Health Status And Delays In Referral-To-Treatment Waiting Times for Elective Admissions of Adults From Deprived Areas And Ethnic Minority Backgrounds: A Study of Healthcare Inequalities

We studied all patients (total 53,611) whose referral-to-treatment (RTT) ended in hospital admission ("admitted pathways") between 01/2019 and 12/2023. Their health status and RTT waiting times were related to indices of deprivation (IMD: combined data from income, employment, education, health, crime, barriers to housing and services, and living environment) and to ethnicities (87% Caucasians; 6% South Asians; 5.1% Other Ethnicities; 0.9% Blacks; 0.7% Mixed Race; 0.3% Chinese). The risk of RTT waiting times > 18 weeks was assessed by logistic regression, adjusted for confounding factors (age, sex and number of comorbidities) and presented as odds ratios (OR) and 95% confidence intervals: least-deprived areas (IMD decile = 10) and Caucasians were reference levels. Patients' median age (66 years, interquartile range = 51-77) was representative of "admitted pathways" UK patients. Major chronic diseases were more common amongst patients from ethnic minority and deprived backgrounds. Risks of RTT waiting times > 18 weeks for elective admissions rose progressively with increasing deprivation: OR = 1.20 (1.05-1.36), compared to the least deprived areas; and mixed race: OR = 1.39 (1.10-1.76), other ethnicities: OR = 1.15 (1.05-1.26), and all ethnic minorities: OR = 1.11 (1.05-1.18), compared to Caucasians. Our findings provide evidence for health and healthcare inequalities associated with individuals from deprived areas and ethnic minority backgrounds, particularly those of mixed race. More research and resources are needed to address these inequalities that include policy interventions to reduce barriers that hinder access to healthcare and advocating for policies that address underlying social determinants of health that reduce inequalities in education, employment and housing.