British Asian Research Articles

Understanding ethnic inequalities in diagnostic intervals of cancer: a cohort study of patients presenting suspected cancer symptoms to general practitioners in England.

UK Asian and black patients experience longer cancer diagnostic intervals - period between initial symptomatic presentation in primary care and cancer diagnosis. To determine whether these differences are due to prolonged primary care intervals (period between first primary care presentation and secondary care referral), referral interval (period between referral and first secondary-care appointment) or secondary care interval (period between the first secondary care appointment and diagnosis). We conducted a cohort study of patients with seven common cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, and ovarian), diagnosed after presenting symptoms in English primary care. Information on symptom presentation and cancer diagnosis was extracted from cancer registry-linked primary care data. Accelerated failure-time models were used to investigate ethnic differences across all four intervals. Across all sites, diagnostic intervals were longer for Asian and black patients compared to white patients. Site-specific analyses showed that, for myeloma, lung, prostate, and colorectal, the secondary care interval was longer in Asian and black patients who also had longer primary care interval in breast and colorectal cancer. There was little evidence of ethnic differences in referral interval. We found evidence of ethnic differences in diagnostic intervals, with prolonged secondary care intervals for four common cancers and prolonged primary care intervals for two. Although these differences are relatively modest, they are unjustified and may indicate shortcomings in healthcare delivery that disproportionately affect ethnic minorities.

Reflections on the Special Issue: Burning of the Qur’an

The following three short texts are the outcome of a roundtable discussion at the European Association for the Study of Religion (EASR) conference held on 19 August 2024 in Gothenburg. The focus of the roundtable was the special issue, Burning of the Qur’an, which was edited by Göran Larsson, Iselin Frydenlund, and Torkel Brekke and published in Temenos, Vol. 60, No. 1 (2024). The special issue contained articles on the development in Sweden, Norway, Denmark, and Finland and a meta reflection on the burning of the Qur’an from a British and South Asian perspective. At the EASR conference the editors invited Assistant Professor Verena Meyer from Leiden University and Professor Jakob Skovgaard-Petersen from the University of Copenhagen to comment on and discuss the special issue. This section of Temenos publishes Meyer’s and Skovgaard-Petersen’s responses, with a short reply from Iselin Frydenlund and Göran Larsson. The discussion focuses on research ethics (‘why study a controversial topic’), legal frameworks, and the lack of ‘Muslim voices’ in the study of controversial topics.

Health, Disability, and Economic Inactivity Following a Diagnosis of a Severe Mental Illness: Cohort Study of Electronic Health Records Linked at the Individual-Level, to Census from England.

The association of social and clinical indicators with employment, disability, and health outcomes among individuals with severe mental illnesses (SMI) remains unclear. Existing evidence primarily comes from smaller cohort studies limited by shorter follow-up and high attrition, or registry-based research, which lacks information on important social determinants. We utilized a novel data linkage consisting of clinical records of individuals diagnosed with schizophrenia-spectrum or bipolar disorders from the South London and Maudsley Mental Health Trust, linked at the individual-level to the 2011 UK Census, a rich source for sociodemographic information. Using logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals to determine associations between socioeconomic and clinical indicators and economic inactivity, self-rated health, and disability outcomes. The sample comprised 8249 people with SMI diagnoses. Economic inactivity (77.3%), disability (68.3%) and poor health (61.1%) were highly prevalent. Longer duration of illness and comorbid substance misuse were associated with economic inactivity, poorer self-rated health, and disability, with associations noted between living alone and all outcomes (aORs and 95% CI: Economic inactivity: 1.72, 1.45-2.03; disability: 1.48, 1.31-1.68; poor health: 1.32, 1.18-1.49). Relative to the White British group, Black African, South Asian, and Other Black groups were more likely to be economically inactive. Black Caribbean and other groups were less likely to report poorer self-rated health or disability. Our findings highlight considerable disability, poorer health, and economic inactivity experienced by people with SMI. Addressing comorbid substance misuse and social isolation could play a role in improving outcomes.

Reproductive timing and social egg freezing within British South Asian communities: a qualitative study

ABSTRACT Background Social egg freezing (SEF) is a technology that enables women to preserve and store healthy, unfertilised eggs for non-medical reasons, for use later on in life. Despite the growing number of women using this technology, very little research has explored the perceptions of SEF among women from ethnically minoritised backgrounds. Method The main aim of this study was to advance understandings of perceptions of reproductive timing within British South Asian communities, and in part, focus on women’s perceptions of assisted reproductive technologies in shaping the timing of motherhood. Data collection took place over two qualitative phases: four focus groups (n = 31) and individual interviews (n = 28) and data were analysed using interpretative thematic analysis. Results The findings in this study demonstrate existence of varied and contrasting perceptions concerning reproductive timing and SEF amongst participants. The analysis developed two overarching themes: (1) Perceptions of SEF as a means of ‘achieving’ motherhood and (2) SEF as challenging normative expectations of reproduction. Conclusion These findings provide novel insights into how perceptions of SEF are mediated by women’s familial, religious and cultural contexts, shaped by perceptions about the ‘right time’ to have children and normative expectations of how women pursue motherhood.

When in Camelot: Space invaders, neurodiversity and popular culture

This autobiographical reflection builds on Nirmal Puwar’s Space Invaders, where she frames women and people not racialised as white as `out of place’ and `out of space’ in white male spaces and places. For me disabled while Black, her work showed we may extend that conversation into how Critical Autism Studies, Disability Studies, and non/fiction publishing of autistic and otherwise disabled authors have been framed as white-only - those not white are seen as add-ons to the frame. Lack of `Black British’ disabled history, further lead me to write disability back into the history of the officially named yet stigmatising `Educationally Subnormal’ Scandal of the 1970s. It is also not difficult to see how `Educationally Subnormal’ [ESN] morphed into ableist term `Special Educational Needs’ [SEN]. The terminology is different but the underlying implications and inequalities remain the same. Going to school in Northants villages for near to the first fifteen years of my life, and playing cricket in those spaces for much longer, Puwar’s work may also point to the experiences of UK Black and Asian people who live and work in towns and the countryside - and in some cases may be able to trace their family history there going back many decades. My in-progress PhD research on Caribbean Northamptonshire Post-1945 takes that further in conversation with media, while I’ve also felt like a `space invader’ to much Black British media centralised on inner-cities - notably London. I found myself in Black characters appearing in rural period dramas, further to shows like Doctor Who and Merlin. From my rural schooling to disability and my questions of popular culture representations, these are all extended metaphors for the possibilities that we might all be space invaders in one context or another - even around people who look like us. This piece is a needed intervention showing there are a million and one ways to be human - just the mainstream is playing catchup, as per usual.

Double Diaspora and Transgenerational Memory in Nikesh Shukla’s The One Who Wrote Destiny

This article offers a focused exploration of Nikesh Shukla's The One Who Wrote Destiny (2018), delving into the challenges and complexities of the 'double diaspora' experienced by British South Asian characters in the UK. Situated at the intersection of literary analysis and sociocultural studies, the study addresses the novel’s thematic core, emphasizing the lasting impact of racism and cultural displacement across multiple generations. Utilizing Jan Assmann's framework of 'communicative memory' and 'cultural memory,' alongside Maya Parmar's exploration of double diaspora, the study investigates the evolution of memory representation, highlighting the transformation from lived, embodied memory to mediated, cultural forms. Central to this research is the examination of double diaspora, as outlined by Parmar, exploring the migration of the Gujarati community from South Asia to East Africa and later to Britain, and the identity struggles arising from these dual displacements. Through this in-depth analysis, the article explores the intricate interplay between memory, generational shifts, and the unique challenges faced by twice-migrant communities. It provides valuable insights into the evolving nature of immigrant experiences, cultural identity, and belonging in the United Kingdom since the turn of the millennium. This analysis contributes to a broader understanding of how transgenerational memory and double diaspora influence cultural adaptation and identity formation within diasporic communities, reflecting wider sociocultural trends in contemporary Britain.

Barriers and Facilitators for Help-Seeking Behaviors in British South Asian Women Who Have Experienced Domestic Violence: A Qualitative Study

The aim of this study is to identify the barriers and facilitators for help-seeking behaviors among British South Asian (BSA) women. A cross-sectional qualitative method was applied, among 15 BSA women who have experienced domestic violence (DV). Five overarching themes emerged: survivors’ lack of recognition and realization of abuse, fear of the negative effects of abuse, informal help-seeking support and barriers, formal help-seeking support and barriers, and advice from survivors for developing help-seeking opportunities. These barriers and facilitators were linked to intersectional socialization, which have influenced the help-seeking behaviors of BSA women. This study can be helpful for researchers, policymakers, and service providers in understanding the complications in terms of help-seeking behaviors and facilitators for BSA women who experience DV and to develop culturally appropriate interventions to inspire effective help-seeking strategies for South Asian women who experience DV.

National reporting on factors associated with health inequalities and infection, antimicrobial resistance and consumption rates in England: 2018–2022

BackgroundThe UKHSA antimicrobial resistance (AMR) health inequalities (HI) workstream was established in 2019 with the UKHSA Health Equity Strategy published in 2023. We aim to highlight changes in national reporting of bloodstream infections (BSI), resistant BSIs and antimicrobial consumption (AMC) by HI factors and to summarise disparities from the 2022/23 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report. MethodsChanges in HI data reporting were reviewed over the 10-years of ESPAUR. BSI and AMR data were obtained from UKHSA's Second-Generation Surveillance System; primary and secondary care prescribing data were obtained from the UKHSA Antibiotic Prescribing Data Warehouse sourced from NHS Business Services Authority and IQVIA, respectively between 2018-2022. Unadjusted binomial regression models were used to examine the difference in AMR burden between the highest and lowest index of multiple deprivation (IMD) quintiles. FindingsIn 2021, reporting of factors associated with HI within the ESPAUR report expanded beyond age and region. Data on resistant BSIs by ethnic group and IMD has been included since 2021–2022. The 2022–23 ESPAUR report showed regional variation, as well as differences by age, ethnicity and IMD for BSIs and AMR, and by age and region for AMC. The highest percentage resistance of BSIs was seen in Asian and British Asian ethnic groups (34·6%; 95% CI 33·2–36·1). Rates of resistant BSIs were 41% higher in the lowest compared to the highest IMD quintile in 2022 (33 vs 23·4 infections per 10 000 population); (p<0·005), an increase of 7% from 2019. While rates of BSI were highest in the Northeast (183·8 per 100 000 population), the burden of resistant infections was highest in London (39·2 per 100 000 population). Antibiotic prescription rates varied by age group with prescribing highest amongst those aged 75-years and over (3·52 items prescribed in GP practices per 1000 inhabitants/day). Between 2018 and 2022 prescribing has consistently been highest in the Northeast and lowest in London. London has much lower levels of primary care prescribing (10·7 DID [defined daily doses per 1000 inhabitants per day]), but the highest levels of secondary care prescribing (4·3 DID) compared to other regions. InterpretationThe 2022–23 ESPAUR report highlights variation in BSI rate, AMR and AMC, by geography, age, ethnicity, and IMD. The dedicated HI outcome within the UK 2024–29 National Action Plan will support the development and evaluation of stewardship and engagement interventions to prevent infections and optimise AMC among populations with factors associated with HI. FundingNone.

Between abolition and opium: civility and force across Asian and Caribbean British imperialisms

ABSTRACT This paper explores the relationship between Britian’s abolition of slavery in its Caribbean colonies in 1838 and its instigation of the First Opium War with China in 1840. In so doing, it works against the occlusion of this relationship in the study of British imperialism despite the centrality of these events to the birth of global systems of free trade and free labour. It draws on the parliamentary debates and correspondence of British Foreign Secretary Lord Palmerston to analyze Britain’s negotiation of anti-slavery efforts with Haiti and its trade of Indian opium with China. It argues that these negotiations position British masculine civility against less-civilized foreign others in ways that legitimate the use of maritime force. This logic of imperial civility produces contradictory effects by demanding an end to the brutality of African enslavement while condoning the devastation of Asian opium addiction enacted in the name of free trade.

Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study.

Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted "think-aloud" interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs.

Influence of Ethnicity and Deprivation on Occurrence of Paget’S Disease in Greater Manchester, UK

There is important variation in the occurrence of Paget’s disease in different regions and populations. There are though few data concerning the occurrence of clinically diagnosed disease in black and ethnic minority groups in the United Kingdom (UK). We undertook an anonymised search using an integrated primary and secondary care-based database in Greater Manchester, covering a population of over 3 million people. We looked also among those with a first positive COVID test, the influence of Paget’s disease on subsequent admission to hospital within 28 days. Within our database, there were 534,571 people aged 60 years and over alive on 1 January 2020. The majority were white (84%) with 4.7% identifying as Asian or Asian British, and 1.27% Black or Black British. There were 931 with clinically diagnosed Paget’s disease. Overall prevalence in the greater Manchester area was 0.174%. Prevalence was higher in men than women (0.195 vs 0.155%). Compared to the prevalence of Paget’s in whites (0.179%) the prevalence was lower among those identifying as Asian or Asian British (0.048%) and higher among those identifying as Black or Black British (0.344%). Prevalence increased with increasing deprivation. Clinically diagnosed Paget’s disease is uncommon affecting 0.174% of men and women aged 60 or more years. Within Greater Manchester, it was more common in those identifying as Black or Black British and less common in those identifying as Asian or Asian British.

Using the Candidacy Framework to understand individual, interpersonal, and system level factors driving inequities in women with breast cancer: a cross-sectional study

BackgroundPersistent inequities in breast cancer outcomes exist. Understanding women’s experiences along the care pathway is the first step to finding solutions to tackle these inequities.MethodsSecondary data analysis of the 2017/2018 English National Cancer Patient Experience Survey (n = 25,408) using logistic regression to explore inequities in care experience by sociodemographic factors (age, ethnicity, socioeconomic position, sexual orientation) across 59 survey questions. We used the Candidacy Framework to interpret and organise our findings.ResultsCompared to older (65–74) and White British women, young (35-44, OR = 0.55 [0.44, 0.69]), Asian (OR = 0.52 [0.41, 0.67]), Black (OR = 0.67 [0.46, 0.97]) and White Other (OR = 0.63 [0.49, 0.81]) women were more likely to rate their overall care experience less positively, respectively. Similar findings were observed along all domains of the cancer pathway. Through a candidacy lens, we identified multilevel factors related to this variation including prolonged help-seeking behaviours (individual), poor patient-provider communication (interpersonal), and variation in access to healthcare professionals and resources (system level).ConclusionMultilevel factors influence inequities in the experience of care along the breast cancer pathway for young women and women from minoritised groups. Interventions are necessary to ensure cancer care systems are responsive to women’s health needs and provide equity of care to all patients.

Genetic architecture of routinely acquired blood tests in a British South Asian cohort

Understanding the genetic basis of routinely-acquired blood tests can provide insights into several aspects of human physiology. We report a genome-wide association study of 42 quantitative blood test traits defined using Electronic Healthcare Records (EHRs) of ~50,000 British Bangladeshi and British Pakistani adults. We demonstrate a causal variant within the PIEZO1 locus which was associated with alterations in red cell traits and glycated haemoglobin. Conditional analysis and within-ancestry fine mapping confirmed that this signal is driven by a missense variant - chr16-88716656-G-TT - which is common in South Asian ancestries (MAF 3.9%) but ultra-rare in other ancestries. Carriers of the T allele had lower mean HbA1c values, lower HbA1c values for a given level of random or fasting glucose, and delayed diagnosis of Type 2 Diabetes Mellitus. Our results shed light on the genetic basis of clinically-relevant traits in an under-represented population, and emphasise the importance of ancestral diversity in genetic studies.

Exploring breed differences in discrimination, reversal learning, and resistance to extinction in the domestic dog (Canis familiaris)

Learning is crucial for shaping domestic dogs’ behaviour through life experiences, yet not all breeds exhibit the same learning aptitude towards a particular task. The current study’s objective was to identify differences in behaviour and learning performance across and within five breed clades and elucidate the underlying factors contributing into these variations. Dogs (n = 111) from five breed clades (UK Rural, Retrievers, Asian Spitz, European Mastiff, and New World) participated in a virtual learning task with their owners. Owners completed validated questionnaires of Impulsivity and Reward Responsiveness. The learning task comprised of reinforcing an arbitrary behaviour (hand-touch) through multiple sessions of Acquisition (reinforcing the hand-touch), Discrimination (reinforcing the hand-touch on one of two hands) and Reversal Learning (reinforcing the hand-touch on the opposite hand), followed by a single session of Extinction (hand-touch not reinforced). Results showed notable differences across the studied breed clades in certain learning and behavioural components. However, the observed disparities may not be entirely attributed to inherent cognitive differences among the breed clades but rather potentially influenced by contextual factors such as the human-dog communication dynamics associated with breeds’ cooperativity. Furthermore, breed clades differed in the contributing factors predicting individual learning performances, which could highlight the potential effect of breeds’ historical function.

British South Asian and Muslim Community's Perceptions and Experiences of Addiction and Traditional Drug and Alcohol Treatment Services.

Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

Anokha emerging: The Asian Underground, new ethnicities, and diversity conservatism

This article tracks the relationship between Britain’s ‘Asian Underground’ music scene and reconfigurations of Britishness in the mid- to late-1990s, through to the more contemporary tightening of border regimes and draconian policies around immigration in the United Kingdom. It examines the role that a small, British-Asian weekly London club night, Anokha, played in the precipitation of an ‘emergent structure of feeling’ that would ultimately shift national conversations about what Britishness signified at the turn of the last millennium. The article places British-Asian club and music aesthetics in a broader terrain of avant-garde cultural production and representational politics that helped to incorporate Britain’s second generation of South Asians inside the national narrative and polity. The article goes on to speculate on the role this proliferation has played in facilitating forms of political closure with respect to migration, race and bordering that have emerged from a generation of conservative British South Asian (and second-generation immigrant) politicians enabled by these forms of incorporation.

Book notes: The Evolution of British Asian Radio in England by Gloria Khamkar

Book notes: <i>The Evolution of British Asian Radio in England</i> by Gloria Khamkar

“Marry somebody who’s here”: negotiating hostile political discourse on arranged marriage

ABSTRACT Arranged marriage is associated in Western political discourse with “forced”, “sham” and transnational. Such discourse holds it to be an anachronistic practice in which parents are portrayed as misguidedly clinging on to “traditional customs” and understood to be premising ethnic and religious cultural reproduction above the needs and happiness of their children. Based on 18 months of ethnographic fieldwork including 44 semi-structured interviews, this paper analyses how an understudied yet implicated “group”, Somali Muslim parents, talk about spouse selection of/for their children. Building on the substantial scholarship on the marital practices of British Asians, this paper provides evidence which contradicts and complicates political assumptions and academic conclusions about the role of religion, “tradition”, and ethnic and cultural reproduction in arranged marriages, and brings into focus and problematizes the ongoing operation of “groupism” in relation to both ethnicity and religion.

Exploring the Impact of Cognitive Dysfunction During Recurrent Depression in a Sample of Mid-to-Older Age British South Asians: A Qualitative Study.

Depression is a major public health issue, increasing the risk of comorbidities. Some people with depression experience cognitive dysfunction, which can persist even after symptomatic recovery. British South Asians are at greater risk of developing depression and are less likely to seek treatment. It is important to understand their experience of subjective cognitive dysfunction in depression and how best to support them. This study explored subjective experience of cognitive dysfunction during recurrent depression, in a sample of 12 British South Asians aged between 45 and 60 years. We conducted semi-structured interviews to explore cognitive dysfunction during recurrent depression. We analysed the data using thematic analysis. Difficulties in attention and concentration resulted in lower quality of social relationships, including not feeling present and social isolation. Learning new information was difficult, thus impacting productivity. Participants found it difficult to engage in enjoyable activities that promoted brain health. The emotional, physical and spiritual impact negatively impacted on quality of life. Cognitive strategies used in therapies could improve brain health and functional recovery in people living with depression. Mental health nurses play a pivotal role in providing culturally appropriate information and strategies for managing cognitive dysfunction in recurrent depression.

‘Going through the motions’; a rich account of the complexity of the anterior cruciate ligament reconstruction pathway, a UK qualitative study

ObjectivesThis study aimed to understand the lived experiences of patients on the anterior cruciate ligament reconstruction (ACLR) pathway up to 3 months before, 3 months after and 1 year after...