Ethnicity Code Research Articles

Morehouse is Home to New Center for Mental Health Policy and Research

Back to table of contents Previous article Next article Professional NewsFull AccessMorehouse is Home to New Center for Mental Health Policy and ResearchAaron LevinAaron LevinSearch for more papers by this authorPublished Online:27 Feb 2015https://doi.org/10.1176/appi.pn.2015.3a21AbstractA focus on mental health equity will characterize a new center for policy and research at Atlanta’s Morehouse School of Medicine.Former U.S. Rep. Patrick Kennedy and former U.S. Surgeon General David Satcher, M.D., last month announced the formation of the Kennedy Center for Mental Health Policy and Research at the Morehouse School of Medicine in Atlanta. The center will be part of the Satcher Health Leadership Institute and will collaborate with the Kennedy Forum, a think tank founded by Kennedy and dedicated to furthering research into neuroscience and mental health.Poll results show that most Americans are ready for major changes in the U.S. mental health system, said former U.S. Rep. Patrick Kennedy (D-Mass.) and former U.S. Surgeon General David Satcher, M.D., in Washington, D.C., as they announced formation of the Kennedy Center for Mental Health Policy and Research at the Morehouse School of Medicine in Atlanta.David Hathcox“The center will increase the visibility of mental health policy issues and solutions among the public, policymakers, and the community,” said Morehouse President and Dean Valerie Montgomery Rice, M.D., at a press conference in Washington, D.C. “It will address not just health disparities but ways of achieving health equity by discovering and promoting best practices in the treatment of mental illness and addiction.”“Both Patrick Kennedy and David Satcher are extraordinary leaders, and we look forward to continuing to work closely with them,” said APA President Paul Summergrad, M.D., who attended the event.Besides urging more research into neuroscience, Kennedy emphasized the core need to fully implement and enforce mental health parity to ensure that patients are getting the care to which they are entitled under the law.“The promise is there, but the practice is not,” he said. “We need full disclosure and transparency by insurance companies to be able to compare mental health and physical health benefits.”Kennedy also reiterated the treatment needs of veterans, most of whom do not go to Veterans Health Administration facilities for mental health care.“Veterans are covered by their employers’ insurance, so parity is important to them,” he said.Yet another way to overcome the artificial division between physical and mental health is to integrate care, a practice now being tested at Atlanta’s Grady Memorial Hospital, said Satcher, whose 1999 report on mental health was a landmark in the field.“We volunteered to take over mental health services in the emergency room and improved the care of patients by reducing waiting times by 80 percent, use of restraints by 70 percent, and costs by 40 percent,” said Satcher. “At Grady, we treat people as whole persons and respond to their needs, whatever they may be.”While Grady serves an inner-city population in Atlanta, the vision of “community” at the new Kennedy Center will be much more expansive, said Rice. “Our community will not have borders and won’t be defined by race, ethnicity, or ZIP code.”The announcement came in the context of a national public-opinion survey of 800 registered voters commissioned by the Kennedy Forum. The survey reported that 66 percent of Americans believe that mental health conditions are a “very serious” problem in the United States. About 71 percent also said they would support “radical” or “significant” changes to the mental health system, an idea that received bipartisan support: 64 percent of Republicans and 76 percent of Democrats agreed. ■More information on the Kennedy Center for Mental Health Policy and Research at the Morehouse School of Medicine can be accessed here. ISSUES NewArchived

Influence of Demographics on Patients' Receipt of Endodontic Therapy or Implant Placement

IntroductionWith the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. MethodsThe study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. ResultsPatient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. ConclusionsDemographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.

PTH-091 Testing For Hepatitis C In High Risk Immigrants – Findings From A Single Practice With A Large Immigrant Population

IntroductionChronic Hepatitis C virus (HCV) is a major cause of liver cirrhosis with a worldwide prevalence of 3%. The UK prevalence is between 0.4–1.0% however pockets of higher prevalence will...

PWE-158 Screening Immigrants Originating From High Prevalence Areas For Hepatitis B Using Primary Care Databases – Experience From A Single Gp Practice With A Large Migrant Population

IntroductionChronic Hepatitis B (HBV), a major cause of liver disease, is underdiagnosed in the UK with pockets of high prevalence in areas with large immigrant populations. Identifying individuals through a...

INTERPRETATION OF THE IMAGE OF LATGALE IN THE CULTURE DISCOURSE

INTERPRETATION OF THE IMAGE OF LATGALE IN THE CULTURE DISCOURSE

Ethnic group variations in alcohol-related hospital admissions in England: does place matter? A cross-sectional study

BackgroundAlcohol is a major cause of disability and mortality in England. This health burden is known to differ both between ethnic groups and geographically. Little is known about the distribution of alcohol-related hospital admissions between ethnic groups living in different parts of the country. Ethnicity data coding has been near complete (>90% of admissions) in English hospital data since 2009–10. This study exploits this to examine variations in alcohol-related hospital admissions between ethnic groups in England and whether these vary by geographical location. MethodsData for this study come from Hospital Episode Statistics, an administrative database that contains data for all people admitted to a NHS hospital in England, for 2010–11. Alcohol-related diagnoses were classified according to the International Classification of Diseases and were in the three broad categories of mental and behavioural disorders due to use of alcohol, alcoholic liver disease, and admissions due to the toxic effect of alcohol. Geographical variations were examined by dividing England into the four regions of London, the south, the north, and the midlands. Ethnic categories were based on the Office for National Statistics classification. Differences between ethnic groups were examined with age-standardised and sex-standardised rates across the three major reasons for an alcohol-related admission, with denominator data from the Office for National Statistics mid-2010 population estimates. Rates were calculated separately for admissions in which the alcohol-related disorder was coded as a primary diagnosis or as a comorbidity. Rates were examined separately across the four different areas of England to ascertain variations in admission rates for people in the same ethnic groups living in different areas. 95% CIs were calculated on the basis of the Poisson distribution to assess whether rates differed. FindingsIn 2010–11, there were 264 870 alcohol-related admissions. Of these, 61 511 (23%) had an alcohol-related disorder as the primary diagnosis and 203 359 (77%) as a comorbidity. Diagnoses associated with behavioural and mental health made up 183 732 (69%), alcoholic liver disease accounted for 55 059 (21%), and the toxic effects of alcohol 26 079 (10%) of these admissions. For alcohol-related primary diagnoses, regional admission rates varied widely for people of the same ethnic origin. White British people had higher admission rates in the north of England than in the south (178 per 100 000 population, 95% CI 177–179 vs 70, 69–71). London had the highest admission rates for white Irish, Caribbean, African, and Indian people (eg, Indian people had an admission rate of 99 per 100 000 [95% CI 94–103] in London compared with 48 [44–53] in the north, and white Irish people had an admission rate of 306 per 100 000 [293–320] in London compared with 186 [173–199] in the north of England). Similar patterns were noted when an alcohol-related diagnosis was coded as a comorbidity. InterpretationEthnic group variation in alcohol-related admission rates differ substantially with geographical location in England. There are, however, some limitations of this study: the available data do not allow us to examine aspects such as religious association, and some patients might have had their ethnic origin incorrectly coded. However, ethnicity coding is now regarded as accurate in most cases. Some of the differences might be caused by variations in socioeconomic status, which was not examined by this study. Interventions to address the growing burden of alcohol misuse may need to be tailored to take the heterogeneity of associated morbidity into account. Finally, any population-level interventions (such as a minimum unit price) should be assessed for their effect on these ethnic group inequalities. FundingNone.

Entrepreneurs from low-skilled immigrant groups in knowledge-intensive industries: company characteristics, survival and innovative performance

This paper analyzes how companies of immigrant entrepreneurs in knowledge-intensive industries differ from companies of native entrepreneurs with respect to start-up characteristics, company survival and innovative performance. I focus on immigrants from the “recruitment countries” of south and southeast Europe, who arrived in Germany mainly in the 1970s to fill labor shortages. They are the largest immigrant group in Germany and can be reliably identified via ethnic name coding. Companies owned exclusively by immigrants tend to be smaller and have higher exit rates. After controlling for size and other company characteristics, I find no differences in patenting activity compared to companies owned exclusively by natives.

Accuracy of routinely recorded ethnic group information compared with self-reported ethnicity: evidence from the English Cancer Patient Experience survey

ObjectiveTo describe the accuracy of ethnicity coding in contemporary National Health Service (NHS) hospital records compared with the ‘gold standard’ of self-reported ethnicity.DesignSecondary analysis of data from a cross-sectional survey...

Managing hypertension in general practice: a cross-sectional study of treatment and ethnicity

NICE guidelines are the accepted standard for determining the management of hypertension in UK primary care. To explore adherence and non-adherence to NICE hypertension guidelines, the extent to which this influences blood pressure control, and the role of ethnicity. A cross-sectional study was conducted based on primary care data from Lambeth DataNet, a database of primary care records in one inner-city London borough. NICE guidelines were used to determine adherence to recommended treatment options for four groups of patients with hypertension: aged <55 years on monotherapy; aged ≥55 years on monotherapy; any age on dual therapy; any age and with comorbid diabetes. Blood pressure control was determined for each treatment category and ethnic group. The study controlled for age, sex, social deprivation, and clustering within general practices. A total of 32 183 patients were identified with a current diagnosis of hypertension. Ethnic coding was available for 28 320 (88.0%). Overall, 13 546 patients with ethnicity coding could be allocated to one of the four clinical categories of hypertension; 44% of these patients received non-guideline-adherent treatment; ethnicity was not a significant determinant. Mean arterial pressure did not differ significantly between those receiving 'correct' or 'incorrect' hypotensive therapy. Evidence-based guidelines for the management of hypertension were not followed in a relatively large proportion of patients included in this study. Nevertheless, no evidence was found that failure to follow treatment recommendations resulted in poorer blood pressure control. Further work is needed to determine the reasons for non-implementation of guideline recommendations in primary care.

Incidence of oral cancer among South Asians and those of other ethnic groups by sex in West Yorkshire and England, 2001–2006

In 2008 there were 11682 cases of oral cancer in the United Kingdom; this is 16.41/100000 population, and 3.7% of all cancers. Ethnic coding of these data is poor, and so databases were combined to report rates for the incidence of oral cancer in South Asians compared with those among other ethnic groups in West Yorkshire, 2001–2006. A total of 2157 patients with oral cancer were identified in West Yorkshire, 138 of whom were South Asian (6.4%). We analysed them by ethnicity, sex, area in which they lived, and site of cancer. Oral cancer was significantly more common among South Asian women than those from other ethnic groups in England and West Yorkshire, and in England alone it was significantly more common in men of other ethnic groups than those from South Asia. Patients from South Asia were at higher risk of being diagnosed with oral cancer than those of other ethnic groups within West Yorkshire, when data were adjusted for age at diagnosis and sex. In England and in West Yorkshire there was a significantly higher rate of oral cancer among Southern Asian women than among those of other ethnic groups, and men in other ethnic groups had a higher incidence than those from South Asia (England only). The excess of oral cancers gives further weight to the association between smokeless tobacco, smoking, alcohol, and dietary intake by ethnic group. This information is particularly pertinent in areas such as West Yorkshire where there are large groups of Asian people.

O3-2.1 Linkage of data in the study of ethnic inequalities and inequities in health outcomes in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS)

<h3>Background</h3> There are striking ethnic variations in health status, outcomes, and health service utilisation. Quantifying and understanding this variation is essential to identify the health needs of ethnically diverse populations and assess the extent to which healthcare is equitable. Incomplete ethnic coding in routine data collection in Scotland undermines these efforts. <h3>Methods</h3> We examined ethnic variations in cardiovascular, cancer, maternal and child, and mental health using data linkage methods to bring together data on self-defined ethnicity and health outcomes. Personal identifiers available in both data sets were used to link the encrypted unique record identifiers (census number and Community Health Index number) using exact and probability matching to create a look-up file containing only corresponding encrypted record identifiers. These methods ensured that no personal information was shared between participating organisations. The resulting anonymised database included information on around 4.6 million people with 7 years9 follow-up data. <h3>Results</h3> Important ethnic differences in all health areas were observed. The White Scottish population had higher cardiovascular risks than Other White British, but Pakistani populations had the highest risks and Chinese the lowest. Breast cancer screening non-attendance was substantially lower in Pakistani women than White Scottish. White Scottish populations had higher hospital admission rates for mental health problems than most other groups, with the exception of African / Black women, and the Mixed groups. <h3>Conclusions</h3> These findings contribute substantially to developing ethnicity and health research internationally and provide data that NHS Scotland can use to highlight ethnic inequalities and inform action to address them.

Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality

ObjectiveTo assess measures of Medicaid and Children's Health Insurance Program (CHIP) coverage duration for potential inclusion in a core set of children's health care quality measures as called for by the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. MethodsWe reviewed published and unpublished reports and spoke to researchers, analysts, and program officials at the federal level and in selected states. Measures available in administrative data were assessed with regard to the feasibility of implementation and their validity in terms of their association with child health outcomes and state policy choices. ResultsAlthough many measures are feasible to construct using existing administrative data, prospective measures of duration that examine a cohort of new enrollees were found to be the most valid measures based on research linking their outcomes to program policies and their consistent interpretation across states with similar enrollment and renewal structures. However, the inability of some states to link together data from their Medicaid and CHIP enrollment files affects the interpretation of these and other measures across states. ConclusionsProspective and retrospective measures of duration were recommended for inclusion in the core set of quality measures. Although the prospective and retrospective measures were ranked high in terms of validity and importance by the Subcommittee on Quality Measures for Children's Health Care in Medicaid and CHIP, concerns were raised about feasibility given that no state currently uses these measures to monitor program performance. Additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment, particularly in the areas of linking Medicaid and CHIP data files, improving reason for disenrollment codes, and improving race and ethnicity coding. Monitoring how well states are doing at enrolling and retaining children in Medicaid and CHIP is a critical component to assessing overall program performance and quality and for interpreting many of the other proposed quality measures.

Prevalence of Adenomas and Colon Cancer in People of Asian Origin in the United States Appears to Be at Least Similar to Those of Non Asians Undergoing Screening

Introduction: Colorectal cancer is the second leading cause of cancer deaths in the United States. Cancer screening rates appear to vary based on race and ethnicity. Data on incidence of colorectal neoplasia in Asian Americans are not clear. AIM: To assess the prevalence of adenomas and colon cancer in Asian Americans undergoing screening at a large urban referral practice and compare them to non Asian Americans undergoing screening colonoscopy. Material and Methods: A retrospective analysis of Asian subjects undergoing a screening colonoscopy between January 2005 and June 2010 at a large urban referral practice was done. Ethnic origin was ascertained by use of NIH ethnicity codes. Data were abstracted using standardized abstraction sheets and included: age, reason for exam, location of the lesion, pathology of the lesion. The control group was comprised of 200 consecutive nonAsian subjects undergoing screening colonoscopy from January 2010. Those with prior history colon cancer or those undergoing colonoscopy for symptom evaluation were excluded. Results: A total of 144 subjects met the inclusion criteria in the Asian group. The frequency data were analyzed using Chi-square test while continuous data were analyzed by analysis of variance. The median age of the Asian group (63) at screening was higher than controls (53). The severity and grade of polypoid lesion was higher as the age increased in Asian subjects only. Further the incidence of all lesions was higher in the Asians as compared to the non-Asians (p=< 0.001). There was a trend for advanced adenoma to be more frequent in Asians (percent vs. percent), although the difference did not reach statistical significant (p=0.092) There was no significant difference in the location of lesions in the two groups (p= 0.732 in low-risk adenomas, p= 0.348 in advanced adenomas). We analyzed a subset of the population below 60 years of age (88 Asians; 200 non-Asians). The median age in the groups was the same (53 years). The incidence of all lesions was noted to be higher in the Asian group (p= 0.031), with subset analysis revealing higher incidence of low-risk lesions (p=0.025) but no statistical difference in advanced adenomas (p= 0.741). Conclusion: There are limited data about colon cancer screening in Asian-Americans. Our study highlights that Asian-Americans had screening done at a later age as compared to the general population. The incidence of low-risk lesions was higher in the study group even when the median age was same in both groups. The incidence of advanced lesions in the Asian population is at least similar to that in the non-Asian population. Asian Americans should adhere to the current guidelines and undergo screening at the age of 50. Limitations: Small sample size, lack of data on duration of residence, dietary habits.

Haydn's Jews (review)

Reviewed by: Haydn's Jews Jonathan Sturm Haydn's Jews, by Caryl Clarke. Cambridge: Cambridge University Press, 2010. 244 pp. $99.00. Prior to the twentieth century, the intersection of Jews and classical music brings to mind Wagner (for his antisemitism), the Mendelssohn family, Mahler, and perhaps Halevy's early Grand Opera La Juive. Dr. Caryl Clarke (whose prior publication has established her a place in Haydn studies) has recently published a new book that takes this intersection back a century, maintaining there was a persistent perception in Haydn's day that Jewishness was a designation of "Otherness." Cultural exoticism—think alla Turca—in [End Page 166] Haydn's time included the resident Other (the Jew) as well as the non-resident Other (peoples from Turkey and farther East). While her book's title suggests a focused topic relating the resident Other's stage portrayal and reception, she weaves a multitude of tangents into her research and writing. At times these are intriguing; at times they seem self-indulgent, straining the reader's stamina to remember her main topic. The Introduction, an important component of this book, sets the stage and provides a relevant overview. This said, I recommend reading the Introduction and concluding Apologia as a unit. The reader who embarks upon the central chapters having read her opening questions and her conclusions together will likely fare better in the detail of her supporting arguments. In the Introduction, Dr. Clark raises some intriguing questions and contends that Haydn was most likely familiar "with the lexicon of Jewish theatrical representation and that he exploited the comic potential of this well-known stage stereotype in two works dating from the 1750s and 1760s," referring to his (now lost) apprentice-era opera Der krumme Teufel, and his early Esterháza opera Lo speziale. Her desire "to uncover possible dialogues and interconnectivities within and between Gentile and Jewish communities," while acknowledging that many of her arguments "rest primarily on circumstantial evidence," leaves us excited to discover that ethnic conflict and stereotype—now accepted as integral to certain music in the nineteenth century—may be proven or disproven to have been an issue a century earlier. Clark builds her case for the intersection of Jew and (Catholic) Austrian at multiple levels, beginning in Chapter One with cultural context, or the ways Jews were represented on stage prior to and during Haydn's early life. What eventually comes to light is that music most likely made the stage stereotype of the Jew—represented sometimes as Fool (Bernardon), sometimes as syphilitic, limping devil—more intense by accentuating the visual and vocal codes already present in the plays of the day. Chapter Two initiates a detailed discussion of the Jewish ghetto in Eisenstadt, postulating that Haydn may well have acquired considerable familiarity with its space and population as he walked to work and to the apothecary for medicines to treat his chronic gastritis. Clark then discusses his Missa brevis St. Joannis de Deo, composed particularly for the Barmherzige Brüder, who ran a hospital and almshouse on the periphery of Eisenstadt. Catholic church history intersects Jewish locale, and Clark postulates that, in a Missa brevis, the telescoping of text (singing multiple lines of the Creed polyphonically at once) and omission of certain liturgical lines of the full Mass (most notably the lines stating Jesus is the Son of God) may point to these Masses being used as "conversion Masses" for Jews [End Page 167] in attendance who were not quite "ready" for the full Christian doctrine. Issues of speculation arise here, all of which may be moot, however, since the Mass is not an operatic stage work, and thus is really not on point. A discussion of early operas at the newly built Esterháza in the 1760s sets the context for a discussion of Haydn's opera Lo Speziale (The Apothecary) in Chapter Three, in which the main focus is upon the elements of ethnic coding found in both libretto and score that make a case for the lead character, Sempronio, being a pejorative caricature of the local Jewish pharmacist. This is the crux of her book, and she marshals a variety of points to support...

Entrepreneurs from Low-Skilled Immigrant Groups in Knowledge-Intensive Industries - Company Characteristics, Survival and Innovative Performance

This paper analyzes how companies of immigrant entrepreneurs in knowledge-intensive industries differ from companies of native entrepreneurs with respect to start-up characteristics, firm survival and innovative performance. I focus on immigrants from the “recruitment countries” of south and southeast Europe, who arrived in Germany mainly in the 1970s to fill labor shortages. They are the largest immigrant group in Germany and can be reliably identified via ethnic name coding. Immigrant entrepreneurs are less than half as likely to found a company in a knowledge-intensive industry as native entrepreneurs. Firms owned exclusively by immigrants tend to be smaller and have higher exit rates. After controlling for resources, I found no differences in patenting activity compared to firms owned exclusively by natives. Firms in mixed immigrant/native ownership have no size disadvantage. In that group, exit rates are higher in services but not in manufacturing, and, again, there are no differences in patenting when resources are taken into account. The lower participation of immigrant entrepreneurs in knowledge-intensive industries can be explained by lower education levels, while smaller firm sizes suggest more limited access to capital.

Classification of Horn of Africa school children: is it appropriate for the educational authorities in England to refer to them as refugees?

Drawing on evidence from a PhD study, this paper raises questions about the appropriateness of English educational authorities to continue to refer to the Horn of Africa children, most of them born in the UK, as refugees. The word refugee, in its broad definition, seemingly masks fundamental differences and may reinforce stereotypical perceptions of immigrant children. Many Horn of Africa people tend to define themselves using their respective national identities. Thus, the paper recommends that when the educational authorities want to categorize children of Horn of Africa origin, they should consider using the Department for Children, Schools and Families’ extended ethnicity codes or preferably refer to them simply as Eritreans, Ethiopians, Somalis and Sudanese.

Out-of-hospital cardiac arrest in South Asian and white populations in London: database evaluation of characteristics and outcome

Objective:To compare out-of-hospital cardiac arrest (OOHCA) characteristics in white and South Asian populations within Greater London.Methods:Data for OOHCAs were extracted from 1 April 2003 to 31 March 2007. Primary study...

The new science of cultural epidemiology to tackle ethnic health inequalities

Bhopal provides an important and timely paper. The census categories for ethnic groups have recently been revised, and there is now explicit emphasis on public health approaches to managing ethnic inequalities in health status and providing effective interventions to reduce inequalities. The shift of policy from addressing inequalities to social inclusion and a broader equalities agenda in which race is one component is also a relevant policy development that this paper challenges. The paper also proposes that the cultural histories and more recent experiences of individuals and groups should not be ignored in understanding inequalities. Bhopal argues that a shared understanding between professionals and public alike is desirable and necessary to reduce inequalities. Achieving such shared understanding on a topic that is often emotionally charged and not value neutral is difficult. The premise of the paper is that a racism-free social environment is a necessary backdrop to making use of routine data. This is unlikely to be achievable, as ever refined forms of individual and structural prejudice and racism have existed in societies far back into human history and are unlikely to disappear. A different approach is that racism and prejudice are part of the human condition and inevitable, and also emerge as inter-group tensions either in the face of scarce resources or simply when relatively isolated groups interact; isolation here may be cultural, linguistic, economic, psychological or geographical. Lack of knowledge and understanding and alienation of the ‘other’ may then be used to justify all sorts of well-intentioned treatment. Not only can social structures generate and sustain inequalities, but science, although it purports to be objective and value neutral, does not have an untarnished history; examples of scientific racism or failures of logic may still emerge. Therefore, it is a professional responsibility to manage such processes, where evident, in order to minimize inequalities. Professionals should also be active to improve the literacy around discrimination and prejudice, and investigate manifestations and mechanisms of inequalities and racism in health care. This debate has to be evidence based and challenge convenient but ineffective policy responses. Therein lies the challenge that evidence takes many forms, and must provide clinical and policy guidelines where the evidence is strong and practical; and the evidence has to relate to real-world situations rather than remaining in the form of complex statistical models with numerous methodological limitations including residual confounding, insufficient power to investigate interactions and poor definition of ethnic groups and factors that may explain ethnic inequalities. The issue of misclassification by ethnic group remains an important problem for researchers. Although there is a move to improve precision of ethnicity categorization, the balance between utility and ethnic misclassification is a major issue for routine data as well as hypotheses-driven research. No matter how many ethnic categories are generated on assumptions of approximating to ever complex ethnic identities, this process is fundamentally imperfect. New categories included in census options for ethnic coding are still ‘ascribed identities’ that are assumed to be meaningful to all in that category. These may never capture an individual’s experienced identity. The notion that we should aspire to minimize risk to those of the lowest risk group is a good one. However, acculturation influences health risks over time and is important for the resident host population as well as the migrant population. The process of classifying people on the basis of ethnicity alone neglects numerous variables, including identity, acculturation, religiosity, integration and acceptance of host values and lifestyle. Cultural identity influences consumption patterns, and can govern forms of social support, gender disadvantage and access to employment. These

Chronic diseases in Europe's migrant and ethnic minorities: challenges, solutions and a vision

The pattern of chronic disease varies hugely internationally, and this is now reflected in Europe's multi-ethnic populations. This is creating challenges for epidemiology, public health and clinical care. Human rights legislation and health policies are mandating equity of service i.e. equal needs being met equally well. Indicators of race and ethnicity demonstrate important variations in health and health care, but the data are sparse, especially in Southern and Eastern Europe, and for some ethnic groups across the continent. Ethnic coding of routine health databases is required. The task will best succeed as a national one, with European level coordination and guidance on concepts. Pending this achievement, data linkage techniques can help fill the information gap. One of many ongoing debates that need resolution across Europe is on the preferred indicator of ethnicity, related terminology and mode of measurement. Original research also needs expansion, especially in relation to cohort studies and trials and boosted samples of ethnic minority groups in large scale European health surveys. Such work may require European legislation of the kind that has been effective in the United States (NIH Revitalisation Act 1993). A dialogue between policy makers, funders, researchers and practitioners is needed urgently as a precursor to engaging the public.

Poster 291: Factors Affecting Nonattendance and Cancellation of Epidural Steroid Injections

Objective: To examine the factors affecting the rates of cancellation and nonattendance of patients scheduled to receive epidural steroid injections. Design: Retrospective chart review. Setting: University hospital. Participants: The records of 1940 subjects scheduled to receive an epidural steroid injection between January 1, 2006 and January 1, 2008 were examined. Main Outcome Measures: Demographic information, including age, sex, ethnicity, marital status, and zip code was collected. Insurance information was examined 4 ways: by primary payer, secondary payer, eligibility for government-sponsored insurance, and by presence/absence of commercial insurance payer.