Ethnic variations in lower respiratory disease. 2001/1
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Introduction
Ethnic origin is a broad term that may reflect cultural or racial
differences in risk factors for disease or its medical care. It
is not recorded in most sources of routine data but is available
in the fourth national study of morbidity in general practice
(MSGP4). Country of birth, which
may reflect ethnic differences in migrants, is recorded on the
death certificate. This factsheet presents data on GP consultations
for lower respiratory disease by ethnic group and on respiratory
mortality by country of birth.
GP Consultations
In MSGP4 ethnic origin was elicited by interview and rates presented
here are for Whites (98.3% of the population), Blacks [Black African
and Black Caribbean and other Black] (0.6%) and south Asians [Indian,
Pakistani and Bangladeshi] (1.1%). There is considerable variability
within these categorisations but they can indicate broad differences
between groups.
Figure 1:Patients consulting
GPs for lower respiratory diseases by ethnic origin.
Most consultations for lower respiratory disease are for infections
(including pneumonia, influenza and acute bronchitis), asthma
or COPD. This figure shows the patient consultation rates (with
95% confidence intervals) for children and adults in 1991-2. There
is little ethnic variability in the proportion of children consulting
for lower respiratory infections but about 40% more black children
consult for asthma than do white children. Among adults, south
Asians are most likely and blacks least likely to consult for
infections. There is little difference between ethnic groups in
patient consultation rates for asthma in adults. Significantly
more white adults consult for COPD (which occurs mostly in the
over 65s) than do blacks or south Asians.
Figure 2:Patients consulting
GPs for lower respiratory diseases by ethnic origin SMRs.
This shows the age-standardised morbidity ratios for patients
consulting GPs for infections, asthma and COPD by ethnic origin.
About 25% more south Asians consult for infections than the other
groups. More blacks than whites consult for asthma while fewer
south Asians than whites consult for COPD.
There are ethnic differences in the proportions of smokers in
MSGP4. About 30% of whites registered currently smoked compared
to 24% of blacks and 15% of south Asians.
Figure 3:Non-smokers consulting
GPs for asthma and COPD by ethnic origin.
Amongst current non-smokers, ethnic difference in consultations
for obstructive airways disease (COPD and asthma) are small. However,
in this group a significantly higher proportion of south Asians,
than of whites, consult for asthma. There are too few known smokers
in the non-white ethnic groups to deduce real ethnic differences.
Figure 4:Patients consulting
GPs for lower respiratory disease by social class and ethnic origin.
Social class variation is a factor which could partially explain
ethnic differences in GP consultations for respiratory disease.
However, significantly more south Asians than whites consult for
all lower respiratory disease (asthma, COPD or infections), independent
of manual or non-manual class.
Mortality
There are considerable differences in respiratory mortality among
male migrants to England and Wales according to place of birth
and social class. All regions of birth except the Caribbean and
East Africa show double the mortality in the manual classes compared
to the non-manual classes. Adjusting for class East African immigrants,
most of whom are Asian in ethnic origin, suffer 62% higher mortality
than average though immigrants from south Asia have average mortality.
Men born in Scotland and Ireland also have higher SMRs
while Caribbean born men have a lower SMR of 70.
Table 1:Standardised mortality
ratios for respiratory diseases.
Summary
-
There are significant differences between ethnic groups in
GP consultations and deaths for respiratory diseases
-
More black children consult for asthma
-
More south Asians consult for respiratory infections
-
Migrants from East Africa have a high mortality rate
Sources
ONS, Morbidity Statistics from General
Practice: Patient Records, Crown Copyright 1999
ONS, Health Inequalities Decennial
supplement DS No. 15, Crown Copyright 1997
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