Diseases and different ethnic groups

Diversity in the UK¹

The UK boasts a culturally diverse population with ethnic minorities accounting for 18.3% of the population in the 2021 census. This represented an increase from 14% in the 2011 census. Caution is needed when making direct comparisons between censuses as there have been changes in questions and tick boxes which encourage the recognition of diversity. However, there is no doubt that the 'mix' is changing. In the 2021 census, the largest ethnic minority box ticked was Asian, Asian British, or Asian Welsh.

Across England and Wales, London is the most ethnically diverse area and the North-East the least.

Ethnicity and health

Population groups with differences determined by culture, religion, or ethnicity also show differences in terms of illness behaviour and beliefs. More work is required to understand these reasons.

Population groups also differ genetically, so that some diseases are more prevalent in certain ethnic groups. This includes conditions such as sickle cell disease and Creutzfeldt-Jakob disease which are well described. It also includes altered prevalence and patterns, in different ethnic groups, of common conditions such as cardiovascular disease (CVD) and type II diabetes.

Health inequalities are seen between ethnic groups for a number of reasons. These are covered in more depth in the separate Ethnicity and health article but may include:

• Difficulties in accessing medical care in an appropriate language and cultural context.

• Medication research does not always recruit evenly from different ethnicities, and there are often significant differences not only in disease patterns, as discussed in this article, but also in responses to therapy.

Awareness of these differences allows focused delivery of health promotion and healthcare so that, for example, programmes to increase the detection of CVD and its risk factors in ethnic groups can be focused and effective. Most surveys have examined conditions such as hypertension, diabetes mellitus and coronary heart disease.

A large proportion of current and historical research examines population cohorts that do not include enough ethnic minority patients. This has meant that results may not necessarily correlate to patients from ethnic groups.²

This article will focus on the results of health surveys on ethnic minority groups in England.

Health Survey for England³

This is a major monitoring tool which has run annually since 1991. It looks at the Nation's health and is used to enable planning and policy decisions. Each year there is a particular focus on a population group, disease or condition.

The last survey to specifically look at ethnicity was in 2022. It showed that the ethnicities most commonly reporting longstanding health conditions were Black Caribbean and White British men and Pakistani women, that obesity was most common in women from Black Caribbean, Black African, and Pakistani backgrounds (and least likely in Chinese women) and that those of White British or White Irish background were most likely to drink over 14 units of alcohol per week.

The survey also showed the following:

• There was a wide variation in the use of any prescribed medication (23 - 49% of men and 29 - 64% of women), with the ethnic difference being largely in the male population.

• Hypertension is highest in the Black Caribbean, Black African,, and Pakistani communities and lowest in those of Chinese ethnicity.

• Diabetes is similarly lowest in those of Chinese ethnicity - Pakistani adults had the highest prevalence.

• Smoking prevalence in men was at similar levels for most ethnicities; among women, those from Indian, Pakistani, Black African and Chinese backgrounds were least likely to smoke.

• There were marked differences in alcohol use, with those from white backgrounds being most likely to have drunk alcohol in the last year and those from Pakistani and Bangladeshi backgrounds least likely to do so.

Ethnic health inequalities

Health inequalities are differences in health status that are driven by inequalities in society. Health is influenced by many different factors - eg:

• Lifestyle - material wealth, educational attainment, aspirations, and expectations.

• Job security, housing conditions.

• Genetic susceptibility and inheritance.

• Discrimination - direct and/or indirect - in access to services.

• Non-shared language of consultation between healthcare professional and patient.

• Cultural differences and expectations between healthcare providers and some groups, affecting level of shared understanding.

• The need for translation services (and the difficulties inherent in this).

• Expectations of healthcare and of disease.

Health inequalities represent the cumulative effect of these factors. They can be passed on from one generation to the next through maternal influences on baby and child development.

Approach to reducing coronary heart disease and cardiovascular disease in ethnic minorities

Management of ethnic minority patients should follow the same approach as management of all patients: to watch for and appropriately manage risk factors, to detect disease early and to offer education and support in beneficial lifestyle choices.

• It is important to factor ethnicity into that risk assessment and to note that thresholds for overweight and obesity vary by ethnicity.

• All patients should have their blood pressure, weight, and height checked - these are easy to perform and non-invasive.

• Evaluate and manage/advise on:

  • Lifestyle factors - smoking, physical inactivity, unhealthy diet.

  • Hypertension.

  • Obesity.

  • Adverse lipid profile.

  • Metabolic syndrome - needs consideration.

  • Impaired glucose tolerance.

  • Hypercoagulability.

  • Age, gender, family history, ethnicity.

• Evaluate all patients for the presence of multiple risk factors and use the risk calculator to determine the cardiovascular risk.

• Patients with a strong family history of diabetes, hypertension and hyperlipidaemia should have these parameters regularly checked - eg, annually.

• Reinforce the importance of lifestyle modifications, even if risk is low - eg, weight reduction, salt reduction, healthy low-fat diet, and increased exercise.

• The above measures may be enhanced by dedicated services available in the patient's language - eg, Gujarati smoking cessation service.

• Patients should be offered health education opportunities where available - eg, community ethnic diabetes mellitus meetings with professionals and patients. Know what services are provided in your area.

• The British Heart Foundation (BHF) recommends that practices keep a register with ethnic codes and diseases.

Dr Mary Lowth is an author or the original author of this leaflet.