Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians

Bhopal, Raj; Hayes, Louise; White, Martin; Unwin, Nigel; Harland, Jane; Ayis, Salma; Alberti, George

doi:10.1093/pubmed/24.2.95

Cited by 144 publications

(135 citation statements)

References 16 publications

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“…However, individuals within and between ethnic groups differ in their regional distribution of excess weight, hence BMI is confounded by variability in physique and remains a relatively crude index of risk. For example, Asians are now known to have both greater disease risk [24][25][26] and greater body fatness 27 than Europeans for any given BMI level, which has led to proposals for ethnic-specific BMI cutoffs to identify overweight and obesity. 13 In our own analyses, population differences in BMI did not match those in body shape.…”

Section: Discussionmentioning

confidence: 99%

Body shape in American and British adults: between-country and inter-ethnic comparisons

Wells¹,

Cole

Bruner³

et al. 2007

Int J Obes

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Background: Recent studies indicate differences between British and American white adults, and between income and ethnic groups within the United States, in the population distribution of lifestyle diseases. Differential prevalence of obesity has been suggested as a contributing factor; however, the conventional approach to categorizing obesity, body mass index, is confounded by ethnic variability in physique. Objective: To compare indices of shape between white British and American adults, and between white, African and Hispanic American adults. Design: Analysis of two large National Sizing Surveys, using identical study design and three-dimensional (3D) body-scanning instrumentation, on adults aged 17 þ years from the UK (3907M and 4710F white), and from the USA (1744M and 3329F white, 709M and 1106F African and 639M and 839F Hispanic). Outcome measures: Weight, height, body circumferences. Results: In the United States, socio-economic status was associated with increasing height and decreasing waist girth in white and Hispanic, but not African Americans. Compared to white British, white Americans had larger weight and girths, especially waist girth in men. Relative to white Americans, African Americans had smaller relative waist girth, but larger thigh girth, whereas Hispanic Americans had larger relative waist girth. Conclusions: Body shape of white American adults differs from that of their UK counterparts. Within Americans, ethnic differences in body shape closely track reported differences in prevalence of the metabolic syndrome, implicating variability in central abdominal fat as a key contributing factor. 3D photonic scanning offers a novel approach for categorizing risk of the metabolic syndrome and monitoring treatment success.

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Section: Discussionmentioning

confidence: 99%

Body shape in American and British adults: between-country and inter-ethnic comparisons

Wells¹,

Cole

Bruner³

et al. 2007

Int J Obes

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“…This may indicate that medical treatment does not match the increased need of the immigrants and may possibly be explained by the lower socioeconomic (SES) status of immigrants. Results from recent studies have shown that individuals with a low SES have a poorer adherence regarding treatment with beta-blockers and statins after acute myocardial infarction (AMI) [7,8], and some studies have also indicated that ethnic differences in cardiovascular disease are caused by differences in SES [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study

Hempler

Diderichsen

Larsen

et al. 2010

Eur J Clin Pharmacol

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Purpose We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and medical treatment were mediated by socioeconomic status (SES). Methods This register-based follow-up study consisted of individuals >17 years of age, admitted to hospital with AMI between 2001 and 2005 (n=25 443). Danish-born residents were compared with immigrants from Turkey, Pakistan and Yugoslavia. Individuals were identified by civil registration number, and data were obtained through linkage to the national registers of hospitalisations and drug prescriptions. Odds of initiating treatment and hazard ratios (HR) of terminating treatment were estimated. Mediators such as income and employment were included in the models. Results Pakistanis were less likely than Danish-born residents to initiate treatment with beta-blockers after AMI [odds ratio 0.52; 95% confidence interval (CI) 0.34-0.80]. Immigrants from Turkey (HR 1.36; 95% CI 1.07-1.73) and Pakistan (HR 1.59; 95% CI 1.21-2.08) were more likely to terminate treatment with beta-blockers before being recommended to do so. Estimates did not change markedly when income and education were included in the models. Conclusions The results of this study suggest that immigrants from Pakistan and Turkey do not receive adequate medical treatment with beta-blockers after a first AMI compared with Danish-born residents. Mediators such as income and employment may not be sufficient indicators of SES when the effect of patient origin on medical treatment is explored. A lower SES of immigrants, communication problems between doctor and patient and doctors' attitudes towards immigrants may explain ethnic differences in medical treatment after AMI.

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“…In Western societies, low socio-economic status is a risk factor for type 2 diabetes and cardiovascular disease, but the extent to which socio-economic status can explain ethnic differences in the prevalence of these diseases between migrants and the host population is still under discussion [4,5]. In recent years, only a few studies from Europe have focused on the associations between diabetes prevalence, ethnicity, modifiable lifestyle factors and socio-economic status [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, only a few studies from Europe have focused on the associations between diabetes prevalence, ethnicity, modifiable lifestyle factors and socio-economic status [5,6].…”

Section: Introductionmentioning

confidence: 99%

Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention

et al. 2005

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Aims/hypothesis: This study was conducted to investigate the prevalence of diabetes and its association with ethnicity and sex, to identify subgroups at special risk. Methods:We performed a population-based cross-sectional survey of 30-to 67-year-olds in an area of Oslo with low socio-economic status, and collected data using questionnaires, physical examinations and serum analyses for the 2,513 participants (attendance rate 49.3%). Results: In the age group 30-59 years, mean BMI was 28.5 (95% CI: 27.5-29.6) for South Asian women, 26.1 (25.9-26.4) for Western women, 26.7 (26.1-27.4) for South Asian men and 27.2 (26.9-27.5) for Western men. The diabetes prevalence rates were 27.5% (18.1-36.9) for South Asian women, 2.9% (1.9-3.4) for Western women, 14.3% (8.0-20.7) for South Asian men and 5.9% (4.2-7.5) for Western men. The age-adjusted odds ratio (OR) for diabetes for women vs men was 1.9 (0.9-4.1) for South Asians, and 0.4 (0.3-0.6) for the Western population (p<0.001). The ageadjusted OR for diabetes for South Asians vs Westerners was 11.0 (5.8-21.1) for women and 3.0 (1.6-5.4) for men, and after adjustment for WHR the ORs were 7.7 (3.9-15.3) for women and 2.6 (1.4-4.9) for men. After additional adjustments for physical activity, education, body height and fertility for women, the OR was 6.0 (2.3-15.4) for women and 1.9 (0.9-4.0) for men. Conclusions/interpretation: The alarmingly high prevalence of diabetes among South Asian women in Norway needs further investigation, as it has considerable public health implications. Ethnic differences in OR for diabetes persisted after adjustment for age, adiposity, physical activity and education. These differences were still present for women after additional adjustment for body height and fertility.

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Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians

Cited by 144 publications

References 16 publications

Body shape in American and British adults: between-country and inter-ethnic comparisons

Body shape in American and British adults: between-country and inter-ethnic comparisons

Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study

Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention

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