Differentials in Clinical Severity and other Patient Activity Indicators amongst Black and South Asian Cancer Patients in England
Author(s): Steffan Willis, Pedro Figueiredo Aparicio, Rhoda Steel, Gaetan Leblay
Background: The link between ethnicity, deprivation and health inequalities is well-established. The relationship between ethnicity and cancer is more complex and influenced by a variety of socio-economic, cultural and physiological factors. Understanding the relationship between ethnicity and patient care indicators for specific cancer types is vital if NHS England is to meet the UK government’s stated priority to reduce health inequalities as it recovers from COVID-19.
This paper explores the impact of ethnicity on clinical severity, treatment costs and a range of patient activity indicators across three cancer types – chronic lymphocytic leukaemia, multiple myeloma and prostate cancer.
Methods: The paper uses a dataset derived from the Hospital Episodes Statistics (secondary care) database covering 2016/17 to 2020/21. This enabled the differential impact of the pandemic on ethnic minority patients to be considered. The data was aggregated by ethnicity and deprivation quintile at a national and Integrated Care System (ICS) level. Clinical severity was proxied using co-morbidity and complications (CC) scores. Multivariate linear regression (OLS) models were used to explore the associations with ethnicity.
Results: Black and South Asian patients CC scores were 11.8% and 20.3% higher than the population average (3.8). Controlling for socio-economic deprivation, South Asian patients had higher average clinical severity (+0.57, p<0.01). In addition, ICSs with large South Asian populations were associated with higher CC scores (+0.69, p<0.01). Treatment costs were higher for Black prostate cancer patients with interventions (+£842, p<0.001) and South Asian multiple myeloma patients (+£1686, p<0.001). Both Black and South Asian patients tend to have more spells in hospital. COVID-19 saw total inpatient admissions fall by 18.9%. Black and South Asian inpatient admissions fell by 1.9 and 2.9 percentage points more than the national average respectively. Average clinical severity increased by 7.1% with the largest increase amongst South Asian (+11.5%) and Black (+8.1%) patients.
Conclusions: The higher clinical severity in South Asian patients and higher treatment costs in Black patients observed in this study are not accompanied by significant variations in patient activity indicators, which may point to drivers associated with delays to diagnosis or barriers to access to primary care.