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Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis

Background The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. Methods We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. Findings 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9·6% [95%CI 8·0–11·2%], black people 16·2% [12·8–19·6%], white people 14·6% [11·5–17·8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7·6% [3·7–11·4%], black people 15·0% [3·5–26·5%], white people 10·6% [4·6–16·7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2·9 [2·4–3·4]) and black people (2·1 [1·8–2·5]). Interpretation The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services. The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9·6% [95%CI 8·0–11·2%], black people 16·2% [12·8–19·6%], white people 14·6% [11·5–17·8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7·6% [3·7–11·4%], black people 15·0% [3·5–26·5%], white people 10·6% [4·6–16·7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2·9 [2·4–3·4]) and black people (2·1 [1·8–2·5]). The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.

Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis

The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences. We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models. 13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9.6% [95%CI 8.0-11.2%], black people 16.2% [12.8-19.6%], white people 14.6% [11.5-17.8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7.6% [3.7-11.4%], black people 15.0% [3.5-26.5%], white people 10.6% [4.6-16.7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2.9 [2.4-3.4]) and black people (2.1 [1.8-2.5]). The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.

Medical Specialties Assuming the Role of Trauma Team Leader in Canadian Trauma Centers

Background: The use of medical staff from various medical specialties as trauma team leaders (TTL) is a subject of debate and varies from one region to another. This survey reports the current situation among Canadian trauma centers. Methods: Trauma centers were identified on the Internet through the provincial health ministry and regional health authority websites and the Trauma Association of Canada (TAC). Provincially designated or TAC-accredited trauma centers were surveyed by telephone and mail to obtain and confirm information regarding hospital designation and the medical specialties assuming the role of TTL. Results: 30 trauma centers in nine of the ten Canadian provinces were identified. Surgeons were assigned the role of TTL in 25 of 30 hospitals (83%), and assumed this role an average of 59.4% (± 39%) of the time. The use of emergency medicine physicians as TTL was reported in 18 hospitals (60%), and 34.4% (± 38%) of the time. Other specialties were reported as TTL in seven hospitals (23%) for 6.2% (± 19%) of the time. Conclusion: Surgeon involvement as TTL remains the most frequent approach used at major Canadian trauma centers, however nonsurgeon specialists, particularly emergency medicine physicians, lead a nonnegligible proportion of trauma team resuscitations.

A Campaign to Promote the Health Authority Website and the Services it Provides

A Campaign to Promote the Health Authority Website and the Services it Provides