Genetic and health determinants of cancer risk in Bangladeshi and Pakistani individuals in the UK.

People with two or more long-term conditions (MLTCs) have a poorer quality of life, a higher treatment burden, and an increased risk of polypharmacy, disability, and mortality compared to people with one long-term condition or none []. Studies suggest that many people from racially/ethnic minoritised groups have as many or more long-term conditions when compared to their white majority counterparts []. In the United States (US), for instance, analysis of data from nearly 600,000 people by Caraballo, Herrin [] suggests that amongst participants aged 30 years and older, the prevalence of MLTCs among Black people is similar to that of Hispanic/Latino, white and Asian people who are 5–10 years older. These inequalities are also evident in the United Kingdom (UK) as the early onset of MLTCs has been found to be more common among South Asian and Black people when compared to white people []. Relatedly, an examination of age-related patterns of MLTCs across racial/ethnic groups suggests that racial/ethnic inequalities in MLTCs emerge from midlife onwards and by later life, older people of Pakistani, Indian, Black Caribbean and other ethnicity have more long-term conditions than white people []. The findings also suggest that compared to their white British counterparts, Gypsy or Irish Travellers are more likely to report MLTCs across all age groups []. When we consider other domains of health, including healthcare and mortality, studies show that racially/ethnic minoritised people with MLTCs receive poorer care quality, and have lower levels of satisfaction with primary care service than their white counterparts [–]. They also experience a higher risk of early death []. These inequalities are concerning and suggest that racially/ethnic minoritised people are disadvantaged at all stages of their MLTCs journey. Left unchecked, inequalities in MLTCs are likely to intersect with other forms of disadvantage to (re)produce new forms of inequality that will continue to negatively impact racially/ethnic minoritised people. The inequalities outlined above raise questions regarding the drivers of racial/ethnic inequalities in MLTCs and the types of initiatives required to prevent the development of long-term conditions, progression towards MLTCs and, ultimately, improve outcomes for racially/ethnic minoritised people with MLTCs. Figure  depicts the drivers of racial/ethnic inequalities in MLTCs. It is based on evidence from the extant literature on racial/ethnic inequalities in MLTCs [, ] and informed by the works of Curtis, Paine [], Hankivsky [] and Bécares, Shaw []. The figure alerts us to the distal drivers of inequalities (e.g. racism) which intersect in complex ways with other powers of oppression (e.g. capitalism) to drive structural inequalities (e.g. allocation of resources, area deprivation, socioeconomic status). Not only do these inequalities impact negatively on healthcare provision, and care quality, but they also (in)directly affect health-seeking behaviour, healthcare utilisation and social support. In turn, these processes lead to the more proximal drivers of health inequalities (e.g. non-adherence, psychological distress, forgone healthcare, and delayed diagnosis), all of which contribute to racial/ethnic inequalities in the prevalence, severity, and prognosis of MLTCs. It is imperative that we identify and critically assess the types of interventions that have been designed and implemented to address racial/ethnic inequalities in MLTCs, the extent to which these interventions have been effective in improving health outcomes for racially/ethnic minoritised people with MLTCs and the mechanisms by which they do so.