Ethnicity and acute hospital admissions: Multi-center analysis of routine hospital data

Abstract

Background: The effects of ethnic and social inequalities on patient outcomes in acute healthcare remain poorly understood. Methods: Prospectively-defined analysis of registry data from four acute NHS hospitals in east London including all patients ≥ 18 years with a first emergency admission between 1st January 2013 and 31st December 2018. We calculated adjusted one-year mortality risk using logistic regression. Results are presented as n (%), median (IQR), and odds ratios (OR) with 95% confidence intervals. Findings: We included 203,182 patients. 43,101 (21%) patients described themselves as Asian, 21,388 (10.5%) Black, 2,982 (1.4%) Mixed, 13,946 (6.8%) Other ethnicity, and 100,065 (49%) White. We excluded 21,700 (10.7%) patients with undisclosed ethnicity. 16,054 (7.9%) patients died within one year. Non-white patients were younger (Asian: 43 [31-62] years; Black: 48 [33-63] years; Mixed 36 [26-52] years) than White patients (55 [35-75] years), with a higher incidence of comorbid disease. In each age-group, non-white patients were more likely to be admitted to hospital. This effect was greatest in the ≥ 80 years age-group (32% non-white admitted to hospital versus 23% non-white in community population). Deprivation was associated with increased mortality in all ethnic groups (OR 1.41 [1.33-1.50]; p < 0.001). However, when adjusted for age, Asian (0.69 [0.66-0.73], p < 0.0001) and Black patients (0.79 [0.74-0.85]; p < 0.0001) experienced a lower mortality risk than White patients. Interpretation: Ethnic and social disparities are associated with important differences in acute health outcomes. However, these differences are masked by statistical adjustment because patients from ethnic minorities present at a younger age. Funding: None.

Fig. 1

Age at admission compared to population distribution by age and ethnic group showing proportions within each ethnic group by age group. * p < 0.001.

Fig. 2

Heat map of comorbid disease by age and ethnic group showing proportions within each ethnic group by age group. Obesity defined as BMI ≥ 30 kg/m², HTN: hypertension, IHD: ischaemic heart disease, MI: myocardial infarction, CHF: congestive heart failure, PVD: peripheral vascular disease, HFRS: hospital frailty risk score.

Fig. 3

Bar charts showing the age-standardised mortality rate (AMR) per 100,000 population per year. Using the 2013 European Standard Population, axis on the left-hand side of each plot. AMR for England available for years 2013 to 2016 were 979 in 2013, 947 in 2014, 987 in 2015, 960 in 2016 per 100,000 population. Line graph showing the comparative mortality ratio (CMR) for each ethnic group compared to white, axis on the right-hand side of each plot. 95% CI shown by error bars.