During the COVID-19 pandemic, the interplay between ethnicity and poor health outcomes has rightly come under scrutiny. A high proportion of those who have lost their lives to COVID-19 were from black, Asian and minority ethnic (BAME) groups.
Pharmacy rarely features in investigations into this health disparity between the ethnicities, but we have previously reported differences in uptake of support for COPD[1]
.
Here, we report further disparities uncovered in a study of 19 community pharmacies in North West London, involving adult asthma patients.
In 2019, we evaluated how data-driven care could support asthma patients within the normal limits of practice. Patients were invited to a consultation on the basis of their patient medication records, the need for a new medicine service consultation or medicines use review, or opportunistically. Not all patients accepted the offer. Using methodology we used previously, we provided consenting patients with tailored support for managing their asthma and, using questionnaires, collected data such as use of medication, use of available support, smoking status and demographics
[2]
. Detailed reporting of this study will begin later this year.
After completion of the study, the local authority (LA) and the individual electoral ward (EW) in which each pharmacy was located was determined from the pharmacy address. The proportion of Asian, black, mixed race or other patients expected in the patient group was calculated, as previously, using 2011 Census data for each EW[1],[3]
.
There were two key findings. Firstly, across ethnicities, there were more women in the cohort than men (71% women; 29% men), while published relative prevalence of current adult asthma is 55% female; 45% male[4]
.
Secondly, although no single recorded ethnicity was significantly under-represented (p>0.5), excluding those of Asian ethnicity, there was a marked under-representation of men of BME ethnicity. Collectively, of black, mixed and other patients, only 3 of 18 (17%) were men. Among 96 asthma patients from North West London, there were only 3 men from black, mixed and other populations. Comparatively, for white and Asian groups, the proportion of men was significantly greater; 15 out of 46 (33%; p<0.05), and 10 out of 32 (31%; p<0.05), respectively.
In a previous study with COPD patients, we reported an under-representation of both Asian and black populations[1]
. We did not include a subgroup analysis by gender because COPD prevalence in men is higher, which was reflected in the patient participants (60% male). The predicted ethnicity values were instead adjusted at LA level using Public Health England prevalence levels.
Two limitations of the present study are the crudeness of the ethnicity classification, and the age of census information. And, since 2011, the BAME population of London is thought to have risen[5]
, making the need to examine disparities more pressing.
The study was designed to reflect the real world, so the seemingly arbitrary basis of patient inclusion is not a limitation. Willingness to join such studies may be influenced by existing use of pharmacy services. Whether low historic usage reduces engagement requires further investigation.
Stephanie Bancroft, Darush Attar-Zadeh, Christine Heading and Usha Shah, on behalf of the Royal Pharmaceutical Society in North West London
References
[1] Attar-Zadeh D, Heading C, Guirguis A et al. 2016. Available at: https://www.researchgate.net/publication/308948149_How_LPF_Engagement_Revealed_Ethnic_Disparities_in_Patient_Support (accessed June 2020)
[2] Attar-Zadeh D, Guirguis A, Heading C et al. Thorax 2017;72(Suppl 3):A242.1–A242. doi: 10.1136/thoraxjnl-2017-210983.432
[3] Office for National Statistics. 2011. Available at: http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rft-table-ks201ew.xls (accessed June 2020)
[4] NHS Digital. 3 December 2019. Available at: http://healthsurvey.hscic.gov.uk/media/81643/HSE18-Asthma-rep.pdf (accessed June 2020)
[5] Greater London Authority. 2015. Available at https://londondatastore-upload.s3.amazonaws.com/Demography/document_archive/update_2014rnd_ethnic_group_results.pdf (accessed June 2020)
