Ethnic variations in asthma hospital admission, readmission and death: a retrospective, national cohort study of 4.62 million people in Scotland

被引:45
作者
Sheikh, Aziz [1 ,2 ,3 ,4 ]
Steiner, Markus F. C. [5 ]
Cezard, Genevieve [1 ]
Bansal, Narinder [1 ,6 ]
Fischbacher, Colin [1 ,7 ]
Simpson, Colin R. [1 ,2 ]
Douglas, Anne [1 ]
Bhopal, Raj [1 ]
机构
[1] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Ethn & Hlth Res Grp, Edinburgh Migrat, Edinburgh EH8 9AG, Midlothian, Scotland
[2] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Asthma UK Ctr Appl Res, Edinburgh EH8 9AG, Midlothian, Scotland
[3] Harvard Univ, Sch Med, Div Gen Internal Med, Boston, MA USA
[4] Harvard Univ, Sch Med, Dept Med, Boston, MA USA
[5] Univ Aberdeen, Sch Med, Dept Child Hlth, Aberdeen AB9 2ZD, Scotland
[6] Univ Cambridge, Dept Publ Hlth & Primary Care, Cardiovasc Epidemiol Unit, Cambridge, England
[7] NHS Natl Serv Scotland, Edinburgh, Midlothian, Scotland
来源
BMC MEDICINE | 2016年 / 14卷
关键词
Asthma; Death; Epidemiology; Ethnic variations; Hospital admission; HEALTH-SERVICE USE; SCOTTISH HEALTH; DISEASE; CARE; LINKAGE; PREVALENCE; CHILDREN; SHELS; ISAAC; UK;
D O I
10.1186/s12916-015-0546-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Our previous meta-analysis found that South Asians and Blacks in the UK were at a substantially increased risk of hospital admission from asthma. These estimates were, however, derived from pooling data from a limited number of now dated studies, confined to only three very broad ethnic groups (i.e. Whites, South Asians and Blacks) and failed to take account of possible sex-related differences in outcomes within these ethnic groups. We undertook the first study investigating ethnic variations in asthma outcomes across an entire population. Methods: This retrospective 9-year cohort study linked Scotland's hospitalisation/death records on asthma to the 2001 census (providing ethnic group). We calculated age, country of birth and Scottish Index of Multiple Deprivation adjusted incident rate ratios (IRRs) for hospitalisation or death by sex for the period May 2001-2010. We calculated hazard ratios (HRs) for asthma readmission and subsequent asthma death. Results: We were able to link data on 4.62 million people (91.8 % of the Scottish population), yielding over 38 million patient-years of data, 1,845 asthma deaths, 113,795 first asthma admissions, and 107,710 readmissions (40,075 of which were for asthma). There were substantial ethnic variations in the rate of hospitalisation/death in both males and females. When compared to the reference Scottish White population, the highest age-adjusted rates were in Pakistani males (IRR = 1.59; 95 % CI, 1.30-1.94) and females (IRR = 1.50; 95 % CI, 1.06-2.11) and Indian males (IRR = 1.34; 95 % CI, 1.16-1.54), and the lowest were seen in Chinese males (IRR = 0.62; 95 % CI, 0.41-0.94) and females (IRR = 0.49; 95 % CI, 0.39-0.61). Conclusion: There are very substantial ethnic variations in hospital admission/deaths from asthma in Scotland, with Pakistanis having the worst and Chinese having the best outcomes. Cultural factors, including self-management and health seeking behaviours, and variations in the quality of primary care provision are the most likely explanations for these differences and these now need to be formally investigated.
引用
收藏
页码:1 / 9
页数:9
相关论文
共 26 条
[11]   A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children [J].
Lakhanpaul, Monica ;
Bird, Deborah ;
Manikam, Logan ;
Culley, Lorraine ;
Perkins, Gill ;
Hudson, Nicky ;
Wilson, Joanne ;
Johnson, Mark .
BMC PUBLIC HEALTH, 2014, 14
[12]   Asthma [J].
Martinez, Fernando D. ;
Vercelli, Donata .
LANCET, 2013, 382 (9901) :1360-1372
[13]  
Masoli M., GLOBAL BURDEN ASTHMA
[14]   Culture and health [J].
Napier, A. David ;
Ancarno, Clyde ;
Butler, Beverley ;
Calabrese, Joseph ;
Chater, Angel ;
Chatterjee, Helen ;
Guesnet, Francois ;
Horne, Robert ;
Jacyna, Stephen ;
Jadhav, Sushrut ;
Macdonald, Alison ;
Neuendorf, Ulrike ;
Parkhurst, Aaron ;
Reynolds, Rodney ;
Scambler, Graham ;
Shamdasani, Sonu ;
Smith, Sonia Zafer ;
Stougaard-Nielsen, Jakob ;
Thomson, Linda ;
Tyler, Nick ;
Volkmann, Anna-Maria ;
Walker, Trinley ;
Watson, Jessica ;
Williams, Amanda C. de C. ;
Willott, Chris ;
Wilson, James ;
Woolf, Katherine .
LANCET, 2014, 384 (9954) :1607-1639
[15]   Ethnic variations in incidence of asthma episodes in England & Wales: national study of 502,482 patients in primary care [J].
Netuveli, G ;
Hurwitz, B ;
Sheikh, A .
RESPIRATORY RESEARCH, 2005, 6 (1)
[16]  
Netuveli G, 2005, LANCET, V365, P312, DOI 10.1016/S0140-6736(05)17785-X
[17]   Remigration of migrants with severe disease: myth or reality?-a register-based cohort study [J].
Norredam, Marie ;
Hansen, Oluf Hoejbjerg ;
Petersen, Jorgen Holm ;
Kunst, Anton E. ;
Kristiansen, Maria ;
Krasnik, Allan ;
Agyemang, Charles .
EUROPEAN JOURNAL OF PUBLIC HEALTH, 2015, 25 (01) :84-89
[18]   Comparison of asthma prevalence in the ISAAC and the ECRHS [J].
Pearce, N ;
Sunyer, J ;
Cheng, S ;
Chinn, S ;
Björkstén, B ;
Burr, M ;
Keil, U ;
Anderson, HR ;
Burney, P .
EUROPEAN RESPIRATORY JOURNAL, 2000, 16 (03) :420-426
[19]  
Scottish Government, Scottish Index of Multiple Deprivation
[20]   Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program [J].
Shields, AE ;
Comstock, C ;
Weiss, KB .
PEDIATRICS, 2004, 113 (03) :496-504