Black and Asian patients likely to underreport health problems

Patients in some ethnic groups are more likely to underreport problems with health and wellbeing, according to an analysis of 2.6 million general practice patients across the UK.

Researchers from the University of Manchester found that people from Asian and Black ethnic groups with long-term health conditions are more likely to underreport symptoms of anxiety, depression, and difficulties in daily activities compared with White respondents.

The researchers say that people from different ethnicities may interpret and rate their health differently, and this type of ‘reporting heterogeneity’ needs to be acknowledged and corrected for.

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The findings, funded by the National Institute for Health and Care Research (NIHR)  and published in the journal Quality of Life Research, could help shape more inclusive NHS services and improve how health outcomes are measured across different communities.

Previous research has suggested that how people from different ethnic backgrounds rate their health can vary, which can affect how health inequalities are measured and reported. In this study, the researchers examine how people across various ethnicities and cultures assess their health differently, even when they have both comparable illnesses and personal circumstances.

The researchers collected data from more than 2.6 million people who took part in nine rounds of the General Practice Patient Survey in England, including 2.3 million White respondents, 160,000 Asian, 70,000 Black, 20,000 of Mixed or Multiple background, and 60,000 from Other ethnic groups.

The data allowed the researchers to examine information on people’s actual health, based on 15 long-term health conditions, and compare it to the way patients report or rate their health, accounting for factors like age, ethnicity, income, recent use of healthcare services, and access to care, which can influence how people describe their health. The researchers assessed five self-reported dimensions of health, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with patients reporting on levels of severity from no problems to extreme problems/unable.

The findings show consistent variation in how people across ethnic groups rate their health. Even when reporting similar illnesses, people of different ethnicities rated their quality of life differently, suggesting cultural or perceptual influences on self-assessment.

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People with White ethnicity tended to choose moderate severity levels across all health dimensions. In contrast, people with Black and Other ethnic groups chose more extreme categories for mobility, and Asian groups chose extreme categories for self-care.

Asian and Black participants were also more likely to report milder problems with anxiety, depression, and daily activities. The category of Other ethnic groups, which includes people from Northern Africa, the Middle East and smaller indigenous groups, was more likely to choose either the lowest or highest severity levels for anxiety and depression.

Lead author Dr Juan Marcelo Virdis from the University of Manchester said: ‘Our study found that certain Black and Asian ethnic groups could be more likely to downplay different aspects of how health affects their lives. This is important because differences between perceived and actual health can affect how you seek healthcare and could, for example, delay a clinical consultation. But understanding these differences is crucial for designing equitable health services and improving outcomes across diverse populations.’

The study also found variation within the ethnic categories, suggesting that experiences and reporting patterns can also differ among people grouped under the same ethnicity. However, the researchers say more work is needed to understand why these variations exist and suggest that subjective responses to how patients view their own health are influenced by background and cultural expectations.

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Dr Virdis added: ‘Our research provides a scenario for further studies using objectively measured health conditions, such as biological risk factors, or objective measures of physical health such as grip strength. In addition, we were not able to investigate the mechanisms at play, so this could be a focus for future qualitative research.’