Subramaniam Hari, Mukaetova-Ladinska Elizabeta B, Wilson Andrew, Bankart John
The Evington Centre, Leicestershire Partnership NHS Trust, UK.
Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK.
BJPsych Bull. 2020 Aug;44(4):145-152. doi: 10.1192/bjb.2020.3.
We aimed to explore access by Black, Asian and minority ethnic (BAME) elders to the memory services in Leicester and Leicestershire, examining any trends over time. We then compared the odds of referral by ethnicity, using observed versus expected referrals for the city of Leicester. We gathered data on a comprehensive county-wide memory clinic used by people with suspected dementia and memory problems from the Trust electronic record system during the period 2011-2017. For Leicester city, we compared referral rates for 2011-2017 and compared observed and expected referral rates with demographics from the UK Census 2011.
In Leicester, there was a significant underrepresentation of referrals from the BAME population as compared with the White population in 2011, 2012 and 2013, when compared with population estimates of those aged ≥60 years from the 2011 UK Census Leicester city data. Data for the Black population were too small for comparisons. The odds of being referred to a memory clinic for the White group was double that of the Asian group in 2011 (odds ratio 2.15, 95% CI 1.52-3.02) and nearly 1.5 times in 2012 (odds ratio 1.40, 95% CI 1.01-1.93). This difference did not persist after 2014. However, this differential odds of referral changes when the age difference between the groups is accounted for. After adjusting for age, there were no differences between the two groups in their odds of referral to the memory clinic from 2011 to 2013, but from 2014 to 2017, members of the Asian group had higher odds of being referred.
The relationship between BAME and access to memory services is complex. The relative lower prevalence of Asian people among referrals to memory services in Leicester from 2011 to 2013 may partly be explained by the lower ages of the Asian population at referral. The higher prevalence of Asian people in 2014-2017 may be owing to use of denominators from the 2011 UK Census, which are likely to be disproportionately low for this group. Further studies are needed to explore any potential barriers to the access of services by BAME communities.
我们旨在探究黑人和少数族裔（BAME）老年人在莱斯特和莱斯特郡获得记忆服务的情况，并研究随时间推移的任何趋势。然后，我们通过比较莱斯特市观察到的转诊率与预期转诊率，按种族比较转诊的几率。我们从信托电子记录系统中收集了2011年至2017年期间全县范围内一个综合记忆诊所的数据，该诊所为疑似患有痴呆症和记忆问题的患者提供服务。对于莱斯特市，我们比较了2011年至2017年的转诊率，并将观察到的和预期的转诊率与2011年英国人口普查的人口统计数据进行了比较。
在莱斯特，与2011年英国人口普查莱斯特市数据中60岁及以上人群的估计数相比，2011年、2012年和2013年BAME人群的转诊人数明显低于白人人群。黑人人口的数据太少，无法进行比较。2011年，白人组被转诊至记忆诊所的几率是亚洲组的两倍（优势比为2.15，95%置信区间为1.52 - 3.02），2012年接近1.5倍（优势比为1.40，95%置信区间为1.01 - 1.93）。2014年后这种差异不再存在。然而，当考虑到两组之间的年龄差异时，这种转诊几率的差异会发生变化。在调整年龄后，2011年至2013年两组被转诊至记忆诊所的几率没有差异，但2014年至2017年，亚洲组被转诊的几率更高。
BAME与获得记忆服务之间的关系很复杂。2011年至2013年莱斯特记忆服务转诊中亚洲人相对较低的患病率，部分原因可能是转诊时亚洲人口年龄较低。2014年至2017年亚洲人患病率较高，可能是由于使用了2011年英国人口普查的分母，而这对该群体来说可能不成比例地低。需要进一步研究来探索BAME社区获得服务的任何潜在障碍。
