Ethnic minorities: disease incidence

Bhopal and colleagues have reported data on coronary heart disease (CHD) incidence and survival by ethnic group in Scotland as part of a project that linked Census data with hospital discharge data. Fuller details are available in the project report, Ethnicity and health in Scotland: can we fill the information gap?(468Kb) and in the paper by Bhopal et al (2011). Compared to the corresponding non-South Asian groups, incidence of myocardial infarction was higher among South Asian men and among South Asian women. Survival after MI was unexpectedly better among South Asians (Fischbacher 2007, see Key references). The finding of better South Asian survival after MI has recently been extended by Zaman et al (2013) to survival after CHD more generally, suggesting provision of healthcare to those with this disease is not inequitable, and therefore public health policy should concentrate on reducing incidence.

Heart failure was shown in a further study Bhopal et al (2012) from the linkage project to be lower than for White Scottish people in other white British men (RR 0.86), in Chinese men, (RR 0.54) and higher in Pakistani men (RR 1.35). Patterns in women were similar. The risk was attenuated by adjusting for educational level  (a key indicator of socio-economic class) in White Other British men and women. This adjustment made little difference to Pakistani men and women and augmented risk in Indian men and women. Other papers on CHD from this linkage study include Bhopal et al 2012 on Ethnic variations in chest pain and angina  and Bhopal et al 2013 on MI incidence and survival.

There is, from an English study, evidence of higher prevalence of type 2 diabetes in South Asians (Khunti et al 2013). The Prevention of type 2 Diabetes and Obesity in South Asians (PODOSA) trial has tested targeted prevention of diabetes and obesity for South Asians in Scotland. Results showed the intervention group experienced modest weight loss in the medium term (Bhopal et al 2014).

Analysis by Knox et al (2016) revealed that rate ratios for admissions for each ethnic group relative to the White Scottish group were lower among White Polish and Chinese groups, with higher rates in some Asian groups, White British and White Other.  Higher rates of CHD were seen among Pakistani and Bangladeshi groups, and lower rates among the Chinese population.