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Trillions of microorganisms inhabit the human gut and are regarded as potential key factors for health 1 , 2 . Characteristics such as diet, lifestyle, or genetics can shape the composition of the gut microbiota 2 – 6 and are usually shared by individuals from comparable ethnic origin. So far, most studies assessing how ethnicity relates to the intestinal microbiota compared small groups living at separate geographical locations 7 – 10 . Using fecal 16S ribosomal RNA gene sequencing in 2,084 participants of the Healthy Life in an Urban Setting (HELIUS) study 11 , 12 , we show that individuals living in the same city tend to share similar gut microbiota characteristics with others of their ethnic background. Ethnicity contributed to explain the interindividual dissimilarities in gut microbiota composition, with three main poles primarily characterized by operational taxonomic units (OTUs) classified as Prevotella (Moroccans, Turks, Ghanaians), Bacteroides (African Surinamese, South-Asian Surinamese), and Clostridiales (Dutch). The Dutch exhibited the greatest gut microbiota α-diversity and the South-Asian Surinamese the smallest, with corresponding enrichment or depletion in numerous OTUs. Ethnic differences in α-diversity and interindividual dissimilarities were independent of metabolic health and only partly explained by ethnic-related characteristics including sociodemographic, lifestyle, or diet factors. Hence, the ethnic origin of individuals may be an important factor to consider in microbiome research and its potential future applications in ethnic-diverse societies. Stool microbiota composition correlates with the ethnic backgrounds of people living in the same city, suggesting that geographical location and ethnicity have distinct effects on microbiota.

Background Preliminary evidence from the COVID-19 pandemic shows the presence of health disparities, especially in terms of morbidity and mortality. This study aimed to systematically review the evidence on the association of racial/ethnic and socioeconomic status (SES) with health outcomes and access to healthcare services during the COVID-19 pandemic. Methods We retrieved published evidence from late December 2019 through March 1, 2021. The target population was the population of the countries during the COVID-19 pandemic. The exposures were defined as belonging to racial/ethnic minority groups and/or low SES. The primary outcomes of interest include (1) death from COVID-19, (2) COVID-19 incidence/infection, (3) COVID-19 hospitalization, (4) ICU admission, (5) need for mechanical ventilation, (6) confirmed diagnosis, and (7) access to testing. We systematically synthesized the findings from different studies and provided a narrative explanation of the results. Results After removing the duplicate results and screening for relevant titles and abstracts, 77 studies were selected for full-text review. Finally, 52 studies were included in the review. The majority of the studies were from the United States (37 studies). Despite the significant incongruity among the studies, most of them showed that racial/ethnic minority groups had higher risks of COVID-19 infection and hospitalization, confirmed diagnosis, and death. Additionally, most of the studies cited factors such as low level of education, poverty, poor housing conditions, low household income, speaking in a language other than the national language in a country, and living in overcrowded households as risk factors of COVID-19 incidence/infection, death, and confirmed diagnosis. However, findings in terms of the association of lack of health insurance coverage and unemployment with the outcome measures as well as the association of requiring mechanical ventilation, ICU admission, and access to testing for COVID-19 with race/ethnicity were limited and inconsistent. Conclusion It is evident that racial/ethnic minority groups and those from low SES are more vulnerable to COVID-19; therefore, public health policymakers, practitioners, and clinicians should be aware of these inequalities and strive to narrow the gap by focusing on vulnerable populations. This systematic review also revealed a major incongruity in the definition of the racial/ethnic minority groups and SES among the studies. Systematic review registration PROSPERO CRD42020190105.

Background Experiences of racial discrimination during adolescence can negatively affect lifelong health. Although many ethnic minority adolescents face discrimination in common worldwide, there are few updated review studies that explored how discrimination affected health status and behavior among ethnic minority adolescents. Methods Comprehensive searches of the PubMed, Embase, PsycINFO, and CINAHL were conducted, integrating keywords about adolescent, ethnic groups, discrimination, and health. The search encompassed articles published between January 2016 and March 2021, following Whittemore and Knafl’s integrative literature review method. Quality appraisal was evaluated by the Risk of Bias Assessment Tool. Results After conducting the initial screening of 167 studies, eleven studies met the inclusion criteria and were included in the review. More than 80% of the studies were conducted African-American/Black adolescents in the United States. There were clear associations between group discrimination and mental health problems. Discrimination was also linked to the low overall health, high substance use, high emotional eating, and high behavioral problems, and low ethnic identity. Of the six studies investigating gender differences, two each reported that discrimination was linked to higher substance use in boys and stronger internalizing symptoms in girls. Conclusion This integrative review provides insights into the discrimination experiences of ethnic minority adolescents, with particular implications for mental health, overall health, substance use, and behavioral problems. This review contributes evidence for need of integrative health promotion programs to mitigate racial discrimination against ethnic minority adolescents for health equity.

Background The associations between ethnicity and mental health problems (MHPs) among children and adolescents in the UK have been reported in recent years. However, this is the first review to compare and synthesise these associations and provides a deep understanding of child MHPs across ethnic groups in the UK. Method A comprehensive literature search across seven electronic databases and fifteen websites was conducted. The inclusion criteria focused on studies reporting quantitative associations between ethnicity and MHPs for children and adolescents aged 0–19 residing in the UK. Given the high heterogeneity of the studies, a narrative synthesis was adopted to analyse the associations. Results Twelve studies met the inclusion criteria, involving a total of 48,281 participants. The review reports no significant differences in the risk of experiencing general MHPs among children from Indian, Pakistani, Bangladeshi, and Black Caribbean groups compared to their White British counterparts. However, Black African children were less likely to develop general MHPs, while children in the Pakistani, Bangladeshi, and Black Caribbean groups showed a higher risk for internalising problems. Externalising and conduct problems were similarly likely among children from Pakistani and Bangladeshi backgrounds compared to White children, with Black Caribbean children showing a higher likelihood of these issues. Conclusion The findings suggest that most ethnic minority children and adolescents in the UK have comparable risks of MHPs to their White counterparts, although specific risks vary by ethnicity and MHP types. The results underscore the need for multifaceted analyses considering socioeconomic and cultural factors, beyond simple ethnic categorisations, to inform mental health services that effectively meet the diverse needs of the UK’s child population. This review calls for more detailed and uniform categorisation in future research to understand and address the mental health disparities across different ethnic groups.

We use the UK Household Longitudinal Study and compare pre-COVID-19 pandemic (2017-2019) and during-COVID-19 pandemic data (April 2020) for the same group of individuals to assess and quantify changes in mental health as measured by changes in the GHQ-12 (General Health Questionnaire), among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed before and during the COVID-19 pandemic. In addition, we find that the average increase in mental distress varies by ethnicity and gender. Both women –regardless of their ethnicity– and Black, Asian, and minority ethnic (BAME) men experienced a higher average increase in mental distress than White British men, so that the gender gap in mental health increases only among White British individuals. These ethnic-gender specific changes in mental health persist after controlling for demographic and socioeconomic characteristics. Finally, we find some evidence that, among men, Bangladeshi, Indian and Pakistani individuals have experienced the highest average increase in mental distress with respect to White British men.

Background To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States. Methods Using a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects. Results Among 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive. Conclusion Findings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities.

Women from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds. The aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe. Searches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies. This was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically. The 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want. Lack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.

Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to \"ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view).\" We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as \"medical\" and \"Eurocentric\") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.