Asian and Black ethnic groups who say they have long term health conditions could be more likely to underreport anxiety, depression, and the ability to carry out daily activities than white populations, new research involving 2.6 million people finds.
The study by health economists at The University of Manchester and funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), is published today in the journal Quality of Life Research.
The authors also say that people from different ethnic groups with health conditions rated their quality of life differently, even when they reported similar prevalence of actual illness.
The findings bring us closer to confirming what researchers have explored but where further empirical evidence was still needed .
Based on the data from General Practice Patient Survey in England - including 2.3 million White respondents, 160 thousand Asian, 70 thousand Black, 20 thousand of Mixed or Multiple background, and 60 thousand from Other ethnic groups - the findings have potential implications on the equitable design of health services and the way health outcomes are measured.
Though the survey data used in the study relies on self-reported long term health conditions to capture illness, the measure is thought to be more objective than other studies to date for England. It's also the largest study to yet tackle differences in self-rating.
Lead author Dr Juan Marcelo Virdis from the University of Manchester said: "Our study found that certain black and Asian ethnic groups could be more likely to downplay different aspects of how health affects their lives.
"This is important because differences between perceived and actual health can affect how you seek healthcare health care and could, for example, delay a clinical consultation.
"But understanding these differences is crucial for designing equitable health services and improving outcomes across diverse populations."
The researchers based their analysis on EQ-5D-5L, a standardized measurement tool developed by a group of European researchers called EuroQol Group (EQ) to measure health-related quality of life.
5D refers to five self-reported dimensions of health it assesses: mobility, self-care, usual activities, pain/discomfort, anxiety/depression.
And the 5L refers to five levels of self-reported severity for each dimension: no problems, slight problems, moderate problems, severe problems, extreme problems/unable.
They analysed five distinct ethnic groups: White ethnic, mixed background, Asian, Black and Other who reported which of 15 long term health conditions they had.
In some cases - such as Mobility for the Black and Other ethnic groups or Self-care for the Asian- the tendency was to choose extreme categories. The study also explored differences within these broader ethnic groups, suggesting that heterogeneity may exist within them as well.
Though the reason why some ethnic groups report differently remain unclear, some researchers speculate that we answer subjective questions on health by saying what is normal for us, influenced by our background and expectations.
Dr Virdis added: "Our research provides a scenario for further studies using objectively measured health conditions, such as biological risk factors, or objective measures of physical health such as grip strength. In addition, we were not able to investigate the mechanisms at play, so this could be a focus for future qualitative research."
The paper Differences in rating of health related quality of life on the EQ-5D-5L between ethnic groups is published here. DOI: 10.1007/s11136-025-04082-y
