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Researching ethnic differences in health: finding the right data Mark Brown, CCSR CCSR Seminar Series: 2004.

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Presentation on theme: "Researching ethnic differences in health: finding the right data Mark Brown, CCSR CCSR Seminar Series: 2004."— Presentation transcript:

1 Researching ethnic differences in health: finding the right data Mark Brown, CCSR CCSR Seminar Series: 2004

2 Ethnic differences in health Context… n1999 study of Black and Minority Ethnic Housing needs in Manchester nHealth emerges as a key issue nMotivation for a more systematic investigation – using survey data n1999 Health Survey for England (with a boosted B&ME sample)

3 Ethnic differences in health Presentation… nan exemplar of the problem of small samples in surveys na new appreciation of the census

4 Ethnicity and health nLong literature but little consensus l about nature or extent of ethnic differences l explanations for those differences

5 Explaining ethnic differences Ethnic differences in health status Explanation Artefact Material Cultural Migration Genetic after controlling for age

6 Ethnicity and health nresearch questions with obvious policy relevance l are service needs among B&ME groups different? in scale? in the nature of need? in terms of appropriate forms of delivery? l heightened interest in light of an ageing population

7 Ageing minorities

8 Contrasting age structures GeneralPakistani

9 Measuring health differences: data issues nReliance on country of birth statistics (relatively recent adoption of ethnicity in population and health statistics) nSmall numbers - especially in national sample surveys e.g. General Household Survey - B&ME sample <1000 hs

10 But a growing interest in ethnic comparisons... nsurveys designed to facilitate analysis of ethnic difference 1994 PSI National Survey of Ethnic Minorities (B&ME sample size > 5,000) 1999 Health Survey for England (HSE) (B&ME sample size = >8,000) nbigger samples nB&ME specific questions

11 1999 Health Survey for England nAim to compare ethnic groups l for selected measures of health (mental as well as physical health) l age dimension - health better or worse for the B&ME elderly?

12 Why the Elderly? nThe demographic situation: Asian elderly time bomb nevidence of a deprived and needy group l hard living conditions - overcrowding l poor physical health - heart disease, stress related illness l loneliness, cultural alienation l suffering a double or even triple jeopardy (being in a poor environment, being old, being non-white)

13 Why Mental wellbeing? nCase for a broad definition of health - taking in mental wellbeing / happiness / quality of life - especially among frail elderly nimpact of factors such as overcrowding and cultural alienation on health likely to be psychological as much as physical ntopical… Bennett Inquiry…

14 Why Mental wellbeing? Bennett Inquiry, 2004: Many mental patients face difficulties in accessing appropriate treatment, but black and ethnic minority communities suffer by far the most serious problems Guardian Leader

15 Measuring psychological wellbeing in a survey? General Health Questionnaire 12 (GHQ 12) ndesigned to detect possible psychiatric morbidity n12 questions about general levels of happiness, depression, anxiety and sleep disturbance over the past four weeks. na score of 4 or more used to identify informants with a possible psychiatric disorder nbut question over validity for B&ME groups

16 Ethnic differences? Figure from main report

17 Ethnic differences? nStatistically significant differences after controlling for age nBangladeshi men twice as likely to have a high GHQ12 score nBut what relationship with age? Masked by standardisation

18 From the Official 1999 HSE report... In the general population, the proportion with a high GHQ12 score did not vary much with age, but among men of South Asian origin and Black Caribbean men, it appeared to increase with increasing age... However, the samples of each sex in the oldest age group (55 and over) were small, and should be treated with caution. nReport generally offers very little detailed analysis by age... but this is vital information for the description of difference for understanding difference in terms of a policy response?

19 High GHQ12 score: % by age by ethnic group (men)

20 34 cases 12 cases

21 High GHQ12 score: % by age by ethnic group (men) 34 cases 12 cases

22 High GHQ12 score: % by age by ethnic group nStriking differences, but... l Based on very small numbers. l Standard errors are big; overlapping confidence intervals nResponse: do some heavy re-coding l on age l on ethnic group l sexes combined nat what price?

23 High GHQ12 score: % by age by ethnic group (men) reduced detail on age 76 cases 51 cases

24 High GHQ12 score: % by age by ethnic group (women) reduced detail on age 28 cases 38 cases

25 High GHQ12 score: % by age by ethnic group (women) reduced detail on ethnic group 18 cases

26 High GHQ12 score: % by age by ethnic group (women) reduced detail on age and ethnic group 66 cases

27 High GHQ12 score: % by age by ethnic group (men) reduced detail on age and ethnic group 127 cases

28 Statistical significance: at a price? Recoding to retain adequate sample size --> A blurring/changing of the story nMasks diversity ngenerates groupings that are conceptually and theoretically unsound: l A single over 55 category for the elderly? l Pakistanis and Bangladeshis combined

29 1994 National Survey of Ethnic Minorities: the same story

30 Observations nEven in targeted surveys, small sample size is a far greater barrier to the researcher than the conceptual or operational crudeness of variable definitions nstrategies to retain adequate sample size mean we never get near exploiting the full detail available in the variables nnot even able to properly describe the differences I wanted to explain

31 Census to the rescue? nCommissioned tables from the 2001 Census nLong Term Limiting Illness by Age by sex by ethnic group (England and Wales) nGeneral Health by Age by sex by ethnic group (England and Wales) nHSE shows fairly strong association between poor General Health and a high GHQ12 score

32 Census to the rescue? 100% data allows measurement of health differences with… nthe full 16 point ethnic classification l the mixed l the Chinese l the Non-British whites nDetail on age including: 55-65; 66-75; 75+

33 men: % not good general health

34 women: % not good general health

35 difference in % with not good general health Indian v general population

36 difference in % with not good general health Pakistani v general population

37 difference in % with not good general health Bangladeshi v general population

38 difference in % with not good general health Black Caribbean v general population

39 difference in % with not good general health Black African v general population

40 difference in % with not good general health Chinese v general population

41 difference in % with not good general health Irish v general population

42 Male : Female Ratio of proportion with not good general health

43 Explaining ethnic differences? nComplex relationships - wont get very far without micro-data - bring on SARs! nbut a detailed description of patterns is a good starting point in research. nExtra detail revealed by Census is basis for more focussed questions

44 Final thoughts on sample surveys nthe balance between variable detail and sample size in the 1999 HSE and the 1994 NSEM seems wrong! We can never get near to the potential promised by the variables neffect of inadequate sample size is that theory underpinning research questions is sacrificed in the pursuit of statistical significance? l But a statistically significant finding may not be interesting or valid. l Just because a finding lacks statistical significance doesnt make it invalid.


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