Eczema patients from minority ethnic or deprived backgrounds are more likely to have severe, poorly controlled disease, yet they are systematically underserved by both research and healthcare. This project uses three linked studies to uncover why. First, the researcher will analyse a UK-wide database of primary and secondary care records to compare how often these groups receive dermatology referrals, treatments, and hospital care versus more advantaged patients. Second, a cohort study will test whether ethnicity or deprivation increases the risk of serious complications linked to eczema—such as infections, mental health problems, fractures, or death. Third, in-depth interviews with patients and healthcare providers will explore the real-world barriers and facilitators driving these inequities. If successful, the work will produce evidence directly usable by policymakers to revise national eczema guidelines. It could lead to tailored screening for high-risk subgroups and clearer care pathways that help patients navigate treatment. A public involvement panel of people from the affected groups will co-author academic papers and co-develop infographics translated into multiple languages, ensuring findings reach the communities that need them most.
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Background: Atopic eczema is a common, visible and stigmatising disease, associated with increased risks of physical and mental health problems. Atopic eczema is poorly controlled in people who are from minority ethnic or socio-economically deprived groups. These groups are typically underserved by research and healthcare. Aims and objectives: To use a mixed-methods approach to understand the drivers and consequences of health inequities in people with atopic eczema, in order to develop future strategies towards equitable service provision and health outcomes. Objective-1 How do ethnicity or socio-economic status impact patterns of healthcare resource use for people with atopic eczema? Objective-2 Are ethnicity or socio-economic status associated with increased risk of adverse health outcomes in people with atopic eczema? Objective-3 A) What are the experiences of accessing healthcare among minority ethnic or socio-economically deprived people with atopic eczema? B) How do healthcare providers contribute to healthcare disparities among minority ethnic or socio-economically deprived people with atopic eczema? Methods: I will use a de-identified database of primary-care electronic health records representative of the UK population, linked to secondary-care records, called Clinical-Practice-Research-Datalink (CPRD). I will conduct a longitudinal study of children and adults to calculate rates of healthcare resource use for dermatology referrals, atopic eczema treatments, dermatology attendance, GP attendance and inpatient-stays. I will compare these across minority ethnic groups and socio-economic status defined by Index of Multiple Deprivation (IMD). Secondly, I will conduct a cohort study. The following outcomes have been associated with atopic eczema: non-cutaneous infections, cutaneous infections, mental health problems, fractures and deaths. I will use regression analysis to investigate whether being from a minority ethnic or socio-economically deprived group increases the risk of developing adverse health outcomes. Thirdly, in an exploratory sequential design, I will use my quantitative findings to inform a purposive sampling strategy. I will conduct in-depth interviews with people with atopic eczema and healthcare providers to deepen our understanding of barriers and facilitators to health inequities. Timelines for delivery: This is a three-year project starting in September 2024. Completion milestones are: Objective-1 June 2025 Objective-2 April 2026 Integration- July 2026 Objective-3 March 2027 Dissemination: I will provide a one-page report to policy-makers to be incorporated into the atopic eczema national guidelines. My public involvement panel (who are individuals with eczema from minority ethnic and socio-economically deprived groups) will co-author published academic articles. We will co-develop patient-facing infographic dissemination materials for translation into different languages and for sharing with healthcare professionals. This will help people with atopic eczema to navigate their care. Impact: This work will empower underserved populations, catalysing a paradigm shift in how eczema is managed in primary- and secondary-care. I will provide evidence to support policy promoting: Improved access to care by identifying and understanding barriers in existing care pathways. Earlier recognition of subgroups of people at a higher risk of adverse health outcomes through development of tailored screening and interventions. Following on from my doctorate, I will use these results to develop a programme of independent research to influence policy and reduce health inequities.
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