Does the ‘Scottish effect’ apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study

Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
BMJ Open (Impact Factor: 2.27). 09/2012; 2(5). DOI: 10.1136/bmjopen-2012-001957
Source: PubMed


Background and objectives
Although ethnic group variations in cancer exist, no multiethnic, population-based, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in all-cancer, and lung, colorectal, breast and prostate cancers.

Design, setting, population, measures and analysis
This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups.

For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups.

The ‘Scottish effect’ does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of cost-effectiveness of screening, given comparatively low cancer rates.

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Available from: Raj S Bhopal
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    ABSTRACT: Purpose: Routine data are needed to monitor ethnic health inequalities. The proportion of hospital discharge records with ethnicity information has been improving in Scotland. The aim of this paper is to assess whether routine data can provide valid comparisons of admission rates by ethnic group. Design/methodology/approach: Routine hospital admissions data in four NHS Boards were analysed by ethnic group and sex to compare incidence rate ratios (IRRs) for acute myocardial infarction (AMI) and coronary heart disease (CHD). A previous study linking health and census ethnicity information for 2001-2003 provided the comparison standard. Findings: There was a similar risk of AMI for South Asian compared to non-South Asian people in 2009-2011 and 2001-2003. South Asian people and Pakistani women had higher risk of CHD than White Scottish people. The Other White group had higher and the White Irish lower risk of AMI admission in comparison to 2001-2003 data. Research limitations/implications: The comparison used a different age range, did not include community deaths, covered a part of Scotland rather than the whole, and may have been affected by changes to denominators, which were based on the UK census 2001. Originality/value: The similar IRRs for AMI from census linkage in 2001-2003 and NHS data from 2009-2011 suggest routine ethnicity data are valid in some NHS Boards. Analyses can reveal previously unknown variations to justify health improvement action. To maximise the precision of analyses, data completeness needs to be increased and sustained.
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