Beyond Survival: Understanding Ethnic and Socioeconomic Disparities in Post-Cancer Healthcare Use in England

Background: Cancer survivors represent a growing proportion of the UK population and often experience higher multimorbidity and healthcare needs. However, limited research in the UK has explored ethnic and socioeconomic disparities in healthcare resource use among long-term cancer survivors. Methods: Using linked primary care (Clinical Practice Research Data) and secondary care (Hospital Episode Statistics-Admitted Patient Care) data between 2010 and 2020, this population-based cohort study compared healthcare utilisation among 170,352 cancer survivors and 415,975 matched controls without a cancer diagnosis. Outcomes included primary care consultations and hospital admissions (planned and emergency). Analyses adjusted for age, sex, body mass index, smoking, ethnicity, and the Index of Multiple Deprivation. Negative binomial models were used to estimate incidence rate ratios (IRRs). Results: Cancer survivors averaged 33 more primary-care consultations over ten years than controls, with Pakistani, Indian, and White survivors recording the higher rates. Hospital admissions were consistently higher among survivors across all age groups, peaking in those aged 60-75 years. Planned admissions were highest among Black Caribbean (IRR 1.80 (95% CI 1.73-1.87)), Pakistani (IRR 1.71 (1.63-1.78)), and Bangladeshi (IRR 1.66 (1.53-1.80)) groups. Emergency admissions followed a similar trend, remaining statistically significant only for Pakistani survivors (IRR 1.23 (1.16-1.30)). A strong socioeconomic gradient was observed, with healthcare utilisation increasing as deprivation worsened. Conclusions: Cancer survivors experience substantially greater healthcare use than matched controls, with persistent ethnic and socioeconomic disparities. Strategies to reduce disparities should focus on earlier diagnosis, enhanced long-term care coordination, and culturally informed interventions addressing both cancer survivorship and multimorbidity.