1. The challenge of
using routinely collected data to compare use of health services by ethnic group in Scotland
Emma McNair
Information Services Division

2. Administrative Health Data in Scotland
Scotland has some of the best administrative health data in the world:
Range of datasets
Trends
Linkage between datasets
Personal characteristics,
including ethnic group,
are often recorded by health
professionals.
Population:
5.42 million (2018 estimate)
Relatively low ethnic diversity: 4% ethnic minority groups overall (2011 census)

3. Recording of Ethnic Group
UK Equality Act 2010: Legislative requirement for public bodies to collect data on protected characteristics.
The aim is to have a valid recording of ethnicity for every
patient.
…Ethnic group is not a fixed characteristic, nor is it necessarily consistently defined.
Completeness has increased considerably in recent years,
but there remain gaps and variation between regions and
datasets.

4. Recording of Ethnic Group on Hospital Admission Records (Scotland 2008-2017)
NHS Dumfries & Galloway -
NHS Western Isles -

5. Analysis of Health Data by Ethnic Group
Challenging with the data available from administrative systems.
Scottish Health and Ethnicity Linkage Study (SHELS): large scale research study that matched health records to ethnic group recorded in the census.
Are there alternative (or complementary) approaches?

6. Exploratory Analysis – Augmenting Ethnicity Recording
Pool ethnicity records over time and from different administrative datasets:
Hospital admissions
Outpatient activity
Death registrations
Create a reference file, holding the most recent valid recording of ethnic group for each patient.
Match this reference file to other health datasets to increase ethnicity recording.

8. Missing Data: Some cases still do not have a valid ethnicity assigned to them…
Cases with “missing” ethnicity were assigned across ethnic groups, according to the distribution observed in the most recent census (2011).
Name based algorithms (Onolytics) were used to check for bias amongst missing ethnicity recording.
Results suggest that there was not a notable bias.

12. Interpretation remains problematic…
Disproportionately high rates for “other” ethnic group.
Suggests over-recording compared to census data.
Lower than expected rates for some minority groups.
Suggests under-recording compared to census data.
Possibly could be related to issues with access?
Small numbers involved for non-white Scottish/British groups.
Similar patterns seen for other datasets, albeit with larger errors observed for datasets with lower activity levels.

13. Conclusions
This kind of approach may have potential, but further work is needed to address issues with data completeness and quality and to explore and explain the differences observed.
We hope that sharing this work will ultimately drive improvement in data quality and use of these data.

14. For more information… Presenter email address: emma.mcnair@nhs.net
ISD website:
ISD report
containing this work:
Measuring Use of Health Services by Equality Group
Related NHS Lothian work:
Related ScotPHO work:
Scottish Health and Ethnicity Linkage Study (SHELS)