National survey of tuberculosis notifications in England and Wales 1978--9. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

A survey of all tuberculosis notifications in England and Wales for a six-month period showed that 70% of 3732 newly notified, previously untreated patients had respiratory disease only, 23% had non-respiratory disease only, and 7% had both. Fifty-seven per cent of patients were of white and 35% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, the latter group contributing over half the cases of non-respiratory disease. The estimated overall annual notification rate per 100 000 population for 1978--9 was 16.4 for England and 13.5 for Wales. The rates differed considerably between the different ethnic groups in England, the highest rates occurring in the Indian and in the Pakistani and Bangladeshi groups and the lowest in the white group; the differences in the non-respiratory rates were the more striking. Nearly a quarter of patients with respiratory disease had large pulmonary lesions, the proportion being higher for the white group than for the Indian subcontinent group. Over half the patients had positive cultures for tubercle bacilli and over a third had positive smears; both proportions were higher for the white group. This survey has identified many of the problems which tuberculosis presents in England and Wales today. These include the substantial number of patients with sputum-positive disease, the considerable variation in the rates in the different ethnic groups, and the not uncommon occurrence of childhood tuberculosis.     

Ethnic differences in general practitioner consultations.

OBJECTIVE--To examine the levels of general practitioner consultations among the different ethnic groups resident in Britain. DESIGN--The study was based on the British general household surveys of 1983-5 and included 63,966 people aged 0-64. Odds ratios were derived for consultation by ethnic group by using logistic regression analysis adjusting for age and socioeconomic group. SETTING--The results relate to people living in private households in England, Scotland, and Wales. RESULTS--After adjustment for age and socioeconomic class, consultation among adults aged 16-64 was highest among people of Pakistani origin with odds ratios of 2.82 (95% confidence interval 1.86 to 4.28) for men and 1.85 (1.22 to 2.81) for women. Significantly higher consultations were also seen for men of West Indian and Indian origin (odds ratios 1.65 and 1.53 respectively). Ethnic differences were greatest at ages 45-64, when consultation rates in people of Pakistani, Indian, and West Indian origin were much higher in both sexes compared with white people. CONCLUSIONS--The ethnic composition of inner cities is likely to influence the workload and case mix of general practitioners working in these areas.     

Increasing incidence of tuberculosis in England and Wales: a study of the likely causes.

OBJECTIVE--To examine factors responsible for the recent increase in tuberculosis in England and Wales. DESIGN--Study of the incidence of tuberculosis (a) in the 403 local authority districts in England and Wales, ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors. SETTING--(a) England and Wales 1980-92, and (b) the London borough of Hackney 1986-93. MAIN OUTCOME MEASURE--Age and sex adjusted rate of tuberculosis. RESULTS--In England and Wales notifications of tuberculosis increased by 12% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the "low risk" white and West Indian communities the incidence increased by 58% from 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian subcontinent origin the increase was 41% (from 51 cases to 72). Tuberculosis in recently arrived immigrants--refugees (11% of the Hackney population) and Africans (6%)--accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infection, nor to an increase in homeless people. CONCLUSIONS--The national rise in tuberculosis affects only the poorest areas. Within one such area all residents (white and established ethnic minorities) were affected to a similar extent. The evidence indicates a major role for socioeconomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas.     

Marriage and family formation among the white and ethnic minority populations in Britain

Recent UK Labour Force Survey data are used to investigate marriage and family formation among the white and ethnic minority populations in Britain. The different age‐sex structures of the white and ethnic minority groups are analysed and the increasing number of UK‐born or ‘second‐generation’ persons identified. Large differentials are seen between ethnic minority groups in the propensity to cohabit, marry and experience marital disruption. Average spousal age differences and the propensity to form interethnic unions are also distinctive. Resulting patterns of family and household composition are described. In particular, the data suggest important divergences between individuals of Indian and those of Pakistani and Bangladeshi ethnic origin, such that we cannot talk about the demography of the South Asian population as a whole. Comparisons of marriage patterns among ‘first‐’ and ‘second‐generation’ individuals within each ethnic group suggest some assimilation in marriage patterns among the Indian, Pakistani and Bangladeshi populations towards those of the white population.     

Analysis of ethnic differences in perinatal statistics.

The 3996 mothers delivered at Dudley Road Hospital, Birmingham, in 1979 were analysed for their ethnic origins. Social classes IV and V predominated in all groups. A high proportion of Indian mothers fell into the low-risk group based on age and parity but had the highest stillbirth and perinatal mortality rates (15.1 and 27.5/1000 respectively) and infants of low mean birth weight (2986 g). Elderly and multiparous mothers were characteristic of the Pakistani and Bangladeshi groups. Young, primiparous mothers were more common among the West Indians and Europeans, in whom the stillbirth and perinatal mortality rates were low; infants in the European group had a mean birth weight higher than in any other group (3231 g). From these findings ethnic origin of the mother is apparently an important factor in perinatal mortality.     

Primary liver cancer incidence and survival in ethnic groups in England, 2001–2007

Background: The patterns of primary liver cancer incidence and survival are not known for detailed ethnic groups within the UK. Methods: Data on patients resident in England diagnosed with primary liver cancer (ICD-10 C22) between 2001 and 2007 were extracted from the National Cancer Data Repository. Age-standardised incidence rate ratios (IRRs) were calculated for different ethnic groups separately for males and females, using the White ethnic groups as baselines. Overall survival was analysed using Cox regression, adjusting sequentially for age, socioeconomic deprivation and co-morbidity. Results: Ethnicity data were available for 75% (13,139/17,458) of primary liver cancer patients. Compared with the White male baseline, Chinese males had the highest IRR. Black African, Bangladeshi, Pakistani and Indian men also had statistically significant high IRRs. Black Caribbean men had a marginally elevated incidence rate compared with White men. In comparison with White women, Pakistani women had the highest IRR. Bangladeshi, Chinese, Black African and Indian women also had high IRRs. As observed in men, Black Caribbean women had an incidence rate closer to that of White women. Pakistani men and women, Black African women and Chinese men had statistically significantly better survival compared with their White counterparts. Conclusion: The variation found in the incidence of primary liver cancer, could be due to established risk factors such as hepatitis B and C infection being more prevalent among certain ethnic groups. Country of birth, age at migration and length of stay in England are likely to be important factors in this disease, and future research should examine these where possible.     

Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study

ObjectivesTo examine whether self reported health status and use of health services varies in children of different social class and ethnic group.DesignCross sectional study from the 1999 health survey for England.Subjects6648 children and young adults aged 2-20 years.SettingPrivate households in England.ResultsLarge socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuiries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian, Pakistani, Bangladeshi, and Chinese children were less likely to have attended outpatient departments in the preceding three months. No significant differences were found between ethnic groups in the admission of inpatients to hospitals. Acute and chronic illness were the best predictors of children''s use of health services. Social classes did not differ in self reported prevalence of treated infections, major injuries, or minor injuries, and no socioeconomic differences were seen in the use of primary and secondary healthcare services.ConclusionsChildren''s use of health services reflected health status rather than ethnic group or socioeconomic status, implying that equity of access has been partly achieved, although reasons why children from ethnic minority groups are able to access primary care but receive less secondary care need to be investigated.

What is already known on this topic

Children from lower socioeconomic classes and from Indian ethnic subgroups may make more use of general practitioners'' services than other childrenAfro-Caribbean, Indian, Pakistani, and Bangladeshi children are less likely to be referred to outpatient and inpatient services at hospitals than white children

What this study adds

Indian, Pakistani, and Bangladeshi children reported less acute and chronic illness, asthma, and injuries than the general population, whereas Afro-Caribbean children reported moreChildren''s self reported health status and use of health services did not vary by social classIndian and Pakistani children make more use of general practitioners'' services, but Indian, Pakistani, Bangladeshi, and Chinese children are less likely to be referred to outpatient clinicsSelf reported health status rather than socioeconomic status or ethnicity is the best predictor of use of primary and secondary services     

Improving uptake of breast screening in multiethnic populations: a randomised controlled trial using practice reception staff to contact non-attenders.

OBJECTIVES: To determine whether a two hour training programme for general practice reception staff could improve uptake in patients who had failed to attend for breast screening, and whether women from different ethnic groups benefited equally. DESIGN: Controlled trial, randomised by general practice. SETTING: Inner London borough of Newham. SUBJECTS: 2064 women aged 50-64 years who had failed to attend for breast screening. Women came from 26 of 37 eligible practices, 31% were white, 17% were Indian, 10% Pakistani, 14% black, 6% Bangladeshi, 1% Chinese, 4% were from other ethnic groups, and in 16% the ethnic group was not reported. MAIN OUTCOME MEASURES: Attendance for breast screening in relation to ethnic group in women who had not taken up their original invitation. RESULTS: Attendance in the intervention group was significantly better than in the control group (9% v 4%). The response was best in Indian women--it was 19% in the intervention group and 5% in the control group. CONCLUSIONS: This simple, low cost intervention improved breast screening rates modestly. Improvement was greatest in Indian women--probably because many practice staff shared their cultural and linguistic background. This intervention could be effective as part of a multifaceted strategy to improve uptake in areas with low rates.     

Marriage and employment patterns amongst UK-raised Indian,Pakistani, and Bangladeshi women

Discussion over marriage migration in the UK has largely focused on the South Asian groups, identified in survey data as Indian, Pakistani, and Bangladeshi. This paper uses qualitative interviews and national Labour Force Survey data to gain some insights into how UK-born Pakistani and Bangladeshi women view marriage and, in particular, marriage to a partner from their country of origin; the extent to which UK-born Indian, Pakistani, and Bangladeshi women and men marry partners from overseas and the key factors that influence this; and the effect on the level of economic activity for Indian, Pakistani, and Bangladeshi women of marriage to a UK-born/raised partner versus a partner from overseas.     

Cognitive and educational attainment in different ethnic groups.

The educational attainment of over 2000 children aged 7-15 years from six different ethnic groups was assessed. Children of Pakistani and of Bangladeshi origin tended to obtain the lowest mean scores on all tests, often well below those of West Indian children, who tended to perform as well as Indian children and often no worse than the indigenous majority. There were few signs of any reliable trends over age. Differences were more pronounced on tests of reading and vocabulary than on tests of mathematics but, on tests of non-verbal reasoning, most ethnic minorities also obtained low scores. Many of these differences were associated with differences in social and family circumstances.     

Drug resistance in Shigella dysenteriae,S flexneri and S boydii in England and Wales: increasing incidence of resistance to trimethoprim.

A total of 2753 strains of shigella belonging to subgroups A, B, and C that were isolated from patients in England and Wales during the period from 1979 to mid-1983 were studied. Of these, 1690 (61%) were from patients recently returned from abroad or in contact with recent travellers, and 760 (45%) of these affected travellers from the Indian subcontinent. The number of strains resistant to sulphonamides and streptomycin remained at a high level throughout (average 76% and 72% respectively). Resistance to tetracyclines, ampicillin, and chloramphenicol rose, reaching 63%, 51%, and 48%, respectively, in 1982. Strains resistant to trimethoprim were seen in substantial numbers for the first time and increased from 1.3% of all strains in 1979 to 9.9% in 1982 and 16.8% in the first half of 1983. The proportion of patients with recent foreign contact was notably smaller among those with strains resistant to trimethoprim than among those with strains sensitive to trimethoprim. The increase in resistance to trimethoprim might partly result from the use in Britain of compounds containing trimethoprim for the treatment of shigellosis.     

Comparative study of mesiodistal crown diameters and arch dimensions between indigenous British and Pakistani immigrant populations

Over the last two decades, the United Kingdom has seen an increase in the number of immigrants from the Indian subcontinent, mainly Pakistan. The amount of information that is available regarding parameters such as mesiodistal crown diameters and dental arch dimensions is, however, somewhat limited for this population. An investigation was carried out to compare corresponding mesiodistal crown diameters and arch dimensions between samples of the indigenous British population in Leeds (England) and the Pakistani immigrant population living in Rochdale (England). Measurements were taken from dental casts. The results showed that there were no significant differences between the two ethnic groups in corresponding mesiodistal crown diameters or arch dimensions. Data are provided for the Pakistani immigrant population in Britain.     

Age at first birth and disadvantage among ethnic groups in Britain

This article examines the relationship between age at first birth and poverty among ethnic minorities in Britain. It is well known that ethnic minorities, particularly Pakistanis and Bangladeshis, have very high rates of family poverty and early fertility. Because it has been established that early motherhood is associated with a high risk of poverty and other disadvantages, it is tempting to link Pakistani and Bangladeshi poverty with their early family formation patterns. We find, however, that age at first birth had little effect on the poverty experienced by ethnic minorities. While the disadvantaged outcomes of teenage motherhood within the white community appear to be associated with the young women's departure from the dominant social norm, when early fertility is the norm in a minority community, it does not lead to any further disadvantage beyond that experienced by the ethnic group as a whole.     

Ethnic variations of a retinoblastoma susceptibility gene (RB1) polymorphism in eight Asian populations

An A → G single nucleotide polymorphism (SNP) at nucleotide 153,104 in the retinoblastoma susceptibility locus (RB1) at 13q14 was previously reported to be present only in Asians. In this study, we determined the distribution of this SNP in normal Southeast Asian populations (Chinese, Malay, Javanese, Thai, Filipino), in South Asian populations (Bangladeshi, Pakistani Pushtun and Indian) and in Chinese retinoblastoma cases and control subjects. TheRB1 SNP was present in all populations at an overall frequency of ≤0.18. Heterozygosity was higher in the Southeast Asian groups (0.14–0.34) than in the South Asian groups (Bangladeshi and Indian) (0.04–0.06). Significant differences in allele frequencies were found between the two population groups. Interestingly, our Pakistani population comprised of ethnic Pushtuns from northwest Pakistan was significantly different from the neighbouring Bangladeshi and Indian populations. No significant difference was found between Chinese case patients and control subjects. ThisRB1 SNP appears to be an ethnic variant prevalent in Southeast Asian populations and may be useful for studyingRB1 inheritance by pedigree analysis.     

Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study.

OBJECTIVE--To compare mortality in south Asian (Indian, Pakistani, and Bangladeshi) and white patients in the six months after hospital admission for acute myocardial infarction. DESIGN--Observational study. SETTING--District general hospital in east London. PATIENTS--149 south Asian and 313 white patients aged < 65 years admitted to the coronary care unit with acute myocardial infarction from 1 December 1988 to 31 December 1992. MAIN OUTCOME MEASURE--All cause mortality in the first six months after myocardial infarction. RESULTS--The admission rate in the south Asians was estimated to be 2.04 times that in the white patients. Most aspects of treatment were similar in the two groups, except that a higher proportion of the south Asians received thrombolytic drugs (81.2% v 73.8%). After adjustment for age, sex, previous myocardial infarction, and treatment with thrombolysis or aspirin, or both, the south Asians had a poorer survival over the six months from myocardial infarction (hazard ratio 2.02 (95% confidence interval 1.14 to 3.56), P = 0.018), but a substantially higher proportion were diabetic (38% v 11%, P < 0.001), and additional adjustment for diabetes removed much of their excess risk (adjusted hazard ratio 1.26 (0.68 to 2.33), P = 0.47). CONCLUSION--South Asian patients had a higher risk of admission with myocardial infarction and a higher risk of death over the ensuing six months than the white patients. The higher case fatality among the south Asians, largely attributable to diabetes, may contribute to the increased risk of death from coronary heart disease in south Asians living in Britain.     

Tuberculosis among immigrants related to length of residence in England and Wales. Report from the British Thoracic and Tuberculosis Association.

Between 1965 and 1971 the notifications of tuberculosis among lifetime residents of the British Isles declined, but among those born in India, Pakistan, and new Commonwealth countries in Africa tuberculosis notifications increased appreciably. Furthermore, the long-held suspicion that among these immigrants the most recent arrivals in England and Wales have higher rates of tuberculosis than those who have lived here longer was confirmed.     

Patterns of mortality among migrants to England and Wales from the Indian subcontinent.

Causes of deaths in immigrants to England and Wales from the Indian subcontinent were assessed by ethnic subgroup. Observed and expected deaths for 1975-7 were aggregated to calculate proportional mortality ratios. Observed mortality due to infective and parasitic diseases, endocrine diseases (notably diabetes), diseases of the circulatory system (notably ischaemic heart disease and cerebrovascular disease, in males), and diseases of the digestive system (notably cirrhosis of the liver) exceeded expected mortality. Fewer than expected deaths were due to malignant neoplasms (notably lung cancer and chronic bronchitis); proportional mortality ratios for cancer were lower for Hindu groups than for Moslems and were lowest for Punjabis. Mortality due to ischaemic heart disease, high in all groups, was highest in Moslems. Significantly more Punjabi males died from cerebrovascular disease and cirrhosis of the liver. Diabetes was commonest among Gujaratis. The variation seen in the patterns of mortality in the different ethnic groups indicates the need for further epidemiological and health service research centred on these communities.     

Effect of doctors' ethnicity and country of qualification on prescribing patterns in single handed general practices: linkage of information collected by questionnaire and from routine data.

OBJECTIVES: To test whether Asian general practitioners who qualified in the Indian subcontinent prescribe items more often, more expensive items, and fewer generic drugs than their British trained Asian and non-Asian counterparts. DESIGN: Linkage study using data collected by questionnaire and from routine sources. SETTING: General practices in England. SUBJECTS: 155 single handed general practitioners: 42 Asian doctors qualified in United Kingdom (group 1), 58 white doctors qualified in United Kingdom (group 2), and 55 Asian doctors qualified in Indian subcontinent (group 3). MAIN OUTCOME MEASURES: Prescribing cost (cost per ASTRO-PU), prescribing frequency (number of items per ASTRO-PU), and generic prescribing (percentage of drugs prescribed that are generic). RESULTS: Doctors in group 1 were significantly younger than those in the other groups and had a higher proportion of patients who were from deprived wards. There was no difference between the groups in the proportion of female doctors and total list size. After adjustment for confounding factors, there were no significant differences between the three groups for prescribing cost (16.58 (95% confidence interval 6.39 to 26.77) for group 1, 17.31 (6.92 to 27.69) for group 2, 17.80 (7.22 to 28.38) for group 3, P = 0.55); prescribing frequency (6.58 (4.60 to 8.40), 6.45 (4.70 to 8.30), 7.89 (6.16 to 9.64), P = 0.34); and generic prescribing (44.44 (38.95 to 49.93), 47.41 (42.12 to 52.70), 44.04 (38.75 to 49.33), P = 0.37). CONCLUSIONS: Asian doctors qualified from the Indian subcontinent did not differ from British trained doctors in their prescribing practice. This study refutes the common belief that Asian doctors are high volume and high cost prescribers.