Which ethnic groups have the poorest health?

This report examines differences in the health of ethnic groups in Scotland and uses census health data to identify variations between groups. The analysis employs age-standardised rates to compare people of similar age, which avoids the often misleading direct comparisons between populations with very different age structures.

3. Methodology

The 2011 Census asked Scotland's population the following two questions[8] about their health:

1. Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? The response categories were: 'Yes, limited a little'; 'Yes, limited a lot'; and 'No'. This analysis considers those who answered either of the 'Yes' options to have a 'health problem or disability'.

2. How is your health in general? The response categories were: 'Very Good', 'Good', 'Fair', 'Bad', 'Very Bad'. This analysis considers those who answered either 'Bad' or 'Very Bad' to have 'poor general health'.

Results for these questions by ethnic group and gender are published in data tables on Scotland's Census website[9] by National Records of Scotland (NRS). Further analysis, including charts and commentary, was published in the Scottish Government's 'Analysis of Equality Results in the 2011 Census' analytical reports[10].

However, interpreting these health results at face value could be misleading, as ethnic groups tend to have younger age profiles than the overall population. This analysis therefore attempts to address the issue by providing age-standardised results, a technique which is used to compare the results of populations whose age profiles are quite different.

The Scotland analysis replicates some of the work already carried out on England and Wales census data by the Centre on Dynamics of Ethnicity[11], allowing comparison across the nations[12].

Older age is strongly associated with an increase in poor health, and since most minority ethnic groups in Scotland are younger than the 'White: Scottish' ethnic group, the overall proportion of a group that has a 'health problem or disability', or 'poor general health' can be low even when their rates are high at each age. Figures in this report are produced with the indirect standardisation method, which calculates how much higher or lower the group's rate of disability or poor health is compared to the average for Scotland. For males and females separately, the calculation applies the Scotland age-specific rates to the group's population to compute an 'expected' number. The age-standardised ratio is the observed number divided by the expected number. In order to compare the rates of minority ethnic groups to that of the 'White: Scottish' ethnic group, we have divided the age-standardised rate of each ethnic group by the rate of the 'White: Scottish'. A figure greater than 1 means that there is higher 'health problem or disability' or 'poor general health', and a figure lower than 1 means there is lower 'health problem or disability' or 'poor general health' than the 'White: Scottish' population.

It should be noted that the Scottish Health Survey (SHeS), a major source of health data for Scotland, tends to report higher overall rates of limiting long-term condition or disability for the population. However, the question wording used in the SHeS[13] differs from that used in the census, and the question is asked as part of a face-to-face interview on people's health. These factors may contribute to the higher estimates observed in SHeS. Since the census collected results for the whole population it provides richer information for smaller groups such as ethnic minorities.


Email: Jon Hunter

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