Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data.

Munerah Almulhem,Neil Thomas,Tiffany Gooden,Krishnarajah Nirantharakumar,Shahjehan Hanif,Jonathan Hazlehurst,Abd A Tahrani,Rasiah Thayakaran,Wasim Hanif,Md Jamal Uddin

doi:10.1371/journal.pone.0262530

Abstract

BackgroundThe effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan.MethodRetrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively.FindingsControlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988–1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999–1.013, p = 0.082).InterpretationIn this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.

Highlights

The Muslim population represents nearly 1.6 billion people, comprising 23% of the global population in 2010 [1]
This is the first study carried out to determine patterns of antibiotic prescriptions before, during, and after Ramadan for a predominantly Muslim community in the UK. In this large population-based study, we have demonstrated that there was an increase in antibiotic prescribing following Ramadan among people of Pakistani or Bangladeshi origin within the UK; this did not remain significant when corrected for antibiotic prescriptions in the white population
The Ramadan period was not associated with altered prescription patterns among older adults (>60) or among those with diabetes, the two groups with the greatest potential infection risk

Summary

Introduction

The Muslim population represents nearly 1.6 billion people, comprising 23% of the global population in 2010 [1]. It is imperative to ascertain the risk of infection in order to provide effective healthcare and advice to this potentially vulnerable population. This is essential during the COVID-19 pandemic, where minority ethnic groups are at an increased risk for adverse medical complications [3]. Prolonged fasting can lead to dehydration which may increase the risk of infection, in warm weather [7]. Insufficient sleep has been associated with reduced immune responses [11], and extensive physical interaction with others can increase the risk of exposure to an infectious agent. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan.

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