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Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England
  1. J S Mindell1,
  2. C S Knott1,
  3. L S Ng Fat1,
  4. M A Roth1,
  5. O Manor2,
  6. V Soskolne3,
  7. N Daoud4
  1. 1Department of Epidemiology & Public Health, UCL (University College London), London, UK
  2. 2School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
  3. 3School of Social Work, Bar-llan University, Ramat-Gana 52900, Israel
  4. 4Public Health, Ben Gurion University of the Negev, Beersheba, Israel
  1. Correspondence to Dr Jennifer Susan Mindell, Department of Epidemiology & Public Health, UCL (University College London), 1-19 Torrington Place, London WC1E 6BT, UK; j.mindell{at}ucl.ac.uk

Abstract

Background The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants.

Method Using HSE 2003–2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28 470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models.

Results Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96).

Conclusions SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.

  • ETHNICITY
  • SELF-RATED HEALTH
  • SOCIAL INEQUALITIES
  • HEALTH BEHAVIOUR
  • SOCIAL CLASS

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