At NIHR ARC Northwest London (NWL), our work is rooted in partnership with our local health and care systems, ensuring that high-quality research is translated into real-world improvements. As one of 15 ARCs across England, we focus on delivering applied health and care research that makes a tangible difference for the diverse communities across our eight boroughs, with a view to scaling learning and impact nationally.
In 2021, we established our Ethnicity and Health Unit (EHU) to help address persistent health inequalities and advance health equity for ethnically diverse communities. Through innovative, inclusive research, we aim to drive meaningful and lasting change. This blog brings together the work of the EHU and our Information and Intelligence theme, highlighting how the Whole Systems Integrated Care (WSIC) Dashboards are being used to improve care. These dashboards provide an integrated view of patients' health and social care information, supporting targeted and proactive care for those who need it most. Alongside this, the anonymised dataset offers a powerful resource for understanding population-level trends and needs.
In the recent publication of the 10-Year Health Plan for England, improving health at the neighbourhood level with Neighbourhood Health Centres was a key theme, bringing local care into communities. Data and its use are central to the NHS Plan, and this data must be used at the local level if it is to inform the planned neighbourhood health service (Department of Health and Social Care). NWL has an ethnically diverse population that contrasts with that of the broader UK population demographics. According to the WSIC and national databases, while the UK population is predominantly white (87%), NWL has a rich diversity of ethnicities: White 36.2%, Asian or Asian British 30.2%, Other ethnic groups 11.2%, Unknown 10.7%, Black or Black British 8.2%, Mixed 3.5%. This article delves into findings on ethnicity and health from the WSIC Discover database, which captures 95% of the NWL’s population, 2.3 million people.
This blog outlines examples of the data derived from that database through an ethnicity lens, drawing upon published work in the fields of: COVID-19 vaccination; the influenza vaccine; hospitalisation rates related to COVID-19 and influenza; healthcare utilisation in children and young people; polypharmacy prevalence; and structured medication reviews. It aims to deepen our understanding of ethnicity and health to inform more equitable care.
COVID-19 poses significant risks to pregnant women, including health, pregnancy and birth-related complications. In 2021, the UK’s Joint Committee on Vaccination and Immunisation recommended the COVID-19 vaccine for pregnant individuals. Despite this, uptake of the vaccine in pregnant women remained low across the UK and worldwide. ARC’s recent study in Northwest London examined demographic and clinical factors influencing vaccine uptake. It found that Asian or Asian British women had the highest first-dose uptake, while Black or Black British women had the lowest. Another study also revealed that ethnic minority women and those from lower socioeconomic backgrounds exhibited greater vaccine hesitancy (Helen Skirrow). This highlights both the heightened risk of COVID-19 for Black women, as well as having lower vaccine uptake. However, despite evidence of black communities experiencing a higher risk of illness with COVID-19, their representation in clinical trials was disproportionately low. The lack of data for pregnant women has fuelled uncertainty around vaccine safety.
Other research supports these findings. For instance, a study examining the insights and beliefs of the UK population on COVID-19 vaccine uptake and hesitancy results found that South Asian groups showed more interest towards the uptake of the approved COVID-19 vaccine.
Similar patterns are observed with influenza vaccination. Woodcock et al. found that Asian or Asian British women were most likely to be vaccinated, while women of Black or Black British ethnicity and those whose ethnicity was not recorded were least likely to be vaccinated. Across both COVID-19 and Influenza vaccination in pregnant women, there is a clear disparity in vaccination amongst different ethnic groups.
Understanding These Differences and Findings
While some studies show higher uptake among Asian and Asian British women, others report hesitancy within specific subgroups. For example, one study found that vaccine hesitancy was high in the Asian or Asian British-Pakistani/Bangladeshi group but lower in the Asian or Asian British – Indian and other Asian background groups. Some existing research highlights that vaccine hesitancy is more common among individuals from Black, Asian, and Mixed ethnic backgrounds. Another study found that participants who self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost three times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants.
This suggests that broad ethnic categories could obscure important differences, and that more granular data is essential for accurate understanding. Vaccine hesitancy is complex, and different studies highlight hesitancy across different ethnic groups, but studies have highlighted that techniques like using trusted and collaborative healthcare and community networks can improve vaccine equity and accessibility.
A further ARC NWL study revealed that the ethnic composition of patients hospitalised for COVID-19 and influenza had significant differences. The COVID-19 cohort had a higher proportion of black ethnicity compared to influenza, and patients who were admitted with COVID-19 were much more likely to die in hospital.
Another study investigated clinical characteristics and predictors of outcomes of hospitalised patients with COVID-19. Black and Ethnic Minority patients were overrepresented in the cohort, and black patients were at increased odds of death.
This raises important questions about factors contributing to high rates of COVID-19 in black individuals, leading to subsequent hospitalisations and higher death rates.
Understanding the factors influencing healthcare utilisation amongst children and young people is crucial for developing effective, tailored interventions. These interventions may improve outcomes and reduce the need for hospital-based care.
A study on NWL’s children and young people population explored patterns of healthcare utilisation in children and young people. This included analysing the following utilisation segments: GP attendances, A&E attendances, outpatient attendances, elective hospital admissions, total length of stay from elective admissions, emergency hospital admissions and total length of stay from emergency admissions. This study found that Asian or Asian British children were more likely to be in higher utilisation segments, while white children were significantly less likely to be in each of the higher utilisation segments, after accounting for age, sex, socioeconomic deprivation and number of long-term conditions.
Reasons for these differences are unclear but could relate to variation in underlying health conditions, access to services or healthcare seeking behaviours. Approaches of preventative care and early interventions must be developed for children and young people at greater risk, and additional research to explore the reasons for higher utilisation in Asian and Asian British are required.
Polypharmacy, the prescription of multiple medications to a patient, is a major challenge for health systems and as populations age, the presence of polypharmacy is expected to increase. While for some people, polypharmacy is appropriate, for others, it can be problematic and even harmful, causing adverse side effects, harmful drug interactions and more.
A recent study on NWL’s population to determine the prevalence of polypharmacy found significant differences between ethnic groups, with Asian individuals experiencing the highest levels of polypharmacy. Furthermore, the burden of polypharmacy was greater for those who are more frail, particularly amongst Black, Asian and Other ethnicities compared to their white counterparts. It has been understood that polypharmacy prevalence varies across countries and is particularly high in Asian countries. One study identified that Afro-Caribbean groups were more sceptical concerning prescribed medications compared to the Asian groups or the European ones.
Medication reviews - defined as ‘a structured evaluation of a patient's medicines with the aim of optimising medicines use and improving health outcomes’ - are widely applied to address polypharmacy. In a study looking into the occurrence of medication and structured medication reviews, Black patients were associated with higher odds of medication reviews. Also, if they were males, more affluent, and frailer, while other ethnicities were less likely to receive medication reviews.
Some evidence suggests that for some ethnic minority groups, people with multiple long-term conditions, there are inadequate initiatives for managing health conditions, perpetuating inequalities in the healthcare system. This could suggest one reason for WSIC data indicating that a lower proportion of some other ethnicities receive structured medication reviews compared to their white counterparts.
Understanding the demographics of polypharmacy to tailor effective healthcare strategies is important.
Findings from the WSIC Discover database shed light on some of the persistent healthcare inequalities across ethnicities in NWL. Across these articles, there are some themes emerging that require further investigation, as well as some contradictory evidence on existing literature.
Black and Black British Ethnicities: Across these papers, using WSIC Discover, we can understand that Black or Black British people have lower uptake in vaccines, including lower COVID-19 and influenza vaccine uptake. Furthermore, among people who are more frail, Black people are more likely to be on polypharmacy than White people. Consistent with this, Black patients are more likely to receive medication reviews.
Asian and Asian British Ethnicities: Asian or Asian British people on the other hand, have highest healthcare interactions with regards to high healthcare utilisation in children, COVID and influenza vaccine uptake. The combination of these findings points to a theme relating to the Asian or Asian British group and interaction with health services.
It is important to highlight that across all of the reviewed WSIC papers, there were significant differences in results across ethnicities. This points to health inequalities and disparities among ethnic groups in NWL that must be recognised and addressed, but also that inequalities in health related to ethnicity is a complex issue.
Some key questions remain unanswered, which is important to delve deeper and address these disparities to ensure we deliver accurate and appropriate care designed for the entire population.
Moving Forward: How?
An important starting point is recognising the potential of our data to uncover inequalities. The NHS Plan has data collection, analysis and usage at its core to inform the future development of the health service. Having data that is localised and granular in nature while still at the population level, is important to inform the neighbourhood agenda. While current WSIC groupings, such as broad ethnic categories, offer some insight, they may not capture differences within communities and identities. Exploring further breakdowns could reveal patterns that are not visible at this level, in conjunction with clinical insights. Further work may be needed to assess the feasibility of using such detailed data in future analyses. WSIC remains a highly valuable resource for research and requires understanding and expertise in its analysis and interpretation.
Further research and data insights, can support understanding factors such as:
Relationship between ethnicity and polypharmacy
Understanding drivers behind vaccine hesitancy and ethnicity
Children’s experience of healthcare utilisation, and the influence that ethnicity has on this
Based on the above, identifying proactive, appropriate and tailored healthcare initiatives for our diverse population
Further research and efforts on the above will enable the healthcare system, healthcare professionals, and policymakers to ensure that our systems are designed for and with everyone, to strive for health equity.
Agostina Secchi MPharm, MSc, Andrew Booth PhD MCLIP, Ian Maidment PhD, Dolly Sud BSc (Hons), PhD., Hadar Zaman MPharm. “Medication management in Minority, Asian and Black ethnic older people in the United Kingdom: A mixed-studies systematic review.” (2022).
Alex Bottle, Carole Cohen, Amanda Lucas, Kavitha Saravanakumar, Zia Ul-Haq, Wayne Smith, Azeem Majeed, Paul Aylin. “How an electronic health record became a real-world research resource: comparison between London's Whole Systems Integrated Care database and the Clinical Practice Research Datalink.” (2020).
Atiya Kamal, Ava Hodson, Julia M. Pearce. “ Rapid Systematic Review of Factors Influencing COVID-19 Vaccination Uptake in Minority Ethnic Groups in the UK.” (2021).
Brenda Hayanga, Mai Stafford, Laia Bécares. “Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis.” (2021).
British Medical Association. “The impact of the pandemic on population health and health inequalities.” (2024).
Daniel Freeman, Bao S Loe, Andrew Chadwick, Cristian Vaccari, Felicity Waite, Laina Rosebrock, Lucy Jenner, Ariane Petit, Stephan Lewandowsky, Samantha Vanderslott, Stefania Innocenti, Michael Larkin, Alberto Giubilini,. “COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II.” (2020).
Department of Health and Social Care. Fit for the future: 10-year health plan for England. 2025.
Elaine Robertson, Kelly S. Reeve, Claire L. Niedzwiedz, Jamie Moore, Margaret Blake, Michael Green, Srinivasa Vittal Katikireddi, Michaela J, Benzeval. Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study. 2021.
Gloria Ihenetu, Paul Aylin, Vesselin Novov, Helen Skirrow, Sonia Saxena, Azeem Majeed, Thomas Woodcock. “Uptake of COVID-19 vaccines and association with hospitalisation due to COVID-19 in pregnancy: Retrospective cohort study.” (2024).
Helen Skirrow, Sara Barnett, Sadie Bell, Lucia Riaposova, Sandra Mounier-Jack, Beate Kampmann, Beth Holder. Women’s views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: a multi-methods study in the UK. 2022.
Hyesung Lee, Yeon-Hee Baek , Ju Hwan Kim , Tzu-Chi Liao , Wallis C Y Lau , Kenneth K C Man , Xiwen Qin , Stephen Wood , Jenni Ilomäki , J Simon Bell , Edward Chia-Cheng Lai , Miriam T Y Leung , Adrienne Y L Chan , Celine S L Chui , Ian C K Wong , Ju-Youn. “Trends of polypharmacy among older people in Asia, Australia and the United Kingdom: a multinational population-based study.” (2023).
Keerti Gedela, Richard Wong, Suki Balendra, Sunder Chita, Helen Jones, Rainer Golombek, Keitumetse-Kabelo Murray and NIHR CRN NWL EDI working group. “Embedding equity, diversity and inclusion processes within clinical trials and health and social care research.” (2025).
Linwei Li, Geva Greenfield, Benedict W J Hayhoe, Derryn Lovett, Vesselin Novov, Azeem Majeed, Paul Aylin, Hadar Zaman, Thomas Woodcock. “Structured medication reviews for patients with polypharmacy in primary care: a cross-sectional study in North West London, UK.” (2025).
Malia Skjefte, Michelle Ngirbabul, Oluwasefunmi Akeju, Daniel Escudero, Sonia Hernandez-Diaz, Diego F Wyszynski, Julia W Wu. “COVID-19 vaccine acceptance among pregnant women and mothers of young children: results of a survey in 16 countries.” (2021).
Pablo N Perez-Guzman, Anna Daunt , Sujit Mukherjee , Peter Crook , Roberta Forlano , Mara D Kont , Alessandra Løchen , Michaela Vollmer , Paul Middleton , Rebekah Judge , Christopher Harlow , Anet Soubieres , Graham Cooke , Peter J White , Timothy B Hall. “Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study.” (2021).
Sadie Bell, Richard Clarke, Sandra Mounier-Jack, Jemma L. Walker, Pauline Paterson. “Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.” (2020).
Sonika Sethi, Aditi Kumar, Anandadeep Mandal, Mohammed Shaikh, Clair A Hall, Jeremy M W Kirk, Paul Moss, Matthew J Brookes, Supratik Basu. The UPTAKE study: a cross-sectional survey examining the insights and beliefs of the UK populaiton on COVID-19 vaccine uptake and hesitancy. 2021.
Thomas Beaney, Jonathan Clarke, Thomas Woodcock, Rachel McCarthy, Kavitha Saravanakumar, Mauricio Barahona, Mitch Blair, Dougal S Hargreaves. “Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London .” (2021).
Thomas Woodcock, Derryn Lovett, Gloria Ihenetu, Vesselin Novov, Thomas Beaney, Keivan Armani, Angela Quilley, Azeem Majeed, Paul Aylin. “Polypharmacy in primary care: A population-based retrospective cohort study of electronic health records.” (2024).
Thomas Woodcock, Geva Greenfield, Ajit Lalvani, Azeem Majeed, Paul Aylin. “5. Patient outcomes following emergency admission to hospital for COVID-19 compared with influenza: retrospective cohort study .” (2023).
Thomas Woodcock, Vesselin Novov, Helen Skirrow, James Butler, Derryn Lovett, Yewande Adeleke, Mitch Blair, Sonia Saxena, Azeem Majeed, Paul Aylin. “3. Health and socio-demographic characteristics associated with uptake of seasonal influenza vaccination amongst pregnant women: retrospective cohort study .” (2023).
This blog was written by our Information and Intelligence Theme and our Ethnicity & Health Unit.