Ethnicity and outcomes for patients with gastrointestinal disorders attending an emergency department serving a multi-ethnic population

Abstract

Background: Ethnic inequalities in acute health acute care are not well researched. We examined how attendee ethnicity influenced outcomes of emergency care in unselected patients presenting with a gastrointestinal (GI) disorder.

Methods: A descriptive, retrospective cohort analysis of anonymised patient level data for University Hospitals of Leicester emergency department attendees, from 1 January 2018 to 31 December 2021, receiving a diagnosis of a GI disorder was performed. The primary exposure of interest was self-reported ethnicity, and the two outcomes studied were admission to hospital and whether patients underwent clinical investigations. Confounding variables including sex and age, deprivation index and illness acuity were adjusted for in the analysis. Chi-squared and Kruskal-Wallis tests were used to examine ethnic differences across outcome measures and covariates. Multivariable logistic regression was used to examine associations between ethnicity and outcome measures.

Results: Of 34,337 individuals, median age 43 years, identified as attending the ED with a GI disorder, 68.6% were White. Minority ethnic patients were significantly younger than White patients. Multiple emergency department attendance rates were similar for all ethnicities (overall 18.3%). White patients had the highest median number of investigations (6, IQR 3-7), whereas those from mixed ethnic groups had the lowest (2, IQR 0-6). After adjustment for age, sex, year of attendance, index of multiple deprivation and illness acuity, all ethnic minority groups remained significantly less likely to be investigated for their presenting illness compared to White patients (Asian: aOR 0.80, 95% CI 0.74-0.87; Black: 0.67, 95% CI 0.58-0.79; mixed: 0.71, 95% CI 0.59-0.86; other: 0.79, 95% CI 0.67-0.93; p < 0.0001 for all). Similarly, after adjustment, minority ethnic attendees were also significantly less likely to be admitted to hospital (Asian: aOR 0.63, 95% CI 0.60-0.67; Black: 0.60, 95% CI 0.54-0.68; mixed: 0.60, 95% CI 0.51-0.71; other: 0.61, 95% CI 0.54-0.69; p < 0.0001 for all).

Conclusions: Significant differences in usage patterns and disparities in acute care outcomes for patients of different ethnicities with GI disorders were observed in this study. These differences persisted after adjustment both for confounders and for measures of deprivation and illness acuity and indicate that minority ethnic individuals are less likely to be investigated or admitted to hospital than White patients.

Keywords: Admission; Emergency care; Ethnicity; Gastrointestinal; Investigation.

Fig. 1

Formation of the analysed cohort. ‘*’ symbol indicates the following: included in analyses of admission; ‘†’symbol indicates the following: included in analyses of investigation status

Fig. 2

Monthly attendances and admissions for patients with GI disorders over the study period

Fig. 3

Logistic regression models showing the relationship between ethnicity with having investigations performed following attendance at the emergency department with GI disorders. Figure 3 shows the adjusted odds ratios and 95% confidence intervals for the relationship between ethnicity with undergoing any investigations after presentation to the emergency department with abdominal pain (n = 34,296) using the imputed dataset. Three models were constructed; the first (blue) is adjusted for age, sex and the year of first attendance at the ED with abdominal pain during the study period. The second (red) is additionally adjusted for EWS. The third (green) is additionally adjusted for the IMD quintile. Estimates are represented by dots and the 95% confidence interval for the estimate by bars. EWS, early warning score; IMD, index of multiple deprivation; Ref, reference level

Fig. 4

Logistic regression models showing the association between ethnicity and admission following attendance at the emergency department with GI disorders. Figure 4 shows the adjusted odds ratios and 95% confidence intervals for the relationship between ethnicity and admission to hospital after presentation to the emergency department with abdominal pain (n = 34,337) using the imputed dataset. Three models were constructed; the first (blue) is adjusted for age, sex and the year of first attendance at the ED with abdominal pain during the study period. The second (red) is additionally adjusted for EWS. The third (green) is additionally adjusted for the IMD quintile. Estimates are represented by dots and the 95% confidence interval for the estimate by bars. x axis is on a log scale. EWS, early warning score; IMD, index of multiple deprivation; Ref, reference level