People Of South Asian Ethnicity Research Articles

South Asian individuals’ experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England

BackgroundExisting literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK,...

Factors associated with bacterial sexually transmitted infections among people of South Asian ethnicity in England

ObjectivesDespite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services (SHS) and sexually transmitted infection (STI) diagnoses, although...

Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: A cross-sectional study using clustering in the UK Clinical Practice Research Datalink.

The population prevalence of multimorbidity (the existence of at least 2 or more long-term conditions [LTCs] in an individual) is increasing among young adults, particularly in minority ethnic groups and individuals living in socioeconomically deprived areas. In this study, we applied a data-driven approach to identify clusters of individuals who had an early onset multimorbidity in an ethnically and socioeconomically diverse population. We identified associations between clusters and a range of health outcomes. Using linked primary and secondary care data from the Clinical Practice Research Datalink GOLD (CPRD GOLD), we conducted a cross-sectional study of 837,869 individuals with early onset multimorbidity (aged between 16 and 39 years old when the second LTC was recorded) registered with an English general practice between 2010 and 2020. The study population included 777,906 people of White ethnicity (93%), 33,915 people of South Asian ethnicity (4%), and 26,048 people of Black African/Caribbean ethnicity (3%). A total of 204 LTCs were considered. Latent class analysis stratified by ethnicity identified 4 clusters of multimorbidity in White groups and 3 clusters in South Asian and Black groups. We found that early onset multimorbidity was more common among South Asian (59%, 33,915) and Black (56% 26,048) groups compared to the White population (42%, 777,906). Latent class analysis revealed physical and mental health conditions that were common across all ethnic groups (i.e., hypertension, depression, and painful conditions). However, each ethnic group also presented exclusive LTCs and different sociodemographic profiles: In White groups, the cluster with the highest rates/odds of the outcomes was predominantly male (54%, 44,150) and more socioeconomically deprived than the cluster with the lowest rates/odds of the outcomes. On the other hand, South Asian and Black groups were more socioeconomically deprived than White groups, with a consistent deprivation gradient across all multimorbidity clusters. At the end of the study, 4% (34,922) of the White early onset multimorbidity population had died compared to 2% of the South Asian and Black early onset multimorbidity populations (535 and 570, respectively); however, the latter groups died younger and lost more years of life. The 3 ethnic groups each displayed a cluster of individuals with increased rates of primary care consultations, hospitalisations, long-term prescribing, and odds of mortality. Study limitations include the exclusion of individuals with missing ethnicity information, the age of diagnosis not reflecting the actual age of onset, and the exclusion of people from Mixed, Chinese, and other ethnic groups due to insufficient power to investigate associations between multimorbidity and health-related outcomes in these groups. These findings emphasise the need to identify, prevent, and manage multimorbidity early in the life course. Our work provides additional insights into the excess burden of early onset multimorbidity in those from socioeconomically deprived and diverse groups who are disproportionately and more severely affected by multimorbidity and highlights the need to ensure healthcare improvements are equitable.

Dietary weight-management for type 2 diabetes remissions in South Asians: the South Asian diabetes remission randomised trial for proof-of-concept and feasibility (STANDby)

We aimed to assess whether a structured weight management programme incorporating a total diet replacement (TDR) (3-5 months ∼850kcal/day formula diet) weight loss phase is acceptable to people of South Asian ethnicity and can achieve type 2 diabetes (T2D) remissions similarly to other populations. Adults of South Asian ethnicity, aged 18-65 years, with T2D for ≤4 years, and BMI 25-45kg/m2 were recruited from primary care and social media, and randomised to commence TDR either immediately (iTDR), or delayed (dTDR) for 3-5 months as a usual care control arm during this period. Intervention effects were tested in randomised comparisons powered to detect significant weight loss, and in an expanded observational analysis to determine remission effect size, including both iTDR and dTDR groups. Acceptability in those recruited was explored by questionnaire and weight change. Current Controlled Trials, ISRCTN10720065. Date of Registration 27/09/2017. Twenty-five eligible individuals were recruited. Mean baseline (SD) age was 45.8 (11.1) years, weight 88.2 (13.7) kg, BMI 32.1 (3.8) kg/m2, HbA1c 60.4 (11.3) mmol/mol, liver fat by MRI 15.6 (9.4)%. In the RCT, mean(SD) weight change after TDR was-7.7 (7.2)% in the intervention group (n=13), and-1.2 (1.4)% in the usual-care control group (n=12) (p=0.005), with T2D remission achieved by 5/13, compared to 0/12 respectively (p=0.039). In the observational study, 23/25 started TDR and 19/23 participants completed the TDR phase. Median time spent in TDR was 105 days (IQR 77-134 days). T2D remission was achieved in 10/23 (43%), and weight changes were concordant with the RCT. Overall, 8/23 (35%) lost over 10% bodyweight. Absolute liver fat proportion near halved from 15.3% at the start of TDR to 8.6% (p<0.001). In UK-based South Asians, TDR-led weight loss and T2D remission rates are comparable to those observed in white cohorts, and the intervention was acceptable in most of those recruited. There is potential to further improve outcomes, but one-third lost >10% body weight, and the mechanism underpinning T2D remission appears similar, driven by weight change with loss of excess ectopic body-fat. We gratefully acknowledge funding for the MRI scans from the, Miss MJM Smith Trust (registered charity: SC040586). No other external funds were provided for this trial. NS is supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217).

Changing socio-economic and ethnic disparities in influenza/A/H1N1 infection early in the 2009 UK epidemic: a descriptive analysis

BackgroundHigher incidence of and risk of hospitalisation and death from Influenza A(H1N1)pdm09 during the 2009 pandemic was reported in ethnic minority groups in many high-income settings including in the United Kingdom (UK). Many of these studies rely on geographical and temporal aggregation of cases and can be difficult to interpret due to the spatial and temporal factors in outbreak spread. Further, it can be challenging to distinguish between disparities in health outcomes caused by variation in transmission risk or disease severity.MethodsWe used anonymised laboratory confirmed and suspected case data, classified by ethnicity and deprivation status, to evaluate how disparities in risk between socio-economic and ethnic groups vary over the early stages of the 2009 Influenza A(H1N1)pdm09 epidemic in Birmingham and London, two key cities in the emergence of the UK epidemic. We evaluated the relative risk of infection in key ethnic minority groups and by national and city level deprivation rank.ResultsWe calculated higher incidence in more deprived areas and in people of South Asian ethnicity in both Birmingham and London, although the magnitude of these disparities reduced with time. The clearest disparities existed in school-aged children in Birmingham, where the most deprived fifth of the population was 2.8 times more likely to be infected than the most affluent fifth of the population.ConclusionsOur analysis shows that although disparities in reported cases were present in the early phase of the Influenza A(H1N1)pdm09 outbreak in both Birmingham and London, they vary substantially depending on the period over which they are measured. Further, the development of disparities suggest that clustering of social groups play a key part as the outbreak appears to move from one ethnic and socio-demographic group to another. Finally, high incidence and large disparities between children indicate that they may hold an important role in driving inequalities.

Extraspinal articular tuberculosis: An 11-year retrospective study of demographic features and clinical outcomes in East London

ObjectivesTo describe demographic features, clinical outcomes and diagnostic delay amongst patients with extra-spinal articular tuberculosis (TB) in a low-incidence setting. MethodsCases of TB treated at our institution between 2004 and 2014 were identified via the London TB register (LTBR). Demographic features of extra-spinal articular TB cases were compared to controls with TB at all other sites. For articular cases (excluding individuals <16 years or with spinal TB without peripheral joint involvement) clinical data were retrospectively collected. Results6,146 TB patients were identified over the study period; 146 (2.4%) cases had extra-spinal articular infection. There was no difference in median age between extra-spinal articular TB cases and controls with TB at other sites (31 vs 32 years, p = 0.57). Articular cases were more likely to be male (70.6% vs 59.5%, p = 0.007), Bangladeshi (28.7% vs 18.0%) or Pakistani (24.0% vs 16.1%) and were less likely to be Black-African (9.5% vs 19.8%) (p < 0.001). 93 cases were included in the case series; 85 (88.5%) were migrants and 83 (89.2%) were South Asian. Knee and elbow joints were affected in 22 (23.7%) and 18 (19.4%) cases respectively. The median durations of pre-healthcare and healthcare associated delay were 16 and 6 weeks respectively. Where mycobacterial culture was performed, 57/75 (76%) were positive for Mycobacterium tuberculosis. 86 (92.5%) cases received standard quadruple therapy for a median of 6 months (IQR 6–9). Recurrence of TB infection occurred in 4 (4.3%) cases and there were no TB related deaths. Seven (7.6%) cases required surgical intervention. ConclusionsExtra-spinal articular TB more commonly affected men and people of South Asian ethnicity. Significant diagnostic delays were identified, including avoidable healthcare-associated delays.

Barriers and Enablers for UK Home Grown South Asian Prospective Students Choosing Nursing and Midwifery Courses and Careers

Background: UK ‘home grown’ (people of South Asian ethnicity, born or socialised in Britain) South Asian (Pakistanis, Bangladeshis and Indians) are underrepresented in the NHS nursing and the allied health workforce. One of the key goals of Health Education England’s (HEE) national framework- Widening Participation-It matters! is to increase understanding and evidence on the specific needs of underrepresented groups as they apply, commence and progress on healthcare courses and careers. There is a dearth of evidence on the views of UK ‘home grown’ South Asian prospective students. This study aimed to explore UK ‘home grown’ South Asian students views on the barriers and enablers to choosing nursing and midwifery courses and progressing into healthcare employment. Methods: A total of nine focus groups were conducted. Four focus groups in two schools/colleges in the town of High Wycombe (n=28) and five focus group discussions in two schools/colleges in Luton (n=27). Results: The main themes emerging for barriers to choosing nursing and midwifery courses and careers were: limited personal, parental and community knowledge influencing perceptions of nursing and midwifery, the role of religion and culture, gender roles-‘not man’s work’, the end of NHS bursaries and racial and religious discrimination. The main themes for enablers were presented as: good information available on applying for nursing or midwifery courses and suggestions on how to widen participation for South Asian groups. Conclusion: To increase numbers of UK ‘home grown’ South Asians on nursing and midwifery courses and in healthcare employment, targeted interventions that raise the profile and status of nursing in the South Asian community should be designed and delivered.

Meeting American Diabetes Association diabetes management targets: trends in Mauritius.

To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c , blood pressure and LDL cholesterol. In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.

Comorbidities, complications and mortality in people of South Asian ethnicity with type 1 diabetes compared with other ethnic groups: a systematic review

ObjectiveThe aim of this systematic review is to explore the association of South Asian (SA) ethnicity on comorbidities, microvascular and macrovascular complications and mortality compared with other ethnic groups in...

A venue-based analysis of the reach of a targeted outreach service to deliver opportunistic community NHS Health Checks to ‘hard-to-reach’ groups

ObjectivesOpportunistic outreach services have been commissioned to overcome potential barriers to uptake, by offering health checks in accessible community venues. This study aimed to evaluate the ability of an outreach health check service to reach key target groups: men, people of South Asian ethnicity and people from deprived areas. The comparator was the health check service provided by GP practices. One aim was to investigate whether the addition of an outreach service would result in a higher percentage of health checks being done for people from the target groups compared to a GP-based service alone. The second aim was to assess which types of venues used for outreach health checks were most effective in reaching these groups. Study designEvaluation of Public Health Programme with retrospective control group comparison. MethodsThe percentages of completed health checks in men, people of South Asian ethnicity, and participants registered at general practices with lowest quintile area-level deprivation status were compared between all opportunistic community checks conducted by the Outreach Service over a ten month period and checks conducted in general practice in a partially-overlapping time period of the same financial year. For the venue-based comparison of Outreach Service checks, the number of checks per visit and percentage of checks in each target group were calculated for each venue. ResultsOf 3849 Outreach Service checks, 38% were in men (compared to 50% of checks conducted in Primary Care), and 11% were in people of South Asian ethnicity (compared to 3% in Primary Care). 3558 Outreach check participants were registered with a general practice in the County (92%), and of these, 32% of checks were in people registered with a general practice in the lowest deprivation quintile (compared to 13% of checks in Primary Care).There were 519 visits by the outreach service to 23 different types of venue. Certain venues recorded large numbers of checks e.g. supermarkets and libraries, but they were not always the most efficient places to recruit people for checks. Mosques and bus stations were the venues with the broadest reach to all target groups. Other venues, despite having lower turnover or recruitment rates, were still good settings to reach specific target groups. ConclusionThe NHS Health Check can successfully be targeted at people from deprived areas and people of South Asian ethnicity using a targeted opportunistic community outreach approach. Our findings show that the reach to different groups varies substantially by venue, and therefore best results may be achieved by combining venues and strategies specific to the target group.

PTU-100 Should we screen the antenatal population for hepatitis C in the UK? a snapshot of seroprevalence from a single london centre:

<h3>Introduction</h3> The paradigm of hepatitis C (HCV) treatment has shifted, with the introduction of revolutionary regimens offering sustained virological response rates of &gt;90%. However, only 3% of HCV patients receive treatment each year, and 50% with chronic HCV are undiagnosed.¹ There are significant differences in HCV prevalence within minority groups. Infection rates in South Asian and Eastern European groups are as high as 2.7%²and 5.1%, respectively.³The area served by Barking, Havering and Redbridge NHS Trust (BHRUT) reflects huge population ethnic diversity. Screening at antenatal (AN) booking allows testing of women not included in current guidelines. Data for AN populations has not been determined. We postulated that AN testing for HCV antibody (HCV Ab) would identify significant seroprevalence. <h3>Method</h3> 1000 sequential AN samples, each representing serum collected from one women at AN booking, were anonymously tested for anti-HCV Ab, hepatitis B surface antigen (HBsAg), and HIV, using ARCHITECT (Abbott). Positive results were confirmed with VIDAS (bioMérieux). Equivocal results were ARCHITECT positive/VIDAS negative. <h3>Results</h3> <h3>Conclusion</h3> Our results demonstrate a snapshot of the seroprevalence of HCV, HBV and HIV in the AN population served by BHRUT. HCV prevalence was in keeping with national statistics. AN HBsAg and HIV Ab positivity was higher than national data.⁴ Limitations include small sample size, reflecting 1 month of AN samples collected. Serum was only tested for HCV Ab; viraemia should be confirmed by PCR. Anonymous testing prevented identification of known cases. We argue that AN testing represents opportunity for early diagnosis. AN testing for HBV and HIV were introduced as diagnosis allowed early treatment, which can now be provided for HCV. It is interesting that prevalence within our AN cohort is similar to that of the general population. AN populations represent well patients, motivated to engage with health care, with high uptake of screening. HCV testing can be added safely and reliably to existing panels. With the revolution in HCV treatment, there must now be an emphasis placed on early identification. <h3>Disclosure of interest</h3> E. Dannhorn Grant/ Research Support from: Research support granted by Abbott, R. Davis: None Declared, C. Koshy: None Declared, P. Kooner: None Declared. <h3>References</h3> Public Health Englang (PHE). HCV in the UK: 2013 report Uddin, <i><i>et al</i></i>. Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin. <i>J Viral Hepat</i>. 2010;<b>17</b>(5):327–35 PHE; HCV in the UK: 2014 PHE; Annual report from the sentinel surveillance study of blood borne virus testing in England: data for Jan-Dec 2013

Characteristics of Glucose Metabolism in Nordic and South Asian Subjects with Type 2 Diabetes

BackgroundInsulin resistance and type 2 diabetes are more prevalent in people of South Asian ethnicity than in people of Western European origin. To investigate the source of these differences, we compared insulin sensitivity, insulin secretion, glucose and lipid metabolism in South Asian and Nordic subjects with type 2 diabetes.MethodsForty-three Nordic and 19 South Asian subjects with type 2 diabetes were examined with intra-venous glucose tolerance test, euglycemic clamp including measurement of endogenous glucose production, indirect calorimetry measuring glucose and lipid oxidation, and dual x-ray absorptiometry measuring body composition.ResultsDespite younger mean ± SD age (49.7±9.4 vs 58.3±8.3 years, p = 0.001), subjects of South Asian ethnicity had the same diabetes duration (9.3±5.5 vs 9.6±7.0 years, p = 0.86), significantly higher median [inter-quartile range] HbA1c (8.5 [1.6] vs 7.3 [1.6] %, p = 0.024) and lower BMI (28.7±4.0 vs 33.2±4.7 kg/m2, p<0.001). The South Asian group exhibited significantly higher basal endogenous glucose production (19.1 [9.1] vs 14.4 [6.8] µmol/kgFFM⋅min, p = 0.003). There were no significant differences between the groups in total glucose disposal (39.1±20.4 vs 39.2±17.6 µmol/kgFFM⋅min, p = 0.99) or first phase insulin secretion (AUC0–8 min: 220 [302] vs 124 [275] pM, p = 0.35). In South Asian subjects there was a tendency towards positive correlations between endogenous glucose production and resting and clamp energy expenditure.ConclusionsSubjects of South Asian ethnicity with type 2 diabetes, despite being younger and leaner, had higher basal endogenous glucose production, indicating higher hepatic insulin resistance, and a trend towards higher use of carbohydrates as fasting energy substrate compared to Nordic subjects. These findings may contribute to the understanding of the observed differences in prevalence of type 2 diabetes between the ethnic groups.

Dying at home: A qualitative study of the perspectives of older South Asians living in the United Kingdom

Background: South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives on, and experiences of, end-of-life care. Aim: To explore beliefs, attitudes and expectations expressed by older South Asians living in East London about dying at home. Design: A qualitative study using focus groups and semi-structured interviews. Data were analysed using a constructivist grounded theory approach. Setting/participants: Five focus groups and 29 in-depth semi-structured interviews were conducted with a total of 55 older adults (24 men and 31 women) aged between 52 and 78 years. Participants from six South Asian ethnic groups were recruited via 11 local community organisations. Results: Two key themes were identified. The theme of ‘reconsidering the homeland’ draws on the notion of ‘diaspora’ to help understand why for many participants, the physical place of death was perceived as less important than the opportunity to carry out cultural and religious practices surrounding death. The second theme ‘home as a haven’ describes participants’ accounts of how their home is a place in which it is possible to perform various cultural and religious rituals. Cultural and religious practices were often seen as essential to achieving a peaceful death and honouring religious and filial duties. Conclusions: Older people of South Asian ethnicity living in East London perceive home as more than a physical location for dying relatives. They make efforts to adhere, and also adapt, to important social and cultural values relating to death and dying as part of the wider challenge of living in an emigrant society.

Ethnicity and obesity in the UK

Mary Gatineau and Shireen Mathrani from the National Obesity Observatory explore the relationship between ethnicity and obesity in the UK There is no straightforward relationship between obesity and ethnicity. Obesity prevalence varies substantially between ethnic groups in the UK and interpretation of data is difficult because of uncertainty about appropriate obesity thresholds and associated levels of health risk. In addition, health behaviours both across and within minority ethnic groups are influenced by a complex interplay of cultural, lifestyle and socioeconomic factors.1 Obesity prevalence The most current data on adult obesity by ethnic group are from the Health Survey for England (HSE) 2004. Findings suggest that compared to the general population, obesity prevalence is lower among men from black African, Indian, Pakistani and most markedly, Bangladeshi and Chinese communities. Among women, obesity prevalence appears to be higher for those from Black African, Black Caribbean and Pakistani groups than for women in the general population and lower for women from the Chinese ethnic group.2 The National Child Measurement Programme (NCMP) provides the most robust data on child obesity in the UK and includes a detailed breakdown by ethnic sub-group. Recent analysis by the National Obesity Observatory (NOO)i shows that in Reception class, obesity prevalence is especially high for boys and girls from Black African and Black other ethnic groups and boys from the Bangladeshi ethnic group.ii The pattern for girls in Year 6 is broadly similar to that of girls in Reception, while for boys in Year 6, obesity prevalence is significantly higher for all ethnic groups compared to White British, with boys of Bangladeshi ethnicity having the highest prevalence. The analysis also finds a trend of rising obesity prevalence for both boys and girls of Bangladeshi ethnicity, with no significant changes in any other ethnic groups.3 Figure 1 provides a summary of this rising trend for Bangladeshi children in Year 6 compared to all other ethnic groups combined. Obesity measures and thresholds There are a number of issues associated with the measurement of obesity and the thresholds used for minority ethnic groups in the UK. Different ethnic groups are associated with a range of different body shapes and different physiological responses to fat storage. Body mass index (BMI) is not always an accurate predictor of body fat or fat distribution in individuals. Research has shown that for the same level of BMI, people of African ethnicity appear likely to carry less fat and people of South Asian ethnicity more fat than the general population. This may have led to an overestimation of obesity among African and an underestimation among South Asian groups.4 South Asian and Chinese populations have been found to be at risk of chronic diseases and mortality at lower levels than European populations. Revised BMI thresholds and waist circumference measures have been recommended for these groups. NCMP findings demonstrate a very high prevalence of obesity among boys of Bangladeshi ethnicity. These findings are in contrast with the general perception that children from Black ethnic groups have the highest obesity prevalence. The high odds of children from Black groups being classified as obese may in fact be due to physical characteristics related to ethnicity and, in particular, height, which can lead to skewed BMI.3,iii Factors determining obesity riskiv Dietary patterns of minority ethnic groups are influenced by many factors including availability of food, level of income, health, food beliefs, religion, cultural patterns and customs.5 While many people from these groups have healthier eating patterns than the White population, less healthy diets are known to be of concern in some groups, in particular those of South Asian origin. Migration to the UK has a significant impact on dietary habits. …

Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Medically Unexplained Symptoms Presenting at Secondary Care—A Comparison of White Europeans and People of South Asian Ethnicity

To assess whether, among new out-patients at secondary care medical clinics, people of South Asian origin have a higher proportion of medically unexplained symptoms, and receive different care compared to white Europeans. A retrospective case note study was performed in a district general hospital with a high proportion of ethnic minorities in the local population. We examined the notes of 100 people each of South Asian and white European origin who were in the 20-39 years age range and attending as new medical out-patients. We recorded the presenting symptoms, investigation results, and management plan, and from this we classified them as either explained by recognized organic disease or medically unexplained. We also recorded the number of investigations and whether psychosocial factors were mentioned in the letter to the referring doctor. Complete data were available for 93 people of South Asian origin and 98 white Europeans. The proportion of each who had medically unexplained symptoms was 52% and 49% respectively. The mean number (SD) of investigations in each was 1.8 (1.5) and 1.7 (1.6). Psychosocial factors were mentioned in correspondence of 42% and 45% respectively. The prevalence of medically unexplained symptoms, in this UK clinic, is similar among younger adults of South Asian and white European origin. South Asians undergo similar investigation and psychosocial inquiry to their white counterparts, suggesting that younger South Asians are managed similarly to white Europeans with respect to this aspect of medical care.

Not being “fat” is not always being “fit”: Why are S. Asians more prone to Type 2 diabetes and atherosclerotic cardiovascular disease?

People of South Asian ethnicity, irrespective of their place of residency, have an increased predisposition to Type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD). S. Asians have often shown similar or lower prevalence of traditional risk factors compared to other ethnic groups in spite of a greater risk as compared to the other groups. Recent evidence indicates that obesity and alterations in the levels or actions of adipokines play a key role in leading to insulin resistance and a proinflammatory state which predispose to T2DM and ASCVD. But how does one explain the fact that in spite of people of S. Asian ethnicity being more prone to T2DM and ASCVD, obesity as defined by Body Mass Index (BMI) is significantly lower in Asian Indians compared to Caucasians? So can one not be fat and yet not be fit?

Ethnic differences in heart rate: can these be explained by conventional cardiovascular risk factors?

South Asians worldwide have an elevated risk of coronary heart disease (CHD), only partly explicable by a higher prevalence of diabetes. Diabetes and dysglycaemia are associated with increased heart rates and abnormal cardiac sympathovagal balance, and are predictive of increased coronary mortality. This study investigated ethnic differences in heart rate, sympathovagal balance, and baroreflex sensitivity (BRS) to establish if they were explained by dysglycaemia/insulin resistance. 84 South Asian and 83 European men (age 45-85 yrs), half with established CHD and half without proven CHD, underwent metabolic profiling and assessment of mean RR interval, heart rate variablility (HRV) and BRS. Mean resting RR interval was greater in Europeans than South Asians (1014 (149) ms vs. 936 (158) ms respectively, means (SD); P = 0.005). This corresponded to resting heart rates of 59.1 bpm for Europeans and 64.1 bpm for South Asians. No ethnic differences were detected in HRV or BRS. Insulin resistance, assessed by the homeostasis model of assessment of insulin resistance (HOMA-IR), correlated with mean RR interval (beta coefficient = -0.189, P = 0.04) and BRS (beta coefficient = -0.246, P = 0.006) and similar correlations were seen with fasting serum glucose. However, ethnic differences in mean RR interval persisted after adjustment for age, systolic BP, beta blocker use, and HOMA-IR. South Asian men have higher heart rates compared with European men. This difference was not explained by measures of insulin resistance or other risk factors. This may be indicative of altered sympathovagal balance, and contribute to the greater coronary disease risk in people of South Asian ethnicity.