Vijaya Sundararajan, Daniel D Reidpath, Pascale Allotey
Discrimination is difficult to measure objectively in clinical settings, although it has been identified as a significant cause of ethnic health disparities. Proxy quantitative indicators relating to differential outcomes based on quality of care can begin to shed some light on the possible discrimination, but current data are largely from countries where there is differential access to healthcare as a result of health insurance schemes, and this is a major confounder in the findings. Using data from Victoria, Australia, where there is currently universal healthcare coverage, we explored a number of quality of care-relatedclinical outcomes across ethnic groups. The aim was to explore the relationship between ethnicity and clinical outcomes for postpartum haemorrhage, sepsis and cardiac rehabilitation in Victoria, Australia, as the first step to developing methods for research into discrimination in quality of care. We drew on the Victorian Admitted Episodes Dataset and undertook a secondary data analysis based on recategorisation of country of birth data. A multivariate logistic regression was used to examine the relationship between ethnicity and specified clinical outcomes. Results showed that the risk for postpartum haemorrhage was higher in ethnic minority groups, and access to intensive care for sepsis lower; however, there was no association with access to cardiac care. Our analyses did not support any strong or consistent barriers to access or pooroutcomes of care for particular ethnic groups. This may be an indication of the protection provided by universal health coverage. However, research in this area in Australia is in its infancy and there is a lack of systematically collected administrative data on ethnicity. Growing ethnic minority populations, not just in Australia but also in many other high-income countries, highlight a critical need for the development of data collection systems that are conceptually sound and useful for the monitoring of ethnic minority health in gene
