Background: Ethnic disparities in healthcare access and outcomes have been widely reported across different settings. In this scoping review, we aimed to explore whether adults from minority racial and ethnic backgrounds face higher risks of death after presenting with injuries to emergency healthcare services in high-income countries.
Methods: We searched five electronic databases [Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane, Scopus and PsycInfo® (American Psychological Association, Washington, DC, USA)] for peer-reviewed studies published between January 2010 and March 2024. We included studies that compared mortality outcomes by race or ethnicity in emergency healthcare settings such as ambulance services, trauma centres and hospital emergency departments in high-income countries.
Results: Out of the 1873 articles identified, 32 met the inclusion criteria. Of these, 20 reported higher risk of mortality for ethnic minority patients compared to White patients following injury. Most studies were conducted in the USA with limited representation from other high-income countries such as Canada and Israel. This strong emphasis on USA-based research limits how well the findings apply to other countries with different healthcare systems. A major issue identified across the studies was the inconsistency in how race and ethnicity were recorded and reported. This lack of standardisation makes it difficult to compare results across studies and may hide the true extent of disparities.
Future work: To better understand and address ethnic disparities in trauma care, future research should adopt consistent and inclusive ethnicity coding to improve data quality and comparability across studies. Studies should be conducted in a wider range of high-income countries and include pre-hospital settings, where disparities may first appear. This will help build a more globally relevant evidence base. Researchers should also take an intersectional approach, examining how ethnicity combines with other social determinants to influence outcomes. In addition to mortality, future studies using longitudinal and mixed-methods designs should explore long-term recovery and access to rehabilitation to gauge the full impact of these health disparities.
Limitations: The review focused solely on mortality outcomes, limiting insight into broader health outcomes such as long-term recovery, quality of life or patient experiences. It also did not explore how ethnicity interacts with other social factors such as gender, income, disability or immigration status. These gaps obscure the full extent of inequalities in emergency care.
Conclusion: This review adds to the growing evidence that ethnic minority patients in high-income countries could be at a higher risk of injury-related deaths. However, inconsistent ethnicity coding and a USA-centric evidence base limit the generalisability of findings. To create fairer and more effective emergency care systems, future research must improve data quality, broaden its geographic scope and consider the complex social factors that shape health outcomes.
Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.
Keywords: EMERGENCY MEDICINE; HEALTH EQUITY; HEALTH SYSTEM; INJURY RESEARCH; PUBLIC HEALTH; RACIAL AND ETHNIC DISPARITIES.
Differences in how people from various ethnic backgrounds access and use healthcare services have been noted in different medical settings. We conducted a scoping review that looked at differences in death rates among injured adults from different ethnic backgrounds, who sought emergency healthcare services in high-income countries such as Europe and North America. We searched five databases for studies published between January 2010 and March 2024, focusing on peer-reviewed papers that reported mortality by race, ethnicity or both in emergency settings (pre-hospital and/or ambulance settings, trauma centres and hospital emergency departments) in high-income countries. Out of 1873 articles identified, we found 32 relevant peer-reviewed papers. The review revealed that adults from ethnic minority backgrounds had a higher risk of dying from their injuries in 20 of these studies. There was also significant variation in how race and ethnicity were recorded by the authors. Most of the studies were from the United States, with a few from Israel and Canada. More research is needed in other high-income countries to determine if these disparities exist elsewhere.