Racial and ethnic disparities in multimorbidity in non-pregnant women of reproductive age in Lambeth, UK: a data linkage study. (November 2021)

• Record Type: Journal Article
• Authors: Catalao, Raquel; Ashworth, Mark; Stewart, Robert; Hatch, Stephani L; Howard, Louise M
• Is Part Of: Lancet. Volume 398:Supplement 2(2021)
• Page Start: S31
• Publication Date: 2021-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(21)02574-5
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: Few studies have explored ethnic inequalities in physical and mental health in non-pregnant women of reproductive age. We aimed to assess the differences in multimorbidity in women according whether they had been in contact with mental health services or not, and differences in primary care in women according to ethnicity. Methods: In this data linkage study, we extracted data in May, 2021, from Lambeth DataNet (LDN; anonymised primary care records of residents of the ethnically diverse inner-city London borough of Lambeth), linked to anonymised electronic mental health records (Clinical Record Interactive Search [CRIS] secondary care database), on selected risk factors for morbidity including low or high body-mass index, smoking, alcohol consumption, substance misuse, micronutrient deficiencies, and physical health diagnoses for women aged 15–40 years who had received secondary mental health care between January, 2008, and December, 2018, and whose record contained no current or historical antenatal or postnatal codes, and an age-matched comparison cohort (case-to-control ratio of 1:4). Univariate and multivariate logistic regression analyses were used to examine the rate of outcomes across cases in contact with mental health services versus controls, and to explore disparities between different ethnic groups in primary care. CRIS was approved by the Oxfordshire Research Ethics Committee in 2008 (reference 18/SC/0372). Approval for linkage with LDN was granted by Lambeth Clinical Commissioning Group and Information Governance Steering Group. Findings: We extracted data for 3633 women in contact with mental health services, and 14 532 controls. Women in contact with mental health services (with or without severe mental illness diagnoses) had a higher prevalence of all risk factors and physical health diagnoses studied after adjustment for deprivation and ethnicity than did controls. Women from minority ethnic groups (12 234 [79·0%] of all 15 491 women with data on ethnicity, comprising 5503 [35·5%] who reported as White Other, 2050 [13·2%] as Black, 1011 [6·5%] as Asian, and 3670 [23·7%] as Mixed or Other) were less likely to be diagnosed with depression in primary care than were White British women (adjusted odds ratio [OR] 0·66, 95% CI 0·55–0·79; p<0·0001), and Black women were more likely to have a severe mental illness than were White British women (adjusted OR 3·41, 2·63–4·43; p<0·0001). Black and Asian women were less likely to smoke (p<0·0001) or misuse substances (p<0·0001) and more likely to be vitamin D deficient (p<0·0001) than were White British women. Compared with White British women, Black women were more likely to be overweight (adjusted OR 4·56, 3·96–5·24); p<0·0001, be diagnosed with hypertension (8·18, 5·59–12·00; p<0·0001), and have two or more physical health conditions (2·98, 2·19–4·07; p<0·0001) after adjustment for deprivation and severe mental illness diagnoses. Interpretation: The differences in multimorbidity present across ethnic groups with and without mental illness in non-pregnant women without children highlight a need for culturally centered integrative models of care across primary and secondary mental health services. Our data also indicate that there are mental and physical health needs of women in contact with mental health services that are not being met by the current model of service provision. Funding: Closing the Gap network.