Ethnic variations in asthma hospital admission, readmission and death : a retrospective, national cohort study of 4.62 million people in Scotland
Abstract
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.
Citation
Sheikh , A , Steiner , M F C , Cezard , G , Bansal , N , Fischbacher , C , Simpson , C R , Douglas , A , Bhopal , R & SHELS researchers 2016 , ' Ethnic variations in asthma hospital admission, readmission and death : a retrospective, national cohort study of 4.62 million people in Scotland ' , BMC Medicine , vol. 14 , 3 . https://doi.org/10.1186/s12916-015-0546-6
Publication
BMC Medicine
Status
Peer reviewed
ISSN
1741-7015Type
Journal article
Rights
© Sheikh et al. 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Description
Funding: Chief Scientist’s Office of the Scottish Government, British Lung Foundation and NHS Health Scotland.Collections
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