title: Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research.
abstract: BACKGROUND
  The increasing diversity of the Western-European population demands identification of potential ethnic healthcare inequities. We developed a framework that helps researchers in interpreting ethnic inequalities in healthcare consumption in equity terms. From this framework, we develop recommendations for the design of future studies.
  
  
  METHODS
  The framework was developed by analysing three typical studies on ethnic inequalities in healthcare consumption with respect to the potential of interpreting their results as healthcare inequities.
  
  
  RESULTS
  Analysing the effects of ethnic variations in healthcare consumption on health outcomes provides important clues about the presence of potential ethnic healthcare inequities. Interpretation of ethnic variations in healthcare consumption as potentially inequitable requires appropriate adjustment for medical need for healthcare, patient preferences and treatment adherence. Because of the central position of medical need, studies need to be disease-specific and based on standardized assessment of risk factors and disease characteristics. A longitudinal study design is necessary to prevent reverse causation.
  
  
  CONCLUSIONS
  The framework shows that ethnic inequalities in healthcare consumption can be justified if healthcare received meets the need for healthcare in all groups and is in accordance with informed patient preferences. It also shows that ethnic equality in healthcare consumption may hide healthcare inequities. We recommend further research on ethnic healthcare inequities using multi-ethnic cohort designs combined with linkage to healthcare registries. We also recommend research to identify clinically relevant ethnic differences in disease profiles and optimization of treatment regimens.
authors.affiliation: 1 Department of Public Health, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: Majda
authors.initials: M
authors.lastname: Lamkaddem
authors.forename: Petra
authors.initials: P
authors.lastname: Jellema
authors.forename: Signe Smith
authors.initials: SS
authors.lastname: Nielsen
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D008962:Models, Theoretical; D011787:Quality of Health Care / Q000706:statistics & numerical data