Background
Importance of taking an intersectional approach
Methods
Sample and procedure
Measures
Health service use
Discrimination
Sociodemographic and socioeconomic indicators
Health status
Life events
Latent class analysis
Indicators of intersectional social status | |||||||
---|---|---|---|---|---|---|---|
Class 1 (n = 100) | Class 2 ( n = 107) | Class 3 (n=106) | Class 4 (n=153) | Class 5 (n=100) | Class 6 (n=181) | Class 7 (n=305) | |
n(%) | n(%) | n(%) | n(%) | n(%) | n(%) | n(%) | |
Ethnicity | |||||||
White British | 0 | 103(97.2) | 42(39.8) | 74(46.5) | 52(52.0) | 0 | 265(86.0) |
Black Caribbean | 21(20.8) | 0 | 8(7.9) | 37(25.4) | 8(8.5) | 0 | 11(3.6) |
Black African | 30(29.8) | 0 | 27(26.0) | 9(5.5) | 6(6.4) | 62(33.8) | 1(0.5) |
White Other | 24(24.3) | 0 | 8(6.6) | 11(7.7) | 19(18.3) | 71(38.0) | 14(4.6) |
Non-White Other | 17(16.6) | 0 | 12(10.9) | 11(6.7) | 13(12.7) | 39(22.5) | 6(2.3) |
Mixed | 8(8.5) | 3(2.8) | 9(8.8) | 11(8.2) | 2(2.1) | 9(5.7) | 8(3.0) |
Migrant status | |||||||
Born in the UK | 25(28.0) | 107(100) | 79(76.8) | 110(74.9) | 52(54.7) | 10(6.8) | 285(95.1) |
Migrant (0-10) | 11(12.1) | 0 | 17(14.4) | 6(4.3) | 9(10.1) | 81(47.3) | 2(0.6) |
Migrant (11-20) | 27(28.5) | 0 | 8(8.2) | 16(11.1) | 4(4.4) | 52(28.6) | 3(1.0) |
Migrant (21+) | 37(31.5) | 0 | 1(0.7) | 17(9.7) | 31(30.8) | 37(17.2) | 10(3.3) |
Educational attainment | |||||||
No qualifications/GCSE | 47(45.0) | 88(80.7) | 13(12.1) | 75(47.9) | 19(17.6) | 12(6.8) | 6(1.8) |
A Level | 35(36.9) | 17(17.4) | 55(52.3) | 65(43.4) | 13(12.7) | 45(24.4) | 32(11.1) |
Degree or above | 18(18.1) | 2(1.9) | 38(35.6) | 13(8.7) | 68(69.7) | 124(68.8) | 267(87.1) |
Social occupational class | |||||||
Class I | 0 | 0 | 0 | 1(0.7) | 0 | 23(13.3) | 59(19.4) |
Class II | 0 | 0 | 0 | 23(14.6) | 0 | 86(47.2) | 197(64.4) |
Class IIINM | 0 | 0 | 0 | 44(27.8) | 0 | 29(16.9) | 30(10.2) |
Class IIIM | 0 | 0 | 0 | 27(18.7) | 0 | 9(5.1) | 16(4.9) |
Class IV | 0 | 0 | 0 | 46(30.3) | 0 | 26(14.0) | 3(1.0) |
Class V | 0 | 0 | 0 | 12(8.0) | 0 | 7(3.5) | 0 |
No SOC assigned | 100(100) | 107(100) | 106(100) | 0 | 100(100) | 0 | 0 |
Employment status | |||||||
Full/part-time employed | 0 | 0 | 0 | 153(100) | 0 | 180(100) | 305(100) |
Student | 6(8.0) | 0 | 78(76.0) | 0 | 0 | 0 | 0 |
Unemployed | 25(29.1) | 27(28.8) | 28(24.0) | 0 | 16(16.6) | 0 | 0 |
Temporary sick/disabled | 19(19.0) | 18(19.2) | 0 | 0 | 4(5.0) | 0 | 0 |
Retired | 30(24.2) | 56(45.8) | 0 | 0 | 53(50.2) | 0 | 0 |
Looking after children | 20(19.7) | 6(6.2) | 0 | 0 | 27(28.2) | 0 | 0 |
Household income | |||||||
£0 - £12,096 | 59(68.6) | 53(56.8) | 14(17.0) | 25(16.6) | 11(11.7) | 11(6.3) | 3(0.8) |
£12,097-£31,494 | 22(23.2) | 41(43.2) | 14(17.5) | 71(51.1) | 25(29.1) | 38(21.5) | 29(9.6) |
£31495+ | 7(8.2) | 0 | 49(65.5) | 43(32.3) | 49(59.2) | 122(72.2) | 261(89.6) |
Any debt | |||||||
No | 61(57.5) | 86(76.7) | 88(83.4) | 104(69.1) | 99(99.0) | 164(90.3) | 289(94.3) |
Yes | 39(42.5) | 21(23.3) | 18(16.6) | 49(30.9) | 1(1.0) | 17(9.7) | 16(5.7) |
Any benefits | |||||||
No | 20(16.4) | 39(31.6) | 87(83.8) | 108(72.1) | 87(86.5) | 162(89.6) | 294(96.6) |
Yes | 80(83.6) | 68(68.4) | 19(16.2) | 45(27.9) | 13(13.5) | 19(10.4) | 11(3.4) |
Tenure | |||||||
Own outright/ mortgage | 0 | 3(2.9) | 31(30.7) | 27(16.3) | 88(89.4) | 57(29.3) | 199(66.4) |
Private rented | 18(19.9) | 10(8.8) | 32(29.9) | 16(11.6) | 5(6.2) | 73(45.3) | 68(26.9) |
Social housing | 79(80.1) | 93(87.6) | 17(15.2) | 101(66.7) | 4(4.4) | 39(21.3) | 15(4.6) |
Other | 0 | 1(0.8) | 24(24.2) | 7(5.4) | 0 | 7(4.1) | 6(2.1) |
Moved in past 2 years | |||||||
Not moved or moved once | 89(89.6) | 106(98.8) | 88(85.2) | 145(94.6) | 97(100) | 157(85.7) | 262(90.4) |
Moved twice or more | 9(10.4) | 1(1.2) | 16(14.8) | 7(5.4) | 0 | 20(14.3) | 26(9.6) |
Gender | |||||||
Male | 32(35.5) | 44(45.8) | 48(52.3) | 60(45.5) | 32(35.2) | 77(48.6) | 144(53.6) |
Female | 68(64.5) | 63(54.2) | 58(47.7) | 93(54.5) | 68(64.8) | 104(51.4) | 161(46.4) |
Age | |||||||
16-34 | 28(34.1) | 13(16.6) | 93(91.1) | 52(44.0) | 15(18.3) | 67(44.3) | 105(41.5) |
35-54 | 35(35.5) | 23(23.8) | 13(8.9) | 70(40.9) | 22(22.2) | 88(44.7) | 155(47.5) |
55+ | 37(30.4) | 71(60.0) | 0 | 31(15.1) | 63(59.5) | 26(11.0) | 45(11.0) |
Statistical analysis
Stressors and health symptoms | Indicators of intersectional social status | |||||||
---|---|---|---|---|---|---|---|---|
Migrant, mixed ethnicity, low SES | White British, low SES | Non migrant, mixed ethnicity, student | Non migrant, mixed ethnicity, skilled | Mixed migration status, mixed ethnicity, economically inactive | Migrant, mixed ethnicity, high SES | White British, high SES | ||
n (%) |
n (%)
| n (%) |
n (%)
|
n (%)
|
n (%)
|
n (%)
|
p
| |
Everyday discrimination | ||||||||
Below median | 41(36.9) | 37(30.9) | 28(26.2) | 39(23.6) | 49(48.1) | 70(36.8) | 153(49.6) | <0.001 |
Median or above | 59(63.1) | 70(69.1) | 78(73.8) | 114(76.4) | 51(51.9) | 111(63.2) | 151(50.4) | |
Reason for everyday discrimination | ||||||||
Race/ethnicity | 16(23.7) | 1(1.4) | 15(17.3) | 30(26.4) | 14(20.1) | 51(36.3) | 19(7.9) | <0.001 |
National origins | 9(12.2) | 0(0) | 3(2.8) | 1(0.8) | 2(2.7) | 12(7.4) | 3(1.4) | |
Education/income | 3(4.2) | 10(12.6) | 4(3.7) | 16(13.1) | 4(5.2) | 7(4.5) | 22(10.1) | |
Age | 5(9.3) | 13(16.4) | 14(14.9) | 10(7.8) | 11(14.7) | 7(5.5) | 40(17.9) | |
Gender | 3(5.0) | 0(0) | 12(11.6) | 4(2.8) | 8(9.8) | 9(5.8) | 30(11.7) | |
Other | 27(45.7) | 50(69.6) | 44(49.7) | 58(49.1) | 31(47.4) | 56(40.5) | 119(51.1) | |
Major discrimination | ||||||||
0 domains | 43(39.6) | 51(43.4) | 57(53.2) | 72(45.5) | 54(54.3) | 83(45.9) | 181(60.1) | <0.001 |
1-2 domains | 28(29.6) | 35(34.8) | 31(30.4) | 61(41.3) | 39(39.1) | 71(40.3) | 97(31.8) | |
3+ domains | 29(30.8) | 21(21.8) | 17(16.4) | 20(13.2) | 6(6.7) | 27(13.9) | 27(8.1) | |
Anticipated discrimination | ||||||||
0 domains | 57(55.4) | 77(67.7) | 70(68.4) | 115(74.7) | 79(79.3) | 122(66.3) | 236(77.1) | 0.008 |
1 domain | 30(30.6) | 19(20.9) | 28(24.7) | 27(18.5) | 17(17.7) | 44(25.2) | 56(18.6) | |
2+ domains | 13(14.0) | 11(11.4) | 8(7.0) | 11(6.8) | 3(3.0) | 15(8.5) | 13(4.3) | |
Mental disorder | 42(44.9) | 42(41.1) | 28(25.5) | 33(20.6) | 15(14.3) | 30(16.2) | 41(13.2) | <0.001 |
Physical disorder | 25(28.9) | 34(38.9) | 19(17.6) | 28(17.7) | 9(9.5) | 18(9.5) | 24(7.6) | <0.001 |
Long standing illness | 69(67.4) | 88(80.4) | 39(34.9) | 70(40.2) | 60(59.3) | 67(35.2) | 95(30.3) | <0.001 |
Health service use (last 12 months) | ||||||
---|---|---|---|---|---|---|
Any mental health service use | Secondary physical health service use | |||||
n (%) | OR 95% (CI)a | OR(95% CI) b | n (%) | OR(95% CI) a | OR(95% CI) b | |
Total | 181(17.1) | 530(48.0) | ||||
Indicators of intersectional social identity | ||||||
Migrant, mixed ethnicity, low SES | 30(30.5) | 4.29(2.37-7.74) | 1.46(0.73-2.93) | 53(49.8) | 1.33(0.83-2.14) | 0.59(0.36-0.99) |
White British, low SES | 21(20.5) | 2.52(1.33-4.78) | 0.88(0.40-1.90) | 74(67.2) | 2.74(1.67-4.50) | 1.00(0.60-1.68) |
Non migrant, mixed ethnicity, student | 27(23.2) | 2.95(1.63-5.33) | 1.83(0.93-3.58) | 52(47.7) | 1.22(0.78-1.91) | 1.48(0.88-2.49) |
Non migrant, mixed ethnicity, skilled | 26(16.1) | 1.87(1.04-3.38) | 1.27(0.65-2.47) | 81(49.7) | 1.32(0.89-1.98) | 1.07(0.69-1.67) |
Mixed migration status, mixed ethnicity, economically inactive | 19(20.0) | 2.44(1.28-4.64) | 2.27(1.11-4.64) | 61(61.3) | 2.12(1.32-3.39) | 1.16(0.66-2.03) |
Migrant, mixed ethnicity, high SES | 28(15.7) | 1.81(1.02-3.22) | 1.63(0.88-3.00) | 72(37.8) | 0.81(0.56-1.19) | 0.72(0.47-1.09) |
White British, high SES (reference group) | 30(9.3) | 1.00 | 1.00 | 137(42.8) | 1.00 | 1.00 |
Health service use (last 12 months) | ||||||
---|---|---|---|---|---|---|
Any mental health service use (n=181) | Secondary physical health service use (n=530) | |||||
n (%) | Unadjusted OR (95% CI) | Adjusted OR1 (95% CI) | n (%) | Unadjusted OR (95% CI) | Adjusted ORa (95% CI) | |
Ethnicity | ||||||
White British | 75(14.1) | 1.00 | 1.00 | 291(52.1) | 1.00 | 1.00 |
Black Caribbean | 15(15.4) | 1.11(0.60-2.03) | 1.08(0.53-2.21) | 43(49.1) | 0.89(0.55-1.44) | 0.91(0.52-1.58) |
Black African | 20(14.2) | 1.01(0.58-1.77) | 0.85(0.43-1.67) | 58(41.3) | 0.65(0.44-0.96) | 0.70(0.45-1.06) |
White Other | 47(33.9) | 3.13(2.00-4.91) | 2.86(1.74-4.68) | 71(45.9) | 0.78(0.53-1.14) | 0.61(0.40-0.92) |
Non White Other | 17(17.0) | 1.25(0.71-2.19) | 1.04(0.55-1.95) | 42(40.6) | 0.63(0.40-0.99) | 0.62(0.38-1.00) |
Mixed | 7(12.9) | 0.91(0.39-2.11) | 0.83(0.35-1.93) | 25(44.5) | 0.74(0.41-1.31) | 0.83(0.45-1.55) |
Migration status | ||||||
Born in the UK | 106(15.8) | 1.00 | 1.00 | 355(50.4) | 1.00 | 1.00 |
Migrant (0-10) | 21(16.4) | 1.04(0.61-1.79) | 1.21(0.67-2.17) | 48(36.2) | 0.56(0.38-0.83) | 0.68(0.44-1.03) |
Migrant (11-20) | 25(22.6) | 1.55(0.92-2.62) | 1.52(0.84-2.75) | 48(41.8) | 0.71(0.47-1.07) | 0.72(0.46-1.13) |
Migrant (21+) | 29(20.7) | 1.39(0.86-2.25) | 1.21(0.71-2.05) | 76(52.7) | 1.10(0.76-1.57) | 0.60(0.40-0.92) |
Educational attainment | ||||||
No qualifications/GCSE | 45(17.8) | 1.20(0.79-1.83) | 0.60(0.35-1.04) | 143(52.3) | 1.41(1.04-1.91) | 0.77(0.54-1.11) |
A Level | 54(20.0) | 1.38(0.93-2.05) | 0.89(0.57-1.39) | 143(52.1) | 1.39(1.02-1.90) | 1.28(0.91-1.80) |
Degree or above | 82(15.3) | 1.00 | 1.00 | 244(43.9) | 1.00 | 1.00 |
Social occupational class | ||||||
Class I/II | 48(11.7) | 1.00 | 1.00 | 165(40.0) | 1.00 | 1.00 |
Class III | 19(12.2) | 1.04(0.57-1.89) | 0.88(0.47-1.67) | 85(51.9) | 1.62(1.09-2.41) | 1.51(0.98-2.32) |
Class IV/V | 16(16.6) | 1.50(0.80-2.80) | 1.15(0.56-2.37) | 40(41.2) | 1.05(0.66-1.66) | 0.91(0.56-1.47) |
No SOC assigned | 97(23.7) | 2.34(1.57-4.47) | 1.26(0.80-1.97) | 240(55.5) | 1.87(1.40-2.51) | 1.26(0.90-1.76) |
Employment status | ||||||
Full/part-time employed | 83(12.5) | 1.00 | 1.00 | 290(43.1) | 1.00 | 1.00 |
Student | 19(20.3) | 1.78(0.99-3.21) | 1.33(0.66-2.70) | 40(46.3) | 1.14(0.73-1.76) | 1.44(0.84-2.47) |
Unemployed | 31(30.6) | 3.08(1.88-5.04) | 1.96(1.11-3.47) | 46(45.9) | 1.12(0.72-1.73) | 0.87(0.55-1.43) |
Temporary sick/disabled | 22(53.0) | 7.86(4.02-15.36) | 1.74(0.74-4.10) | 30(73.0) | 3.58(1.74-7.35) | 1.13(0.51-2.50) |
Retired | 16(12.1) | 0.96(0.54-1.72) | 0.53(0.25-1.12) | 102(73.1) | 3.59(2.35-5.50) | 1.45(0.82-2.54) |
Looking after children | 9(18.0) | 1.53(0.72-3.25) | 1.05(0.46-2.43) | 22(42.1) | 0.96(0.54-1.71) | 0.80(0.42-1.50) |
Household income | ||||||
£0 - £12,096 | 40(23.4) | 1.77(1.14-2.73) | 0.85(0.49-1.46) | 90(48.3) | 1.13(0.80-1.61) | 0.59(0.39-0.89) |
£12,097-£31,494 | 44(17.7) | 1.25(0.83-1.88) | 0.90(0.56-1.45) | 133(52.3) | 1.33(0.96-1.84) | 0.91(0.63-1.32) |
£31495+ | 77(14.7) | 1.00 | 1.00 | 250(45.1) | 1.00 | 1.00 |
Any debt | ||||||
No | 123(13.6) | 1.00 | 1.00 | 452(48.0) | 1.00 | 1.00 |
Yes | 58(35.1) | 3.44(2.37-5.00) | 1.99(1.26-3.16) | 78(47.9) | 0.99(0.71-1.40) | 0.80(0.53-1.21) |
Any benefits | ||||||
No | 106(13.3) | 1.00 | 1.00 | 396(47.3) | 1.00 | 1.00 |
Yes | 75(29.0) | 2.66(1.89-3.76) | 1.39(0.91-2.11) | 134(50.2) | 1.12(0.85-1.48) | 0.69(0.50-0.96) |
Tenure | ||||||
Own outright/ mortgage | 63(15.3) | 1.00 | 1.00 | 208(49.5) | 1.00 | 1.00 |
Rent/private | 42(19.2) | 1.32(0.84-2.05) | 1.16(0.72-1.88) | 91(39.0) | 0.65(0.46-0.91) | 0.82(0.56-1.20) |
Rent/council | 69(19.7) | 1.35(0.92-2.00) | 0.71(0.45-1.13) | 195(53.5) | 1.17(0.87-1.57) | 0.90(0.65-1.24) |
Other | 5(11.5) | 0.72(0.27-1.91) | 0.48(0.13-1.76) | 22(48.0) | 0.94(0.50-1.76) | 1.38(0.69-2.73) |
Moved in past 2 years | ||||||
Not moved or moved once | 162(17.1) | 1.00 | 1.00 | 494(50.1) | 1.00 | 1.00 |
Moved twice or more | 17(21.3) | 1.31(0.73-2.37) | 1.63(0.85-3.10) | 24(29.6) | 0.42(0.26-0.69) | 0.56(0.32-0.98) |
Health service use (last 12 months) | ||||||||
---|---|---|---|---|---|---|---|---|
Health service use for mental health (n=181) | Secondary physical health service use (n=530) | |||||||
n (%) | OR(95% CI)a | OR(95% CI)b | ORb (95% CI)c | n (%) | OR(95% CI)a | OR(95% CI)b | OR(95% CI)c | |
Everyday discrimination | ||||||||
Below median | 52(12.5) | 1.00 | 213(48.8) | 1.00 | ||||
Median or above | 129(19.9) | 1.74(1.21-2.49) | 1.28(0.85-1.93) | 1.23(0.81-1.88) | 317(47.6) | 0.95(0.74-1.24) | 0.84(0.62-1.16) | 0.87(0.63-1.19) |
Major discrimination | ||||||||
0 domains | 79(14.7) | 1.00 | 1.00 | 1.00 | 255(44.6) | 1.00 | 1.00 | 1.00 |
1-2 domains | 59(15.6) | 1.07(0.74-1.55) | 0.71(0.46-1.10) | 0.68(0.43-1.06) | 181(47.8) | 1.14(0.87-1.49) | 1.12(0.82-1.53) | 1.14(0.83-1.56) |
3+ domains | 43(29.4) | 2.42(1.55-3.76) | 0.84(0.47-1.50) | 0.74(0.39-1.41) | 92(59.9) | 1.85(1.26-2.73) | 1.38(0.87-2.18) | 1.39(0.86-2.25) |
Anticipated discrimination | ||||||||
0 domains | 106(13.6) | 1.00 | 1.00 | 1.00 | 364(45.7) | 1.00 | 1.00 | 1.00 |
1 domain | 49(22.9) | 1.89(1.28-2.80) | 1.28(0.79-2.09) | 1.36(0.83-2.22) | 120(52.3) | 1.30(0.95-1.79) | 1.28(0.89-1.85) | 1.28(0.88-1.85) |
2+ domains | 26(34.4) | 3.34(1.92-5.82) | 1.91(1.01-3.63) | 1.85(0.93-3.71) | 45(57.8) | 1.63(0.98-2.70) | 1.38(0.78-2.43) | 1.29(0.72-2.31) |
Indicators of intersectional social identity | ||||||||
Migrant, mixed Ethnicity, low SES | 1.38(0.68-2.81) | 1.26(0.60-2.63) | 0.54(0.32-0.93) | 0.51(0.30-0.89) | ||||
White British, low SES | 0.83(0.38-1.80) | 0.81(0.37-1.77) | 0.98(0.58-1.66) | 1.03(0.60-1.75) | ||||
Non migrant, mixed ethnicity, student | 1.72(0.87-3.40) | 1.85(0.93-3.68) | 1.45(0.86-2.46) | 1.47(0.86-2.51) | ||||
Non migrant, mixed ethnicity, skilled | 1.22(0.63-2.36) | 1.21(0.63-2.34) | 1.08(0.69-1.69) | 1.06(0.68-1.67) | ||||
Mixed migration status, mixed ethnicity, economically inactive | 2.28(1.11-4.69) | 2.32(1.11-4.84) | 1.15(0.65-2.03) | 1.18(0.67-2.09) | ||||
Migrant, mixed ethnicity, high SES | 1.56(0.84-2.90) | 1.57(0.84-2.95) | 0.69(0.45-1.03) | 0.71(0.46-1.07) | ||||
White British, high SES (reference group) | 1.00 | 1.00 | 1.00 | 1.00 |
Results
Characteristics of the sample
Total sample | |
---|---|
n (%) | |
Total | 1052 |
Indicators of intersectional social status | |
Class 1: Migrant, mixed ethnicity, low SES | 100(9.5) |
Class 2: White British, low SES | 107(9.3) |
Class 3: Non migrant, mixed ethnicity, student | 106(12.9) |
Class 4: Non migrant, mixed ethnicity, skilled | 153(14.3) |
Class 5: Mixed migration status, mixed ethnicity, economically inactive | 100(8.2) |
Class 6: Migrant, mixed ethnicity, high SES | 181(17.1) |
Class 7: White British, high SES | 305(28.7) |
Age | |
17-39 | 479(54.0) |
40-59 | 381(31.7) |
60+ | 192(14.3) |
Gender | |
Female | 615(52.5) |
Male | 437(47.5) |
Everyday discrimination | |
Below median | 417(37.6) |
Median or more | 634(62.4) |
Reason for everyday discrimination | |
Race/ethnicity | 146(18.7) |
National origins | 30(3.4) |
Education/income | 66(8.0) |
Age | 100(12.7) |
Gender | 66(7.6) |
Other | 385(49.6) |
Major discrimination | |
0 domains | 541(50.7) |
1-2 domains | 362(35.1) |
3+ domains | 147(14.2) |
Anticipated discrimination | |
0 domains | 756(71.0) |
1 domain | 221(21.8) |
2+ domains | 74(7.2) |
Any mental health service use | 181(17.1) |
Secondary physical health service use | 530(48.0) |
Mental disorder | 231(22.1) |
Physical disorder | 157(15.4) |
Long standing illness | 488(43.9) |
Life events | |
0-3 events | 464(46.4) |
4-7 events | 435(43.5) |
8+ events | 104(10.1) |