequently hinder research. Older minority ethnic adults are particularly excluded from research,
with almost all studies and government reports using data from the infrequent Health Survey for England “ethnic minority boost” samples, most recently done in 1999 and 2004. This marginalisation in research reflects a broader lack of attention on ethnic inequalities, with the social gradient in health dominating the health equity agenda throughout Europe.
As the disproportionate burden of deaths due to COVID-19 in minority ethnic groups
and the surrounding political debate have highlighted, a detailed description of ethnic inequalities in health among older adults in England is needed, together with research into the drivers of inequalities. This study aims to describe ethnic inequalities in health for older adults using data from five waves (2015–17) of the English General Practice Patient Survey (GPPS), which is a large, nationally representative, cross-sectional survey. This large sample allows estimation of ethnic inequalities in health for older adults, even among smaller ethnic groups, including Arab and Gypsy or Irish Traveller.
We use a robust multidomain measure of health-related quality of life (HRQoL), and explore several determinants of health as intermediate outcomes. We consider proximal factors, including multimorbidity, intermediate determinants (eg, health-care experiences and support from local services), and finally, area-level social deprivation, which captures aspects of the broader context in which health is produced.
In this cross-sectional study, we analysed data from five waves (2015–17) of the GPPS, collected biannually for the 2015 survey year (publication fieldwork dates July 1–Oct 9, 2014 [wave one], and Jan 5–April 3, 2015 [wave two]), and for the 2016 survey year (publication fieldwork dates July 1–Oct 2, 2015 [wave three], and Jan 4–April 1, 2016 [wave four]), and as a single larger wave for the 2017 survey year (publication fieldwork dates Jan 3–April 7, 2017 [wave five]).
Read the full study here


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