Study finds ethnic disparities in health outcomes, costs in SG

Using a dynamic Markov microsimulation model, researchers have found varying disease trajectories and healthcare expenditures by 2050 among adults aged ≥51 years in Singapore.

“Our projections indicate an increasing prevalence of chronic conditions, comorbidities, obesity, and disabilities, with ethnic differences,” the investigators said.

The researchers used data from the Singapore Multi-Ethnic Cohort study, Well-being of the Singapore Elderly survey, and Singapore Longitudinal Aging Study. They adapted the Future Elderly Model to estimate future health conditions and healthcare expenditures for the three main ethnic groups in Singapore: Chinese, Malays, and Indians. Overall, approximately three-quarters (74.3 percent) of the resident population were Chinese, followed by Malays (13.5 percent) and Indians (9 percent). [Nat Aging 2025;5:1358-1369]

Risk factors

By 2050, smoking prevalence is estimated to be 13.1 percent for Malays and 5 percent for both the Chinese and Indian subgroups. This finding aligns with a study showing that the incidence of daily smoking is highest among Malays. [https://isomer-user-content.by.gov.sg/3/4bf349c8-25d6-4eb8-bf02-af769321458f/nphs-2020-survey-report.pdf, accessed October 13, 2025] “While the overall smoking prevalence is projected to decrease, Malays are projected to maintain a persistently higher rate,” the researchers said.

Malays and Indians are more likely to be overweight or obese by 2050 (>50 percent) as opposed to the Chinese (20.7 percent). The researchers noted that these factors establish a concerning association with the development of future chronic diseases.

Chronic disease

Malays and Indians are also estimated to have a higher prevalence of diabetes by 2050, with a steeper trend among the former, the researchers noted. In the Chinese subset, the projected incidence is 11.3 percent.

Similarly, 58 percent of Malays and Indians are projected to have hypertension, while only a third of Chinese individuals are estimated to be hypertensive by 2050.

The researchers partly attributed the high incidences of diabetes and hypertension in older Malay and Indian adults to the increasing obesity rates. Moreover, individuals with hypertension often exhibit insulin resistance and have a higher risk of developing diabetes. [Can J Cardiol 2018;34:575-584]

The incidence of heart disease is estimated to be more than twice as high in Indians as in Chinese and Malays, which, according to the researchers, may be partly due to the high prevalence of diabetes and hypertension. Indians with diabetes are also more likely to develop ischaemic heart disease than those without, and myocardial infarction events are greater among Indians than Chinese. [Diabetologia 2006;49:2866-2873; Eur Heart J 2003;24:151-160]

“In addition, more Indians have abdominal obesity, insulin resistance, lower levels of high-density lipoprotein cholesterol, and glucose intolerance than Malay and Chinese people in Singapore,” they said.

Healthcare cost

The projected lifetime healthcare expenditure is highest among Indians (US$93,900), followed by the Chinese (US$75,700) and Malays (US$70,000). Malays were also estimated to have the lowest lifetime primary healthcare costs (US$4,690).

The high lifetime healthcare costs among Indians may be due to the high incidence of chronic diseases in this ethnic group, while Malays had the lowest healthcare cost projection due to their shorter life expectancy. [BMC Public Health 2013;13:1012]

Implications

“[O]ur study demonstrates disparities in trends and costs among different ethnic groups in Singapore and assesses the long-term impacts of interventions in preventing diseases and reducing healthcare costs,” said the researchers. “Our study emphasizes the necessity of planning for the growing disease burden due to population ageing.”

“This study provides a concrete step toward a policy discussion on the ethnic disparities of healthcare financing, presents an assessment of the benefits of long-term lifestyle interventions in Singapore, and contributes valuable insights to ageing research in the broader region,” they added.