Ethnic Minorities Missing Out on Access to Hospital Services During Pandemic

Tom Broder

November 30, 2021

The COVID-19 pandemic has disrupted access to hospital care in all ethnic groups in England. But new research suggests that ethnic minority groups may have been disproportionately affected.

The study, by researchers from the Institute of Fiscal Studies, Imperial College London and Harvard University, looked at levels of elective hospital admissions and non-COVID emergency admissions across England during the first 10 months of the pandemic.

The findings showed that areas with the highest ethnic minority populations experienced much larger reductions in emergency care than occurred in other local areas.

Max Warner, research economist and lead author on the study, told Medscape UK: “This pattern risks exacerbating pre-existing health inequalities if the large reductions in care lead to worse outcomes for patients in these areas.

“Health leaders should pay particular attention to those groups of patients who missed the most care, and encourage people to come forward if they require treatment.”

National Observation Study

Healthcare systems across the world saw falls in hospital admissions during the COVID-19 pandemic, due to both cancellation of hospital admissions and fewer patients seeking care.

Previous research showed that care was not impacted equally across different ethnic groups. Areas with high ethnic minority populations, which already had worse average health outcomes prior to the pandemic, were disproportionally affected. However, it was not clear whether socio-economic or other factors are driving this difference.

This new national observational study analysed data from NHS Hospital Episode Statistics in England to measure weekly volumes of elective and emergency admissions in different local areas.

Between March and December 2020 there were 3 million (35.5%) fewer elective admissions to hospital than in 2019, and 1.2 million (22.0%) fewer non-COVID emergency admissions.

The study split local areas in England into five quintiles based on the proportion of pre-pandemic hospital admissions from ethnic minority patients. It then looked at the reduction in admissions for each group relative to the group with the lowest ethnic minority admissions.

For elective hospital admissions, there was relatively little difference between quintiles. But for non-COVID emergency admissions, the group with the highest ethnic minority populations experienced a far larger reduction. This quintile underwent a 36.7% reduction (95% CI 24.1% to 49.3%) compared with areas with the lowest ethnic minority populations.

Determining Factors

Crucially, the study controlled for factors that might differ depending on the ethnic mix of local areas, including levels of socio-economic deprivation, suggesting that the findings were not driven by the fact that ethnic minorities might have different demographics or live in poorer areas.

And the results did not substantially change when the study controlled for higher local rates of COVID-19 infections or hospitalisation rates, suggesting these were not a driving factor either.

“Although we cannot conclusively determine the factors behind these differences, our results suggest they were in part driven by changes in patient behaviour,” Mr Warner explained to Medscape UK. He pointed to recent survey evidence that suggested that people from Black and ethnic minority backgrounds were more likely to avoid using hospital services during the pandemic.

Whatever the mechanisms behind these differences, director of policy and strategy at NHS Providers, believes the report “provides further evidence of the differential impact of COVID-19, which has exacerbated pre-existing health inequalities and disproportionately impacted ethnic minority populations.”

“Addressing this issue is an urgent priority for trusts and their partners.”

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