Hospital data may be more accurate than census data in estimating the ethnic composition of general practice populations

Abstract

Background Equity of service provision by age, ethnicity and sex is a key aim of Government policy in the UK. The prevalence, natural history and management of common chronic conditions, such as diabetes and hypertension, vary between ethnic groups. Developing and monitoring responsive local services requires accurate measures of ethnicity and language needs. Hence establishing the ethnic composition of GP populations is important. Objective To compare three methods of estimating the ethnic composition of GP registered populations in three east London primary care trusts (PCTs). Design Self-reported ethnicity, routinely collected at practice level (and considered the 'gold standard'), was compared with two indirect methods of attributing ethnicity. The indirect method currently used in the UK assigns ethnicity to GP populations based on geographical postcode attribution from the national census. A proposed alternative indirect method uses the ethnic breakdown of hospital admission data from practice lists to attribute ethnicity to the whole practice population. Comparisons were made between practice self-report recording and these two indirect methods. Bland-Altman plots

Prescribing in general practice for people with coronary heart disease; equity by age, sex, ethnic group and deprivation

“…One advantage is the high recording of self-reported ethnicity for people with coronary heart disease. The use of individual reports of ethnicity means that our data is not subject to the ecological bias that results when ethnicity is ascribed from geographically-based census data, which aggregates populations of 10,000 or more individuals (Hull et al 2009). As shown in Table 1, ethnicity derived from census data may lead to underestimates of Black African/Caribbean and South Asian populations in comparison to practice data.…”

Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management

“…Such methods tend to underestimate young people and minority ethnic groups -particularly in inner-city areas -and are subject to the ecological fallacy (the assumption that practice populations are ethnically similar to the census super output areas). 28,29 As selfreported ethnicity was recorded for over 95% of the study sample, it is possible to be confident that the relationships between ethnicity and multimorbidity are not prone to the biases of census-attribution methods.…”

Does higher quality primary health care reduce stroke admissions? a national cross-sectional study

“…23 The Care Quality Commission provided a deprivation weighting for each practice produced by aggregating Index of Multiple Deprivation scores from postcodes of individual registered patients, and an estimate of the Black/Black British ethnic minority population for each practice, derived from small area ethnicity breakdowns of HES data, which have been externally validated. 24,25 Statistical analysis The basic unit of analysis was the practice population. Indirect standardisation is generally accepted as more robust when counts are relatively small, so indirectly standardised admission counts were calculated for each practice, based on the England age-and sex-specific rates and practice population age/sex breakdowns.…”