Fair shares in health care? Ethnic and socioeconomic influences on recording of preventive care in selected inner London general practices

Abstract

Objective: To describe the association of ethnic and socioeconomic status with recording of preventive care information by selected general practitioners.

Design: Random selection of people aged 20-64 registered with 43 general practitioners. Ethnic and social characteristics of stratified samples were determined at interview in the subject's home. Recording of preventive information was ascertained from general practitioners' medical records.

Setting: Inner London borough of Tower Hamlets.

Subjects: 505 out of 739 people confirmed as resident at their home address (190 white, 86 black, 112 Bangladeshi, 105 Chinese or Vietnamese, 12 other).

Main outcome measures: Socioeconomic characteristics, consultation with general practitioner, and recorded preventive activities for ethnic groups.

Results: Minority ethnic groups were considerably more disadvantaged than white people and five times more likely to be overcrowded (31% v 6%), three times less likely to own their own home (11% v 37%), twice as likely to be in social classes IV and V (54% v 28%) and less likely to be employed (34% v 63%). There were no significant differences between white, black, Bangladeshi, and Chinese or Vietnamese subjects in recording of smoking, blood pressure, alcohol consumption, weight, and height in the general practitioners' medical records. White women were more likely to have a record of mammography (46% v 20%; P=0.03) and of cervical smears than women in minority ethnic groups.

Conclusion: Despite major socioeconomic inequity, equitable recording of preventive activity for the major causes of death for white, black and Bangladeshi populations is possible. Chinese and Vietnamese people had lower levels of recording and consultation. Mammography and, to a lesser extent, cervical cytology are inequitably recorded and require additional support at practice level.