Ethnicity Linkage Study Research Articles

Care planning: improving population health and outcomes for patients with heart failure

British Journal of Cardiac NursingVol. 17, No. 12 British Society for Heart FailureCare planning: improving population health and outcomes for patients with heart failureDelyth RucareanDelyth RucareanCorrespondence to: Delyth Rucarean; E-mail Address: [email protected]Morriston Hospital (Ysbytu Treforus), Swansea Bay University Health Board, Swansea, WalesSearch for more papers by this authorDelyth RucareanPublished Online:3 Jan 2023https://doi.org/10.12968/bjca.2022.0132AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bhopal RS, Bansal N, Fischbacher CM et al.. Ethnic variations in heart failure: Scottish health and ethnicity linkage study (SHELS) Heart. 2012;98;468e473. https://doi.org/10.1136/heartjnl-2011-301191 Crossref, Google ScholarConrad N, Judge A, Tran J et al.. Temporal trends and patters in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018;391(10120):572–580. https://doi.org/10.1015/S0140-6736(17)32520-5 Crossref, Google ScholarFitzsimons D, Doherty LC, Murphy M. Inadequate communication exacerbates the support needs of current and bereaved caregivers in advanced heart failure and impedes shared decision-making. J Cardiovasc Nurs. 2019. https://doi.org/10.1097/JCN.0000000000000516 Crossref, Google ScholarGeriatric Medicine Research. Clinical frailty scale 2007–2009. 2022. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html (accessed 15 December 2022) Google ScholarLawson CA, Zaccardi F, Squire I et al.. 20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study. 2019;4(8):e406–e420. https://doi.org/10.1016/S2468-2667(19)30108-2 Google ScholarLawson CA, Zaccardi F, Squire I et al.. Risk factors for heart failure: 20-year population-based trends by sex, socioeconomic status, and ethnicity. Circulation: Heart Failure. 2020;13(2):e006472. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006472 Crossref, Google ScholarLawson C, Crothers H, Remsing S et al.. Trends in 30-day readmissions following hospitalisation for heart failure by sex, socioeconomic status an ethnicity. 2021;38:101108. https://doi.org/10.1016/j.eclinm.2021.101008 Google ScholarNHS England. The NHS Long Term Plan. 2019. https://tinyurl.com/te7uzzxx (accessed 15 December 2022) Google ScholarNational Institute for Health and Care Excellence. NICE impact: cardiovascular disease management. 2021. https://tinyurl.com/mr4dwjnv (accessed 15 December 2022) Google ScholarWest Midlands Academic Health Science Network. Impulse CVD programme is subject of Heart, British Medical Journal paper. 2022. https://tinyurl.com/39yb252c (accessed 15 December 2022) Google Scholar FiguresReferencesRelatedDetails 2 December 2022Volume 17Issue 12ISSN (online): 2052-2207 Metrics History Published online 3 January 2023 Published in print 2 December 2022 Information© MA Healthcare LimitedPDF download

Revealing the Complex Relationships Between Ethnicity and Health: 29 Outcomes From the Scottish Health and Ethnicity Linkage Study (SHELS) Cohort

Objectives: To present a data visualization approach based on epidemiological principles that can be used to illustrate the complexity of health inequalities by ethnicity. Methods: We provide an example of our technique by presenting results from the Scottish Health and Ethnicity Linkage Study (SHELS) on 29 different health outcomes across ten ethnic groups. SHELS is a census-based retrospective cohort study of the general population of Scotland (4.62 million people) linking ethnicity data to health records. We employed different colors to show health advantage, disadvantage or equivalence; different color shades to represent degree of certainty, combining effect size and precision of estimate; and different font sizes for absolute rates, to highlight more common conditions. We ranked health conditions by age-adjusted rate within each ethnic group to identify differences in burden of disease. Results: Data visualization clearly demonstrates that ethnic differences in health vary substantially depending on outcome, sex and ethnic group. Inequalities were present for every outcome but were not uniformly worse for non-White populations. The patterns are also complex within each ethnic group such as the Pakistani population where strong advantage for some outcomes (e.g. RR=0.52 in men for all-cause mortality) coexists with strong disadvantage for others (e.g. RR=1.80 in women for cardiovascular disease). Despite large differences in relative disease rates, ranking conditions within ethnic groups showed that most ethnic groups have similar disease priorities. Conclusions: Our approach demonstrates the complexity of ethnic differences in health. The use of these simple data visualization techniques can facilitate interpretation of this complexity and avoid misleading generalizations that the health of ethnic minorities is worse or better than majority populations. Using absolute rates of disease and ranking conditions within ethnic groups is also useful as large relative differences in rates of disease between ethnic groups may not always translate into different disease priorities.

Ethnic differences in self‐assessed health in Scotland: The role of socio‐economic status and migrant generation

AbstractThis study investigates ethnic differences in self‐assessed health in Scotland and their determinants, focusing on socio‐economic status and migrant generations. We use the Scottish Health and Ethnicity Linkage Study (SHELS) and apply regression analysis to data for 4.6 million people. The analysis shows that the White British, Other White and Chinese groups reported better health than the White Scottish population, whereas Pakistani and Indian populations had worse health outcomes. For the latter two groups, this contrasts with previous findings of mortality advantage and thus highlights a morbidity–mortality paradox in these South Asian populations. Our findings imply that socio‐economic deprivation, health selection and acculturation explain health inequalities for some ethnic groups, but for other groups, especially those of Pakistani origin, other mechanisms deserve further exploration.

Evidencing the gap between health expectancy and life expectancy for ethnic groups in Scotland.

Background
 Recent evidence has shown that ethnic minorities live longer than the majority population in Scotland. This mortality advantage in ethnic minorities is not unique to Scotland. However, whether morbidity patterns by ethnicity align with mortality patterns by ethnicity is unknown. Thus, this study explores ethnic differences in health expectancies (HE) in Scotland and contrasts HE with life expectancy (LE) findings.
 Methods
 The Scottish Health and Ethnicity Linkage study anonymously links the Scottish Census 2001 for 4.6 million people to mortality records. The Scottish Census 2001 collected two measures of self-assessed health, self-declared ethnicity, age, and sex. Utilising the life tables used to calculate life expectancy by ethnicity and sex in Scotland, the Sullivan method was employed to calculate two measures of health expectancy (healthy life expectancy and disability-free life expectancy) by ethnicity and sex. 95% confidence intervals were calculated to detect significant differences compared to the majority White Scottish population, taken as reference.
 Results
 Longer health expectancies were found in males and females of Other White British, Other White, and Chinese origins as well as in Indian males compared to White Scottish populations. Any Mixed Background and Pakistani populations had the shortest healthy life expectancies. Patterns of health expectancy by ethnicity mostly aligned with patterns of life expectancy by ethnicity with the clear exception of the Pakistani population who showed among the longest life expectancies with the shortest health expectancies. Contrasting HE with LE findings, the number of years in an unhealthy state was greater in females than in males for each ethnic group. In relation to ethnicity, Pakistani and Indian populations had the highest number of years in an unhealthy state in Scotland. Pakistani females showed the strong-est disadvantage in this respect.
 Conclusion
 Pakistani populations had the shortest health expectancies contrasting with the longest life expectancies in Scotland. Future research should aim to understand why such a discrepancy occurs while policy makers ensure that fair and adapt-ed care is provided to offer better quality of life for the most vulnerable.

Ethnic variations in falls and road traffic injuries resulting in hospitalisation or death in Scotland: the Scottish Health and Ethnicity Linkage Study

ObjectivesTo investigate ethnic differences in falls and road traffic injuries (RTIs) in Scotland. Study designA retrospective cohort of 4.62 million people, linking the Scottish Census 2001, with self-reported ethnicity, to hospitalisation and death records for 2001–2013. MethodsWe selected cases with International Classification of Diseases–10 diagnostic codes for falls and RTIs. Using Poisson regression, age-adjusted risk ratios (RRs, multiplied by 100 as percentages) and 95% confidence intervals (CIs) were calculated by sex for 10 ethnic groups with the White Scottish as reference. We further adjusted for country of birth and socio-economic status (SES). ResultsDuring about 49 million person-years, there were 275,995 hospitalisations or deaths from fall-related injuries and 43,875 from RTIs. Compared with the White Scottish, RRs for falls were higher in most White and Mixed groups, e.g., White Irish males (RR: 131; 95% CI: 122–140) and Mixed females (126; 112–143), but lower in Pakistani males (72; 64–81) and females (72; 63–82) and African females (79; 63–99). For RTIs, RRs were higher in other White British males (161; 147–176) and females (156; 138–176) and other White males (119; 104–137) and females (143; 121–169) and lower in Pakistani females (74; 57–98). The ethnic variations differed by road user type, with few cases among non-White motorcyclists and non-White female cyclists. The RRs were minimally altered by adjustment for country of birth or SES. ConclusionWe found important ethnic variations in injuries owing to falls and RTIs, with generally lower risks in non-White groups. Culturally related differences in behaviour offer the most plausible explanation, including variations in alcohol use. The findings do not point to the need for new interventions in Scotland at present. However, as the ethnic mix of each country is unique, other countries could benefit from similar data linkage-based research.

Visualising the complex relationships between ethnic group and health in Scotland: 2001-2013

Abstract Background With growing numbers of migrants worldwide, accurate data are needed to assess the health of migrants and ethnic minorities, highlight inequalities and evaluate relevant policies and actions. To summarise and reveal the complexity of the findings, we developed data visualisation techniques based on epidemiological principles. Methods We used published results from the Scottish Health and Ethnicity Linkage Study (SHELS), a retrospective cohort of 4.62 million people linking census ethnicity data to health service and death records during 2001-2013. In tables mainly using rate ratios, we employed different colours to show health advantage, disadvantage or equivalence; different colour shades to represent degree of certainty, combining effect size and precision of estimate; and different font sizes for absolute rates, to highlight more common conditions. We ranked health conditions by age-adjusted rate within each ethnic group to show differences in burden of disease and disease priorities. Results Using 30 health outcomes for up to 11 ethnic groups, we show that ethnic differences vary greatly depending on outcome, sex and ethnic group. The patterns are complex with some ethnic groups showing strong advantages for some outcomes and strong disadvantages for others. Using absolute rates highlighted differences in common conditions such as myocardial infarction, COPD, and falls. Ranking conditions within ethnic groups showed that most ethnic groups have largely similar disease priorities. Conclusions Our approach helps reveal and interpret the complexity of ethnic health differences. Simplistic generalisations that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Using absolute rates and ranking conditions within ethnic groups are useful as large relative differences in disease rates between ethnic groups may not translate into different disease priorities. Key messages Statements that the health of migrants or ethnic minorities is worse or better than majority populations are often misleading and best avoided. Large relative differences in disease rates between ethnic groups may not translate into different disease priorities.

4.6-W1The Scottish Health and Ethnicity Linkage Study (SHELS): a fertile oasis of information for an increasingly diverse society

4.6-W1The Scottish Health and Ethnicity Linkage Study (SHELS): a fertile oasis of information for an increasingly diverse society

1.1-O5Mortality, ethnicity and country of birth on a national scale 2001-2013: the Scottish Health and Ethnicity Linkage Study

1.1-O5Mortality, ethnicity and country of birth on a national scale 2001-2013: the Scottish Health and Ethnicity Linkage Study

Mortality, ethnicity, and country of birth on a national scale, 2001-2013: A retrospective cohort (Scottish Health and Ethnicity Linkage Study).

BackgroundMigrant and ethnic minority groups are often assumed to have poor health relative to the majority population. Few countries have the capacity to study a key indicator, mortality, by ethnicity and country of birth. We hypothesized at least 10% differences in mortality by ethnic group in Scotland that would not be wholly attenuated by adjustment for socio-economic factors or country of birth.Methods and findingsWe linked the Scottish 2001 Census to mortality data (2001–2013) in 4.62 million people (91% of estimated population), calculating age-adjusted mortality rate ratios (RRs; multiplied by 100 as percentages) with 95% confidence intervals (CIs) for 13 ethnic groups, with the White Scottish group as reference (ethnic group classification follows the Scottish 2001 Census). The Scottish Index of Multiple Deprivation, education status, and household tenure were socio-economic status (SES) confounding variables and born in the UK or Republic of Ireland (UK/RoI) an interacting and confounding variable. Smoking and diabetes data were from a primary care sub-sample (about 53,000 people). Males and females in most minority groups had lower age-adjusted mortality RRs than the White Scottish group. The 95% CIs provided good evidence that the RR was more than 10% lower in the following ethnic groups: Other White British (72.3 [95% CI 64.2, 81.3] in males and 75.2 [68.0, 83.2] in females); Other White (80.8 [72.8, 89.8] in males and 76.2 [68.6, 84.7] in females); Indian (62.6 [51.6, 76.0] in males and 60.7 [50.4, 73.1] in females); Pakistani (66.1 [57.4, 76.2] in males and 73.8 [63.7, 85.5] in females); Bangladeshi males (50.7 [32.5, 79.1]); Caribbean females (57.5 [38.5, 85.9]); and Chinese (52.2 [43.7, 62.5] in males and 65.8 [55.3, 78.2] in females). The differences were diminished but not eliminated after adjusting for UK/RoI birth and SES variables. A mortality advantage was evident in all 12 minority groups for those born abroad, but in only 6/12 male groups and 5/12 female groups of those born in the UK/RoI. In the primary care sub-sample, after adjustment for age, UK/RoI born, SES, smoking, and diabetes, the RR was not lower in Indian males (114.7 [95% CI 78.3, 167.9]) and Pakistani females (103.9 [73.9, 145.9]) than in White Scottish males and females, respectively. The main limitations were the inability to include deaths abroad and the small number of deaths in some ethnic minority groups, especially for people born in the UK/RoI.ConclusionsThere was relatively low mortality for many ethnic minority groups compared to the White Scottish majority. The mortality advantage was less clear in UK/RoI-born minority group offspring than in immigrants. These differences need explaining, and health-related behaviours seem important. Similar analyses are required internationally to fulfil agreed goals for monitoring, understanding, and improving health in ethnically diverse societies and to apply to health policy, especially on health inequalities and inequities.

Scottish Health and Ethnicity Linkage Study: Disseminating findings to the public and professionals

Scottish Health and Ethnicity Linkage Study: Disseminating findings to the public and professionals

Is the linkage of census and health data justified? Views from a public panel of the Scottish Health and Ethnicity Linkage study.

Using routine health data for research aimed at improving health requires the public's awareness and trust. The Scottish Health and Ethnicity Linkage study explores variations in health between ethnic groups. We aimed to establish a public panel to obtain their views on its methods, findings and dissemination, including use of routine health data without individual opt-in consent. Adult applicants were sought via a range of sources, aiming for a balance of age, gender and ethnicity. Three half-day meetings were held in 2015-16. Discussion covered the study's aims and governance; record linkage methods; data security; main findings, dissemination and publication processes. Of 29 applicants, 19 joined the panel. Panellists were from 10 ethnic groups, 11 were females, ages 29-69 years. With some reservations, they enjoyed the meetings. After methods and security were explained, they unanimously accepted the study's use of linked data without individual opt-in consent. They thought explaining such complex methods to the general public was difficult. They recommended more should be done to communicate study findings to the public, practitioners and policy makers. The panellists' support for the study methods was reassuring. Their recommendations have led to the implementation of a wider dissemination plan.

Lessons learned from linking to 2001 census in Scotland

ABSTRACT
 ObjectivesSHELS (Scottish Health and Ethnicity Linkage Study) linked Scotland's 2001 census to various hospital and death data sets with national coverage. Census ethnicity data were assigned to the study records to build a cohort of most of the Scottish population; included in the cohort were people with no health records.
 ApproachCreate a lookup table of a person's census index to the Scottish eHealth index, the CHI, equivalent of English new national health number. A modified versionof the eHealth administrative matching system was used to satisfy census confidentiality requirements. There were two linkages performed in 2004 and 2008. 2004 was a feasibility run; the 2008 applied lessons learned from the previous linkage and used much more completely indexed health records.
 ResultsThe first linkage produced match rate of 95% of 4.9 million 2001 census entries; the second 96%.
 Conclusions
 Lessons learned. Linking datasets using indexes is the most accurate and efficient way to produce study cohorts. Indices change over time; a methodology called 'reconciliation' was devised to retrospectively and continually adjust previously indexed (linked) records.
 How to Track members who migrate out of the cohort. A linkage resource called a residential events dataset (RESEVENT) was built for the 2008 linkage run; it holds merged history of linkage identifier fields by date from january 2000 to the present based on GP registrations.
 This introduces a time dimension to indexed linking.How to build RESEVENT like linkage resources; should they be census based? What should they contain? How to do daily national census and select controls for case/control cohorts from RESEVENT resource.
 How postcode changes over time can be handled (reconciled) - same address, different postcode, but no address present. Proposal for an index of national indices based on national administrative datasets starting with NHS number (new and old NHSCR) and NI number to make linking even more efficient - this is not a RESEVENT resource; this resource would mean data need be matched to index only once, all subsequent linkages would be deterministic links of reconciled indices.

Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study.

Aims Preventing alcohol-related harms, including those causing liver disease, is a public health priority in the UK, especially in Scotland, but the effects of ethnicity are not known. We assessed liver- and alcohol-related events (hospitalisations and deaths) in Scotland using self-reported measures of ethnicity. Methods Linking Scottish NHS hospital admissions and mortality to the Scottish Census 2001, we explored ethnic differences in hospitalisations and mortality (2001–2010) of all liver diseases, alcoholic liver disease (ALD) and specific alcohol-related diseases (ARD). Risk ratios (RR) were calculated using Poisson regression with robust variance, by sex, adjusted for age, country of birth and the Scottish Index of Multiple Deprivation (SIMD) presented below. The White Scottish population was the standard reference population with 95% confidence intervals (CI) calculated to enable comparison (multiplied by 100 for results). Results For all liver diseases, Chinese had around 50% higher risks for men (RR 162; 95% CI 127–207) and women (141; 109–184), as did Other South Asian men (144; 104–201) and Pakistani women (140; 116–168). Lower risks for all liver diseases occurred in African origin men (42; 24–74), other White British men (72; 63–82) and women (80; 70–90) and other White women (80; 67–94). For ALD, White Irish had a 75% higher risk for men (175; 107–287). Other White British men had about a third lower risk of ALD (63; 50–78), as did Pakistani men (65; 42–99). For ARD, almost 2-fold higher risks existed for White Irish men (182; 161–206) and Any Mixed Background women (199; 152–261). Lower risks of ARD existed in Pakistani men (67; 55–80) and women (48; 33–70), and Chinese men (55; 41–73) and women (54; 32–90). Conclusions Substantial variations by ethnicity exist for both alcohol-related and liver disease hospitalisations and deaths in Scotland: these exist in subgroups of both White and non-White populations and practical actions are required to ameliorate these differences.

Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study.

Preventing alcohol-related harms, including those causing liver disease, is a public health priority in the UK, especially in Scotland, but the effects of ethnicity are not known. We assessed liver- and alcohol-related events (hospitalisations and deaths) in Scotland using self-reported measures of ethnicity. Linking Scottish NHS hospital admissions and mortality to the Scottish Census 2001, we explored ethnic differences in hospitalisations and mortality (2001-2010) of all liver diseases, alcoholic liver disease (ALD) and specific alcohol-related diseases (ARD). Risk ratios (RR) were calculated using Poisson regression with robust variance, by sex, adjusted for age, country of birth and the Scottish Index of Multiple Deprivation (SIMD) presented below. The White Scottish population was the standard reference population with 95% confidence intervals (CI) calculated to enable comparison (multiplied by 100 for results). For all liver diseases, Chinese had around 50% higher risks for men (RR 162; 95% CI 127-207) and women (141; 109-184), as did Other South Asian men (144; 104-201) and Pakistani women (140; 116-168). Lower risks for all liver diseases occurred in African origin men (42; 24-74), other White British men (72; 63-82) and women (80; 70-90) and other White women (80; 67-94). For ALD, White Irish had a 75% higher risk for men (175; 107-287). Other White British men had about a third lower risk of ALD (63; 50-78), as did Pakistani men (65; 42-99). For ARD, almost 2-fold higher risks existed for White Irish men (182; 161-206) and Any Mixed Background women (199; 152-261). Lower risks of ARD existed in Pakistani men (67; 55-80) and women (48; 33-70), and Chinese men (55; 41-73) and women (54; 32-90). Substantial variations by ethnicity exist for both alcohol-related and liver disease hospitalisations and deaths in Scotland: these exist in subgroups of both White and non-White populations and practical actions are required to ameliorate these differences.

Ethnic variations in upper gastrointestinal hospitalizations and deaths: the Scottish Health and Ethnicity Linkage Study.

Upper gastrointestinal (GI) diseases are common, but there is a paucity of data describing variations by ethnic group and so a lack of understanding of potential health inequalities. We studied the incidence of specific upper GI hospitalization and death by ethnicity in Scotland. Using the Scottish Health and Ethnicity Linkage Study, linking NHS hospitalizations and mortality to the Scottish Census 2001, we explored ethnic differences in incidence (2001-10) of oesophagitis, peptic ulcer disease, gallstone disease and pancreatitis. Relative Risks (RRs) and 95% confidence intervals were calculated using Poisson regression, multiplied by 100, stratified by sex and adjusted for age, country of birth (COB) and socio-economic position. The White Scottish population (100) was the reference population. Ethnic variations varied by outcome and sex, e.g. adjusted RRs (95% confidence intervals) for oesophagitis were comparatively higher in Bangladeshi women (209; 124-352) and lower in Chinese men (65; 51-84) and women (69; 55-88). For peptic ulcer disease, RRs were higher in Chinese men (171; 131-223). Pakistani women had higher RRs for gallstone disease (129; 112-148) and pancreatitis (147; 109-199). The risks of upper GI diseases were lower in Other White British and Other White [e.g. for peptic ulcer disease in men, respectively (74; 64-85) and (81; 69-94)]. Risks of common upper GI diseases were comparatively lower in most White ethnic groups in Scotland. In non-White groups, however, risk varied by disease and ethnic group. These results require consideration in health policy, service planning and future research.

Risk of respiratory hospitalization and death, readmission and subsequent mortality: scottish health and ethnicity linkage study.

Limited and dated evidence shows ethnic inequalities in health status and health care in respiratory diseases. This retrospective, cohort study linked Scotland's hospitalization/death records on respiratory disorders to 4.65 million people in the 2001 census (providing ethnic group). For all-respiratory diseases and chronic obstructive pulmonary disease (COPD) from April 2001 to 2010 we calculated age, country of birth and Scottish Index of Multiple Deprivation (SIMD) adjusted risk ratios (RRs), by sex. We calculated hazard ratios (HRs) for death following hospitalization and for readmission. We multiplied ratios and confidence intervals (CIs) by 100, so the reference Scottish White population's RR/HR = 100. RRs were comparatively low for all-respiratory diseases in Other White British (84.0, 95% CI 79.6, 88.6) and Chinese (67.4, 95% CI 55.2, 82.3) men and high in Pakistani men (138.1, 95% CI 125.5, 151.9) and women (132.7, 95% CI 108.8, 161.8). For COPD, White Irish men (142.5, 95% CI 125.3, 162.1) and women (141.9, CI 124.8, 161.3) and any Mixed Background men (161, CI 127.1, 203.9) and women (215.4, CI 158.2, 293.3) had high RRs, while Indian men (54.5, CI 41.9, 70.9) and Chinese women (50.5, CI 31.4, 81.1) had low RRs. In most non-White groups, mortality following hospitalization and readmission was similar or lower than the reference. The pattern of ethnic variations in these respiratory disorders was complex and did not merely reflect smoking patterns. Readmission and death after hospitalization data did not signal inequity in services for ethnic minority groups.

Epidemiology Data from the Scottish Health and Ethnicity Linkage Study (SHELS)

We linked the 2001 Scottish Census, which contains ethnicity, socio-economic and demographic data to health and death records, creating an anonymised retrospective cohort study of 4.65 million people to assess the association between ethnicity and health outcomes in Scotland. The databases contain data mostly from hospital discharge and mortality records, but also from other registers. The databases are stored in a safe haven at the National Records of Scotland (NRS). NRS is currently exploring the feasibility of making Scottish Health and Ethnicity Linkage Study (SHELS) data open access while ensuring that the same level of confidentiality is maintained. If SHELS becomes open access it could be reused, with the appropriate approvals, to assess the influence of other socio-economic or demographic measures on the Scottish population’s health.

Explaining ethnic inequalities in health in Scotland: a pilot study linking primary care to census data to account for ethnic variations in cardiovascular disease

BackgroundEthnic health inequality is striking. Quantifying this inequality is important. The Scottish Health and Ethnicity Linkage Study (SHELS) linked National Health Service hospital discharges and mortality to the 2001 Scottish Census. Our analyses adjusted for age, country of birth, and socioeconomic status. However, the understanding of the role of other risk factors is crucial. The aim of this project was to explore the feasibility and value of linking risk factors from primary care to census and health data in cardiovascular disease. MethodsTen of 17 general practices in Glasgow and Edinburgh provided data relating to cardiovascular disease that were linked to census records using encrypted identifiers (for ethnic group labels, we used Census Scotland terminology). This process created a retrospective cohort study comprising 52 975 people, of whom around 8500 belonged to non-White ethnic groups. This cohort was linked to our pre-existing data on hospital admissions for cardiovascular disease. Risk ratios (RR) for first hospital admission were calculated, by sex, using Poisson regression with robust variance, adjusting for age, and then for smoking or diabetes status, with 95% CIs. The White Scottish population was the reference group (RR=100). The main outcome assessed whether ethnic variations in cardiovascular disease were attenuated on adjustment for smoking and diabetes. Ethics approval (11/MRE00/4) was obtained from Scotland A Research Ethics Committee. FindingsData completeness was similar across ethnic groups. 48 325 (91%) of 52 975 records had a valid smoking status and 2900 (5·5%) people had diabetes. Compared with White Scottish people, Pakistani people had the highest prevalence of diabetes (RR for men 274, 95% CI 238–314; RR for women 364, 305–434). Pakistani men (n=1165) and women (n=1075) were at higher risk of any hospital admission for cardiovascular disease than were White Scottish men (n=9890) and women (n=11 550) (153, 137–170 for men; 193, 158–235 for women). In Pakistani women adjustment for smoking increased the age-adjusted risk (216, 170–274), whereas adjustment for diabetes reduced the risk (161, 134–194). InterpretationThe high rate of hospital admissions for cardiovascular disease among Pakistani people can be explained partly by higher rates of diabetes, but not smoking. Our dataset is a non-representative sample, so results should be treated with caution. However, we have shown potential value (for further research and for health-care planning) in linking primary care to census data to shed light on ethnic variations in cardiovascular disease. FundingChief Scientist Office of the Scottish Government (grant numbers CZH/4/432, CZH/4/648, and CZH4/878).

Ethnic variations in five lower gastrointestinal diseases: Scottish Health and Ethnicity Linkage Study

ObjectivesOur objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower...

Ethnic variations in respiratory disorders in Scotland: asthma, COPD and infections

Background Respiratory disease is responsible for considerable morbidity and mortality. In a world of rapidly increasing ethnic diversity, there is a paucity of data around ethnic differences in respiratory diseases in the UK. The Scottish Health and Ethnicity Linkage Study (SHELS) sought to address this important knowledge gap. Methods This retrospective cohort study of 4.65 million people in Scotland securely linked NHS hospital admissions and mortality to the Scottish census 2001, to investigate ethnic variations …