Ethnicity, Race and Inequality in the UK

Byrne, Bridget; Alexander, Claire; Khan, Omar; Nazroo, James; Shankley, William

doi:10.51952/9781447351269

Cited by 5 publications

(1 citation statement)

References 212 publications

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“…[3] The extent to which these differences are related to genetics, differences in socio-economic status [4] or factors such as differential access to healthcare [5][6][7] is uncertain. [8][9][10] Incidence and mortality from hypertension and stroke is increased among Black and South Asian ethnic groups and occurs at a younger age. [11][12][13] In the UK, patients with hypertension are treated based on the National Institute for Health and Care Excellence (NICE) hypertension guidelines.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of ARB and ACEi for cardiovascular outcomes and risk of angioedema among different ethnic groups in England: an analysis in the UK Clinical Practice Research Datalink with emulation of a reference trial (ONTARGET)

Baptiste,

Wong,

Schultze

et al. 2024

Preprint

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ObjectiveTo study the comparative effectiveness of angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEi) in ethnic minority groups in the UK.DesignObservational cohort study using a reference trial emulation approach benchmarked against the ONTARGET trial.SettingUK Clinical Practice Research Datalink Aurum data from 01/01/2001-31/07/2019. Participants Black, South Asian, or White patients with a prescription for an ARB/ACEi who met the ONTARGET trial criteria.Main outcome measuresThe primary composite outcome was: cardiovascular-related death, myocardial infarction, stroke, or hospitalisation for heart failure with individual components studied as secondary outcomes. Angioedema was a safety endpoint. We assessed outcomes using a propensity-score-weighted Cox proportional hazards model for ARB vs ACEi with heterogeneity by ethnicity assessed on the relative and absolute scale.Results17,593 Black, 30,805 South Asian, and 524,623 White patients were included. We benchmarked results against ONTARGET comparing ARB with ACEi for the primary outcome (hazard ratio [HR] 0.96, 95% CI: 0.95 to 0.98) and found no evidence of treatment effect heterogeneity(Pint=0.422). Results were consistent for most secondary outcomes. However, for cardiovascular-related death, there was strong evidence of heterogeneity (Pint=0.002), with ARB associated with more events in Black individuals and with fewer events in White individuals compared to ACEi, and no differences in South Asian individuals. For angioedema, HR 0.56 (95% CI: 0.46 to 0.67) for ARB vs ACEi (Pint=0.306). Absolute risks were higher in Black individuals, with number-needed-to-harm of 204 in Black individuals compared with 2000 in South Asian individuals and 1667 in White individuals (Pint=0.023).ConclusionsThese results demonstrate variation in drug effects of ACEi and ARB by ethnicity and suggest the potential for adverse consequences from current UK guideline recommendations for ARB in preference to ACEi for Black individuals.

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Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of ARB and ACEi for cardiovascular outcomes and risk of angioedema among different ethnic groups in England: an analysis in the UK Clinical Practice Research Datalink with emulation of a reference trial (ONTARGET)

Baptiste,

Wong,

Schultze

et al. 2024

Preprint

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Understanding the relationship between social determinants of health and maternal mortality

Jones

Mitchell

Hirst

et al. 2022

BJOG

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Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.

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‘It seems like a luxury to be able to offer that’: Factors influencing the implementation of annual health checks for autistic people in England

Davies

Remington

Buckley

et al. 2023

Autism

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Autistic people in England face worse health outcomes than non-autistic people. Autism-specific annual health checks have been proposed as one solution to this issue. This study identified strategies to incentivise primary care providers to offer autism-specific annual health checks, using a behavioural science approach. In phase 1, we conducted interviews and focus groups with autistic people ( n = 10) and primary care providers ( n = 11). In phase 2, we conducted a national survey of primary care providers ( n = 196). Qualitative data were analysed using a framework method and the Theoretical Domains Framework. Quantitative data were analysed descriptively, and comparisons between sub-groups of survey respondents were made using Mann–Whitney U and Kruskal–Wallis tests. The most salient theoretical domain was environmental context and resources. Participants identified lack of time and staff as key barriers to implementation. Delegating tasks to non-physician practitioners and automating processes were seen as key facilitators. Autism-specific knowledge was another relevant domain; education produced and delivered by autistic people was posited to increase health check uptake and quality. Overall, participants were enthusiastic about autism-specific annual health checks but were concerned about the practical aspects of implementation. We identified specific barriers and facilitators that can be addressed prior to policy adoption to maximise chances of success. Lay abstract Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient’s weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.

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Ethnicity, Race and Inequality in the UK

Cited by 5 publications

References 212 publications

Comparative effectiveness of ARB and ACEi for cardiovascular outcomes and risk of angioedema among different ethnic groups in England: an analysis in the UK Clinical Practice Research Datalink with emulation of a reference trial (ONTARGET)

Comparative effectiveness of ARB and ACEi for cardiovascular outcomes and risk of angioedema among different ethnic groups in England: an analysis in the UK Clinical Practice Research Datalink with emulation of a reference trial (ONTARGET)

Understanding the relationship between social determinants of health and maternal mortality

‘It seems like a luxury to be able to offer that’: Factors influencing the implementation of annual health checks for autistic people in England

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