Indian Subcontinent Ethnic Groups Research Articles

Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK

BACKGROUNDWhether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation. This study reports clinical outcomes and quality...

Does vitamin d deficiency account for ethnic differences in tuberculosis seasonality in the UK?

Objectives. Notifications of tuberculosis in England and Wales are reported to peak in the summer season. The purpose of this study was to confirm that finding and to determine to what extent patients of Indian Subcontinent (ISC) ethnic origin contributed to the seasonality. The clinical presentation of the disease is presumed to occur some months following reactivation of the endogenous latent focus of tuberculosis infection. There arises the possibility of vitamin D deficiency producing immunological inadequacy at the end of winter and beginning of spring. Patients and methods. Monthly (or 4‐weekly) aggregated data over 7 years were collected from the three countries of mainland Britain, England, Wales, Scotland and from the city of Birmingham in England. The notifications from Birmingham were divided into those of ISC ethnic origin and ‘whites’. The presence or absence of seasonality was determined by fitting a sinusoidal curve by the technique called ‘cosinor analysis’. In this method amplitude gives a measure of the extent of the seasonal variation. Results. The summer peak of clinical diagnosis was confirmed in the UK series from England, Wales and Scotland. In England and Wales without Scotland a larger seasonal variation was present. Scotland, with a lower proportion of population of ISC ethnic origin, was examined separately and the results in Scotland alone failed to confirm seasonality. In the data from Birmingham, seasonality was confirmed with a greater amplitude, particularly in those over 60 years of age. The finding was influenced by those of ISC ethnic origin, seasonality not being present in the ‘white’ population. Conclusion. The results from Birmingham are very striking, but there were almost three times as many patients in the ISC ethnic group as in indigenous ‘white’ patients. A series with larger numbers of ‘white’ patients would be necessary to confirm the absence of seasonality in the ‘white’ population. The discussion reviews the evidence that vitamin D may have an important hormonal role in immunological defence in the prevention of tuberculosis.

Tuberculosis in England and Wales in 1993: results of a national survey. Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

BACKGROUND: A national survey of tuberculosis notifications in England and Wales was carried out in 1993 to determine the notification rate of tuberculosis and the trends in the occurrence of...

Adult Asian acute asthma admissions reassessed: Blackburn 1991–1992

Two hundred and fifty-five admissions for acute asthma with a minimum 25% PEFR improvement in patients aged 15–44 years were studied in 1991–1992. Two hundred of these patients were in the white ethnic group (84 male; 116 female) with 33 (17·4%) being readmissions (15 male; 18 female). Fifty-five admissions (19 male; 36 female) were in the Indian subcontinent (ISC) ethnic group with 3 (5·5%; all female) readmissions. The readmission rate was significantly higher in the white ethnic group ( χ 2=4·83; 0·05< P<0·01). Admission rates per thousand population in 5-yr cohorts were calculated from the 1991 Census data. The admission rate was higher in the ISC ethnic group in all cohorts except females aged 15–19 years, and was significantly higher in males aged 15–19 years and 40–44 years, and in all four cohorts between 25–44 years in females. Initial PEFR and % initial PEFR/highest PEFR did not suggest increased severity of asthma in the ISC ethnic group.

Results of tuberculosis contact tracing: Blackburn 1982–1990

Between 1982 and 1990, 649 index cases of tuberculosis were seen of which 429 (66·1%) were of Indian Subcontinent (ISC) ethnic origin: 7017 close contacts of these cases were screened, 50 cases of tuberculosis were detected (7·7% of notifications) and 372 children given chemoprophylaxis. All cases of tuberculosis detected in the white ethnic group were contacts of smear-positive pulmonary disease, six (46%) found at initial screening, five (38%) at 1 year and one (8%) at 2 year follow-up. Of 37 cases detected in the ISC ethnic group, only 14 (38%) were contacts of smear-positive disease, 17 (46%) being contacts of other respiratory disease, and six (16%) contacts of non-respiratory disease. Eighteen (49%) of ISC cases detected were at initial screening, with six (16%), eight (22%) and three (8%), respectively, at 6 month, 1 year and 2 year follow-up. The results support the revised Joint Tuberculosis Committee advice on contact tracing, with differential contact programmes depending on type of disease and ethnic group of index cases.

National survey of tuberculosis notifications in England and Wales in 1983: Characteristics of disease

The number of newly notified, previously untreated patients in a survey of notifications of tuberculosis in England and Wales conducted by the MRC in 1983 was 26 % lower than in the previous MRC survey in 1978/79. In both surveys the great majority of patients were of White (about half) or Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin (just over a third). The notification rates in the Indian subcontinent (ISC) ethnic groups were much higher than for the White group and were highest in those most recently arrived in the UK. There were a number of differences in the findings for the White and the ISC ethnic groups.Nearly two-thirds of the White patients but less than half of the ISC patients were male and the White patients were, on average, older, about half aged 55 years or more compared with 14 % of the ISC patients.Respiratory disease occurred in 82 % of the White patients compared with 66 % of the ISC patients. Radiographically, at independent assessment, more of the White patients had pulmonary lesions, 88 % compared with 63 % and these were, on average, more extensive and cavitated than in the ISC patients. Isolated mediastinal lymphadenopathy, however, was more common in the ISC patients. The diagnosis was confirmed bacteriologically on culture of a respiratory specimen in a higher proportion of the White than the ISC patients (65 % and 41 % respectively) and more were positive on smear as well (45 % and 25 % respectively). The level of initial drug resistance was lower in the White patients: only 10 (1.6 %) of the 623 strains tested were resistant compared to 23 (12.8 %) of the 179 from ISC patients.In both White and ISC ethnic groups the commonest non-respiratory lesion was peripheral lymph node involvement, namely 37 % of the 369 White and 53 % of the 503 ISC patients with non-respiratory disease. The diagnosis was confirmed by bacteriological examination of the lymph node in 47 % of the ISC patients compared with 29 % of the White patients with a lesion. Bone or joint disease occurred in 11 % of the White and 20 % of the ISC patients; the commonest site in both groups was the spine. Genitourinary disease was present in 98 (27 %) of White and 24 (5 %) of ISC patients with a non-respiratory lesion. There were 61 patients with tuberculosis involving the central nervous system, including 55 with meningitis, the proportions being similar for the White and the ISC ethnic groups, 7 % and 5 % respectively.

The geographical distribution of tuberculosis notifications in a national survey of England and Wales in 1983

A survey of all tuberculosis notifications in England and Wales for the first 6 months of 1983 has made it possible to estimate the annual notification rates for that year for the White and the Indian subcontinent (Indian, Pakistani and Bangladeshi) ethnic groups for the nine regions of England and Wales and for the 33 boroughs of Greater London. The rates have been compared with those estimated from an earlier 6-month survey in 1978/79. However, for the 53 counties and the 370 local authority areas outside Greater London only the overall rates could be calculated because population data by ethnic group were not available. There was considerable variation between the 9 regions in the notification rates for all ethnic groups combined (range 28.1 per 100,000 in Greater London to 4.5 per 100,000 in Anglia) and for the White ethnic group (range 13.1 per 100,000 in Greater London to 3.1 per 100,000 in Anglia). The rates for the Indian subcontinent (ISC) ethnic group were high in all the regions and were 15-60 times higher than the corresponding rates for the White ethnic group. Between 1978/79 and 1983 there was a decline in all of the regions in the notification rates for all ethnic groups combined and the White group. For the ISC ethnic group there was a decline in all regions apart from Anglia (where the number of cases was small). The difference in rates for the London boroughs, from 92.3 per 100,000 for Brent to 5.7 per 100,000 for Havering, were associated not only with the proportion of the population who were of ISC ethnic origin but also with indices of socio-economic class for the borough. There was, however, no evidence to suggest that high rates in the White population were a consequence of the presence of a large number of infectious patients of ISC ethnic origin. Notification rates for the 53 counties apart from Greater London ranged from 23.7 per 100,000 for the West Midlands to 3.1 per 100,000 for Surrey and with few exceptions there was a decline in rates between the surveys. Considering the 370 local authorities outside Greater London, the number with a notification rate of less than 5 per 100,000 increased from 73 in 1978/79 to 105 in the 1983 survey and the number of local authorities in which no cases were notified in the 6-month survey period increased from 32 to 41.