Ethnic and Socioeconomic Inequalities in Health and Social Care Utilisation Among People with Dementia: A Population-Based Study

Background

People affected by dementia experience intersecting care inequalities. We explored relationships between ethnicity and health and social care resource use among people with dementia in an ethnically diverse urban region.

Methods

We conducted a retrospective observational cohort study using Discover-NOW, including patients with dementia between 1.4.2015 and 1.4.2025. We calculated ethnic density as the percentage of the Middle Layer Super Output Area (SOA) population self-identifying with the same ethnic group. Regression models, clustered by Local SOA, tested whether ethnic density moderated relationships between ethnicity and primary care, outpatient, inpatient, emergency and social care service use, controlling for sociodemographic characteristics, deprivation, comorbidities and time of diagnosis.

Findings

We included 30,704 people with dementia. People from Black and Mixed ethnic groups used more primary care, and those from Asian ethnic groups less primary and secondary care, than White ethnic groups. Rates of local authority social care packages were similar across ethnic groups. High ethnic density predicted fewer GP consultations in Black ethnic groups, but more in South Asian groups.

Interpretation

Among Black ethnic groups, primary care use was relatively high, especially in areas of low ethnic density, perhaps reflecting greater needs among communities at risk of racism and isolation. The trend towards increased primary care use among South Asian people in areas of higher ethnic density may reflect communities mitigating help-seeking hesitancy related to cultural and language barriers. Greater care integration could reduce care inequalities among minority ethnic communities who may experience fewer barriers to social relative to health care.

Research in context

Evidence before this study

We searched MEDLINE, EMBASE, and PsycINFO from inception to March 2026, using terms combining dementia, ethnicity, minority ethnic groups, health service use, social care, and ethnic density. We included studies in English reporting on health or social care utilisation among people with dementia from minority ethnic groups. Previous systematic reviews and cohort studies consistently documented that people from minority ethnic groups with dementia access planned health care, including primary care, memory services, and outpatient appointments, less frequently than White majority populations. A 2021 systematic review found that minority ethnic groups with dementia faced substantial barriers to accessing health services, including stigma, language barriers, unfamiliarity with services, and lack of culturally competent care. Studies using UK primary care data have similarly shown lower rates of physical health monitoring and psychotropic prescribing among minority ethnic groups with dementia. No prior study had examined how area-level ethnic density, the local concentration of co-ethnic residents, might moderate the relationship between ethnicity and care use in dementia, despite evidence from severe mental illness research that ethnic density is associated with lower mortality and may buffer against the health harms of racism and social isolation.

Added value of this study

This is the first study to examine whether ethnic density moderates the relationship between ethnicity and health and social care use among people with dementia. Using a large, linked, ethnically diverse primary care dataset of over 30,000 people with dementia registered at GPs in Northwest London, we found that people from Black and Mixed ethnic groups used primary care more frequently than White ethnic groups, while those from Asian ethnic groups used both primary and secondary care less. Strikingly, among Black ethnic groups, GP interaction rates were highest in areas of lowest ethnic density, consistent with greater unmet needs. Conversely, among South Asian groups, higher ethnic density was associated with a trend toward more frequent GP interactions, potentially reflecting greater cultural competency and community facilitation of help-seeking in these areas. We also provide, to our knowledge, the first quantitative evidence on social care package use by ethnicity in dementia, finding that over two-thirds of people with a dementia diagnosis received no community social care, with no statistically significant differences between ethnic groups.

Implications of all the available evidence

Persistent and patterned inequalities in health and social care access among people with dementia from minority ethnic groups, are shaped not only by individual and cultural factors but also by the ethnic composition of local communities. The finding that ethnic density modifies care-seeking in opposite directions for Black and South Asian groups underscores that minority ethnic communities are not homogeneous and that place-based strategies should be tailored to their needs. The England 10 Year Health Plan’s commitment to shifting care from hospital to community settings offers an opportunity to reduce these inequalities, but only if implementation is equitable. Neighbourhood care models that bring secondary care expertise into primary care settings could improve access for groups currently underusing specialist services. Greater integration of health and social care, with social care workers trained and resourced to play active roles in dementia management, may be particularly valuable for communities who appear more willing to engage with social than health care. Future research should examine ethnic density effects across other regions and healthcare systems, investigate the mechanisms linking community composition to care access, and evaluate whether integrated, culturally competent service models reduce the inequalities documented here.