Spatial inequalities and the impact of multiple environmental risks on ethnic minority children's health: results from the Born in Bradford study

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PURPOSE: Urban environments are a key determinant of health and health inequality. We explore the impact of multiple spatial inequalities on primary healthcare use in a prospective multi-ethnic urban cohort of children. METHOD: Primary-care consultations and prescription data for 4949 children were collected from birth to 10 years. Environmental exposure scores for air-pollution, road-traffic, green-space, and proximity to fast-food outlets were calculated longitudinally using home-addresses. The top 20% of addresses were classified as hazardous; environmental risk was calculated using the count of exposures above this threshold (range 0-4). Health impacts were assessed using negative binomial regression models adjusting for ethnicity; sex; age; birth outcomes; family financial status; area-level deprivation; maternal education and maternal health behaviours. Interaction terms were included for financial status and ethnicity. RESULTS: Half of Pakistani heritage and one-third of Other ethnic minority children experienced multiple environmental risks, compared to 7% of white British children. Rates of annual consultations and prescriptions increased for ethnic minority children as environment risks accumulated (consultations: no risks- Pakistani: 3·97 (95% CI: 3·79-4·15); Other: 3·37 (95% CI: 3·13-3·61); 4 risks- Pakistani: 4·23 (95% CI: 3·95-4·52); Other: 4·14 (95% CI: 3·55-4·72). Prescriptions (no risks- Pakistani: 6·14 (95% CI: 5·69-6·58; Other: 6·20 (95% CI: 5·53-6·87); 4 risks- Pakistani: 8·32 (95% CI: 7·41-9·22); Other: 6·54 (95% CI: 5·09-7·99). The reverse was found for white British children. CONCLUSIONS: Ethnic minority children are disproportionately exposed to multiple environmental risks and are more vulnerable to their harmful effects. Improvements to multi-ethnic urban neighbourhoods may mitigate health inequalities.

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