Ethnic variations in chest pain and angina in men and women: Scottish Ethnicity and Health Linkage Study of 4.65 million people

Abstract

Background: European research on ethnic variations in cardiovascular disease has mostly examined mortality endpoints using country of birth as a proxy for ethnicity. We report on chest pain and angina by ethnic group.

Design and methods: Retrospective cohort linking the Census 2001 for Scotland (providing 14 ethnic group categories) and hospital discharge/community and hospital deaths data. Directly age-standardized rates and rate ratios were calculated. Risk ratios were adjusted for age and then highest educational qualification of the individual using Poisson regression. Ratios were multiplied by 100 and 95% confidence intervals (CI) were calculated. The reference was the White Scottish population (100). In the results below, the 95% CI excludes 100.

Results: There was raised chest pain mortality/hospital discharge risk in Indian men (rate ratio 141.2), Other South Asian women (rate ratio 140.9), and Pakistanis (rate ratio 216.2 in men, 243.0 in women). Rate ratios were lowest in other White British (rate ratio 76.1 in men, 73.7 in women) and Chinese (rate ratio 67.6 in men, 76.7 in women). Adjustment for age and education attenuated, but did not abolish, differences in other White British (risk ratio from 73.5 to 83.5) and Pakistani (risk ratio from 209.0 to 198.2) male populations and increased them in most others, e.g. other South Asian men (from risk ratio of 128.9 to 140.1). Pakistani populations had the highest risk of angina (rate ratio 189.3 in men, 159.7 in women). Other White British (rate ratio 81.4 for men, 78.0 for women), Other White (rate ratio 89.6 men, 85.2 women), and Chinese (rate ratio 60.5 men, 67.4 women) had the lowest risk. Adjustment for education did not greatly alter these patterns.

Conclusions: There were important ethnic variations. The results call for replication elsewhere in Europe and targeted prevention programmes and vigilant diagnosis and management by clinicians.

Keywords

Angina cardiovascular chest pain cohort epidemiology ethnicity inequalities variations

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References

Rafnsson

Bhopal

. Large-scale epidemiological data on cardiovascular diseases and diabetes in migrant and ethnic minority groups in Europe. Eur J Public Health 2009; 19(5): 4844–4891.

Wild

Fischbacher

Brock

Griffiths

Bhopal

. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001–2003. J Public Health (Oxf) 2007; 29(2): 191–198.

Bos

Kunst

Deerenberg

IMK

Garseen

Mackenbach

. Ethnic inequalities in age- and cause-specific mortality in the Netherlands. Int J Epidemiol 2004; 33(5): 1112–1119.

Fischbacher

Bhopal

Povey

Steiner

Chalmers

Mueller

. Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health 2007; 7(1): 142–142.

Beauchamp

Peeters

Tonkin

Turrell

. Best practice for prevention and treatment of cardiovascular disease through an equity lens: a review. Eur J Cardiovasc Prev Rehabil 2010; 17(5): 599–606.

Fischbacher

Bhopal

Unwin

White

Alberti

. The performance of the Rose angina questionnaire in South Asian and European origin populations: a comparative study in Newcastle, UK. Int J Epidemiol 2001; 30(5): 1009–1016.

Teoh

Lalondrelle

Roughton

Grocott-Mason

Dubrey

. Acute coronary syndromes and their presentation in Asian and Caucasian patients in Britain. Heart 2007; 93(2): 183–188.

Zaman

Crook

Junghans

Fitzpatrick

Feder

Timmis

. Ethnic differences in long-term improvement of angina following revascularization or medical management: a comparison between south Asians and white Europeans. J Public Health 2008; 31(1): 168–174.

Chaturvedi

Rai

Ben-Shlomo

. Lay diagnosis and health -care-seeking behaviour for chest pain in south Asians and Europeans. Lancet 1997; 350(9091): 1578–1583.

10.

Ranganathan

Bhopal

. Exclusion and inclusion of nonwhite ethnic minority groups in 72 North American and European cardiovascular cohort studies. PLoS Med 2006; 3(3): e44–e44.

11.

Bhopal

Fischbacher

Povey

Chalmers

Mueller

Steiner

. Cohort profile: Scottish health and ethnicity linkage study of 4.65 million people exploring ethnic variations in disease in Scotland. Int J Epidemiol 2010. (e-publication ahead of print).

12.

Boyd

. Ethnicity and the ethics of data linkage. BMC Public Health 2007; 7(1): 318–318.

13.

Bhopal

Unwin

White

Yallop

Walker

Alberti

. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999; 319(7204): 215–220.

14.

Hemingway

Langenberg

Damant

Frost

Pyorala

Barrett-Connor

. Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation 2008; 117(12): 1526–1536.

15.

Information Services Division. NHS hospital data quality: towards better data from Scottish hospitals. An assessment of SMR01 and associated data 2004–2006: Scotland report, September 2007, Edinburgh: NHS National Services Scotland, 2007.

16.

Kelaher

Paul

Lambert

Ahmad

Smith

. The applicability of measures of socioeconomic position to different ethnic groups within the UK. Int J Equity Health 2009; 8(4): 1–8.

17.

Williams

Wright

Hunt

. Social class and health: The puzzling counter-example of British South Asians. Soc Sci Med 1998; 47(9): 1277–1288.

18.

Davey Smith

Chaturvedi

Harding

Nazroo

Williams

. Ethnic inequalities in health: a review of UK epidemiological evidence. Critical Public Health 2000; 10(4): 377–408.

19.

Jurek

Greenland

Maldonado

Church

. Proper interpretation of non-differential misclassification effects: expectations vs observations. Int J Epidemiol 2005; 34(3): 680–687.

20.

Yusuf

Reddy

Ounpuu

Anand

. Global Burden of Cardiovascular Diseases Part II: Variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001; 104(23): 2855–2864.

21.

Harding

Rosato

Teyhan

. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979–2003: slow declines notable for some groups. Heart 2008; 94(4): 463–470.

22.

Zaman

MJS

Shipley

Stafford

Brunner

Timmis

Marmot

. Incidence and prognosis of angina pectoris in South Asians and Whites: 18 years of follow-up over seven phases in the Whitehall-II prospective cohort study. J Public Health 2011; 33(3): 430–438.

23.

Fischbacher

Steiner

Bhopal

Chalmers

Jamieson

Knowles

. Variations in all cause and cardiovascular mortality by country of birth in Scotland 1997–2003. Scott Med J 2007; 52(4): 5–10.

24.

Nijjar

Wang

Quan

Khan

. Ethnic and sex differences in the incidence of hospitalized acute myocardial infarction: British Columbia, Canada 1995–2002. BMC Cardiovasc Disord 2010; 10(38): 1–7.

25.

Shah

Bhopal

Gadd

Donohoe

. Out-of-hospital cardiac arrest in South Asian and white populations in London: database evaluation of characteristics and outcome. Heart 2010; 96(1): 27–29.

26.

Mathews

Alexander

Rahemtulla

Bhopal

. Impact of a cardiovascular risk control project for South Asians (Khush Dil) on motivation, behaviour, obesity, blood pressure and lipids. J Public Health 2007; 29(4): 388–397.

27.

Bhopal

. Ethnicity, race, and health in multicultural societies; foundations for better epidemiology, public health, and health care, Oxford: Oxford University Press, 2007.

28.

Nazroo

. Ethnicity, class and health, London: Policy Studies Institute, University of Westminster, 2001.

29.

Scottish Executive. Analysis of ethnicity in the 2001 census, Edinburgh: The Scottish Government, 2007.

30.

Lallukka

Manderbacka

Keskimaki

Hemingway

Rahkonen

Lahelma

. Angina pectoris: relation of epidemiological survey to registry data. Eur J Cardiovasc Prev Rehabil 2011; 18(4): 621–626.

31.

Bhopal

Rafnsson

Agyemang

Fagot-Campagna

Giampaoli

Hammar

. Mortality from circulatory diseases by specific country of birth across six European countries: test of concept. Eur J Public Health 2011. (e-publication ahead of print).

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