Ethnicity data in health: why measurability matters

Giovanna Maria PolatoDr Veena S RaleighInformaticsHealthcare Commission

26 March 2007

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Healthcare Commission’s role

• Assess NHS performance against DH standards, NSFs, NICE guidance, national targets etc

• Monitor compliance with equality legislation

• Healthcare Commission committed to reducing inequalities in all aspects of health and healthcare

• eg thematic reviews: selection criteria include potential to reduce health inequalities

• Health Commission review of race equality

• Health Commission support to improving ethnicity data

• National targets indicator on ethnicity coding since 2003

• Healthcare Commission sponsorship of ethnicity coding in CDS

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Equality legislation

• Race equality duty

• Disability equality duty

• Gender equality duty

• Employment equality (age) regulations

• Employment equality (religion & belief) regulations

• Sexual orientation discrimination in provision of goods and services

• Focus today on ethnicity: - age, gender fairly well covered in available data- but not disability, religion, sexual orientation

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Ethnicity data: why measurability matters

• Profound ethnic differences in risk factors, health status, access to healthcare and outcomes

• Growing numbers and proportions of BME populations

• Evidence of widening health inequalities generally

• BMEs 13% of E&W population (2001 ONS census)

• BMEs high proportion of spearhead PCT populations,risks to achievement of national targets

• Potential users of data: - commissioners- providers- patients, choice agenda- public- regulators

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Availability and usage• Issues: incomplete coverage, variable coding quality, low use

• Births and deaths data: by country of birth, not ethnicity (about half of E&W population is UK-born)

• >90% of health contacts occur in primary care: no data

• Ethnicity coding mandatory for inpatients since 1995, but still c20% incomplete

• Ethnicity coding not required for patients treated out of hospital (HSCIC addressing ethnicity coding in all CDS)

• HSCIC report: ethnicity missing/invalid in 84% of 2004/05 outpatient records, but as high as 95% for some providers

• Poor awareness of utility of data

• Poor utilisation by commissioners and providers

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5.5

5.7 4.1

5.8 4.1

5.0 6.0

11.2 6.5

4.9 10.5

4.3 10.5

5.0

4.7 5.0

4.7 4.3

5.7 5.2

9.3 7.2

3.5 7.8

3.6 9.3

0 2 4 6 8 10 12

All mothers: E&W

Scotland

N Ireland Irish Rep

Rest of Europe Bangladesh

India

Pakistan

East Africa

S Africa Rest of Africa

Far East Caribbean

1999-2001 2003-2005

Mother's country of birth

Infant mortality by mother’s country of birth*

Rate/1000 live births

Source: ONS

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0

10

20

30

40

50

60

70

80

90

100

2002/03 2003/04 2004/05 2005/06

HES MH HES Acute MHMDS inpatient MHMDS other patient

Percent of records with valid ethnicity coding: HES, MHMDS

Percent

80%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Trusts

Percent

Percent of records with valid ethnicity coding: acute trusts, HES 2005/06

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Percent of records with valid ethnicity coding: MHMDS 2005/06 non-inpatients

Percent

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Trusts

10

Mental health: admission ratios by ethnicity, 2006*

Source: Count me in census, E&W = 100

0 100 200 300 400 500 600

British

Irish

Other White

White and Black Caribbean

White and Black African

White and Asian

Other mixed

Indian

Pakistani

Bangladeshi

Other Asian

Caribbean

African

Other Black

Chinese

Other

Admission ratios

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0 50 100 150 200 250 300

British

Irish

Other White

White and Black Caribbean

White and Black African

White and Asian

Other mixed

Indian

Pakistani

Bangladeshi

Other Asian

Caribbean

African

Other Black

Chinese

Other

Learning disabilities: admission ratios by ethnicity, 2006*

Source: Count me in census, E&W = 100

Admission ratios

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Making the most of available data

130

50

100

150

200

250

300

Chinese WhiteBritish

White/BlackAfrican

BlackAfrican

Other Black White/Asian White/BlackCaribbean

BlackCaribbean

Other Asian Indian Pakistani Bangladeshi

Diabetes: proportional admission ratios, 2005/06 HESPARs (Eng=100)

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Newham LA: 2001 ONS census population and 2005/06 HES FCEs

Population non-white: England 9%, Newham 60%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Chinese or other: Other Ethnic Group

Chinese or other : Chinese

Black or Black British:Other Black

Black or Black British: African

Black or Black British: Caribbean

Asian or Asian British: Other Asian

Asian or Asian British: Bangladeshi

Asian or Asian British: Pakistani

Asian or Asian British: Indian

Mixed: Other Mixed

White and Asian

White and Black African

White and Black Caribbean

White: Other White

White: Irish

White: British

Percent

HES FCEs * Pop

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Newham: 2005/06 HES FCEs vs IMD 2004, by electoral ward

0

50

100

150

200

250

300

350

0 10 20 30 40 50 60

IMD 2004

FCEs/1000 population

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Independent sector issues

• Growing plurality of service provision

• Blurring of lines between NHS and IS service provision

• Need to monitor IS on comparable basis with NHS

• Data flows generally poor/non-existent for NHS-commissioned services from IS

• Where centrally contracted services (eg ISTCs), strong levers

• But many IS services locally commissioned eg mental health:- 11% of MH inpatients in PVH, but not included in MHMDS- 20% of LD inpatients in PVH

• Significant and growing volumes of NHS patients in the IS

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Ways forward• Highlight the importance of ethnicity data for a range of users

• Improve the state of play vis:- coverage- coding completeness and quality- usage

• Facilitatory role of key stakeholders: DH, HSCIC, ONS, CfH, PHOs, HC

• Promote more effective use of ethnicity data by:- SHAs- commissioners- NHS and IS providers

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