Ethnic and Socioeconomic Variation in Pre-Conception Long-Term Conditions: A Cross-Sectional Electronic Health Record Study of 3.4 Million Pregnancies in Cprd Aurum

Cockburn, Neil; Singh, Megha; Wambua, Steven; Gonzalez-Izquierdo, Arturo; Ing Lee, Siang; Phillips, Katherine; Elsmore, Amy; Ilaalagan, Ragave; Holland, Robyn; Hanley, Stephanie J.; Laws, Elinor; Hodgetts-Morton, Victoria; Gibbon, Marion; Judd, Nathan A.; Seymour, Rowland G.; Taylor, Beck; Singh Chandan, Joht; Parry-Smith, William; Nirantharakumar, Krishnarajah

Abstract

Background: Inequalities in pregnancy outcomes between different ethnic groups and backgrounds of deprivation have been observed in the UK and elsewhere for several decades. Pre-existing long-term health conditions increase risks of adverse outcomes and require focussed action to diagnose, prevent, and manage these conditions. We aimed to estimate differences in the prevalence of pre-conception long-term conditions between different groups to assess health needs.


Methods: This was a cross-sectional study conducted in primary care using Clinical Practice Research Datalink (CPRD) Aurum data. Diagnostic information was extracted from CPRD Aurum at the beginning of all eligible pregnancies for 79 conditions between 2000 and 2021. Age-standardised was estimated and risk ratios calculated between the overall population, and ethnic groups and Index of Multiple Deprivation quintiles. Statistical process control was used to detect conditions with elevated prevalence within groups..

Findings: In 2021, at the start of a pregnancy, women from ethnic minority groups were less likely to have been diagnosed with any one of the 79 conditions than the general population. Women from mixed ethnic groups were 4% more likely to be diagnosed, and from white ethnic groups 2% more likely to be diagnosed. Women from black groups were 5% less likely to be diagnosed, from Asian groups 26%, other ethnic groups 32%, and women missing ethnic group information 13%. Women living in the most deprived quintile of areas were 8% more likely to have been diagnosed than the overall population, and from least deprived areas 8% less likely to have been diagnosed.

Interpretation: Pre-existing long-term conditions are a major driver of maternal morbidity and mortality, but the healthcare needs and policy priorities differ substantially between ethnic and socially disadvantaged groups. Universal health policies that narrow inequalities and targeted action are both needed to meet health needs equitably.

Citation

Cockburn, N., Singh, M., Wambua, S., Gonzalez-Izquierdo, A., Ing Lee, S., Phillips, K., Elsmore, A., Ilaalagan, R., Holland, R., Hanley, S. J., Laws, E., Hodgetts-Morton, V., Gibbon, M., Judd, N. A., Seymour, R. G., Taylor, B., Singh Chandan, J., Parry-Smith, W., & Nirantharakumar, K. (2025). Ethnic and Socioeconomic Variation in Pre-Conception Long-Term Conditions: A Cross-Sectional Electronic Health Record Study of 3.4 Million Pregnancies in Cprd Aurum

• Working Paper Type: Preprint
• Publication Date: Jan 23, 2025
• Deposit Date: May 19, 2025
• DOI: https://doi.org/10.2139/ssrn.5103707
• Public URL: https://keele-repository.worktribe.com/output/1238716
• Publisher URL: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5103707