Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

Journal of Epidemiology and Community Health - Tập 68 Số 12 - Trang 1133-1144 - 2014
Jennifer S. Mindell1, Craig Knott1, Ligia Făt1, M. Roth1, Orly Manor2, Varda Soskolne3, Nihaya Daoud4
1Department of Epidemiology & Public Health, UCL (University College London), London, UK
2School of Public Health, The Hebrew University of Jerusalem, Jerusalem, Israel
3School of Social Work, Bar-llan University, Ramat-Gan 52900, Israel.
4Department of Public Health, Ben Gurion University of the Negev, Beersheba, Israel.

Tóm tắt

BackgroundThe 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.MethodUsing 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.ResultsCompared 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).ConclusionsSEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.

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Tài liệu tham khảo

Marmot MC , Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organisation, 2008.

10.2105/AJPH.89.12.1807

10.1080/09581590010005331

10.1093/ije/dyh189

Sproston K Mindell J , eds. Health Survey for England 2004. The health of minority ethnic groups. London: TSO, 2006.

10.1111/j.1467-9566.2007.01043.x

10.1093/ije/dyq073

10.1093/pubmed/fds004

Nielsen, 2012, Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review, Int J Public Health, 55, 357, 10.1007/s00038-010-0145-4

10.1093/ije/30.suppl_1.S48

10.1007/s10654-007-9108-3

10.1111/1467-9566.00126

Hemingway, 2001, Psychosocial risk factors for coronary disease in White, South Asian and Afro-Caribbean civil servants: the Whitehall II study, Ethn Dis, 11, 391

10.1007/s00127-011-0345-0

10.1016/S0277-9536(03)00349-6

10.1371/journal.pmed.1000316

10.1038/ajh.2010.28

10.2105/AJPH.87.9.1491

Friedli F . Mental health, resilience and inequalities. Copenhagen: World Health Organisation Regional Office for Europe, 2009.

Jivraj S . How has ethnic diversity grown 1991–2001–2011? Manchester: Centre on Dynamics of Ethnicity (CoDE), University of Manchester, 2012.

10.2105/AJPH.93.2.277

Mindell, 2013, Cohort profile: the Health Survey for England, Int J Epidemiol, 41, 1585, 10.1093/ije/dyr199

Office for National Statistics. Census 2001 key statistics—local authorities KS06 ethnic group. London: Office for National Statistics, 2004.

10.2105/AJPH.80.4.446

Craig R Mindell J , eds. Health Survey for England 2006. Cardiovascular disease and risk factors. London: The Information Centre, 2008.

10.1093/aje/kws412

10.1136/bmjopen-2013-003485

Becares L . Which ethnic groups have the poorest health? Ethnic health inequalities 1991 to 2011. Manchester: University of Manchester, 2013.

Gupta, 1996, Avoiding premature coronary deaths in Asians in Britain, BMJ, 311, 1035, 10.1136/bmj.311.7012.1035

10.1136/bmj.319.7204.215

10.1371/journal.pone.0045602

Harding S Maxwell R . Differences in mortality of migrants. In: Drever F Whitehead M , eds. Health inequalities: decennial supplement no. London: The Stationery Office, 1997:108–21.

Nazroo JY . The health of Britain's ethnic minorities: findings from a national survey. London: Policy Studies Institute, 1997.

10.1016/S0277-9536(01)00118-6

Marmot MG Adelstein AM Bulusu L . Immigrant mortality in England and Wales 1970–78: causes of death by country of birth. London: HMSO, 1984.

10.1093/ije/30.3.600

10.2105/AJPH.92.4.588

10.1080/713667451

Tackey ND Casebourne J Asston J . Barriers to employment for Pakistanis and Bangladeshis in Britain. Research report DWPRR 360. London: Department for Work and Pensions, 2006.

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Thông tin xuất bản

Journal of Epidemiology and Community Health

Tập 68 Số 12

1133-1144

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