Mortality, ethnicity, and country of birth on a national scale, 2001-2013: A retrospective cohort (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).
复制标题
DOI：
10.1371/journal.pmed.1002515
复制
发表时间：
2018-03
期刊：
影响因子：
15.8
通讯作者：
Sheikh A
中科院分区：
文献类型：
--
作者：
Bhopal RS;Gruer L;Cezard G;Douglas A;Steiner MFC;Millard A;Buchanan D;Katikireddi SV;Sheikh A
移民和少数民族群体往往被认为相对于多数人口健康状况较差。很少有国家有能力研究按族裔和出生国分列的死亡率这一关键指标。我们假设，在苏格兰，不同种族群体的死亡率至少有10%的差异，这种差异不会因社会经济因素或出生国的调整而完全减弱。我们将苏格兰2001年人口普查与死亡率数据联系起来（2001-2013年）462万人（估计人口的91%），计算年龄调整死亡率比率（RRs;乘以100作为百分比），13个种族组的95%置信区间（CI），以苏格兰白色群体为参考（民族分类遵循苏格兰2001年人口普查）。苏格兰多重继承指数、教育状况和家庭保有权是社会经济地位（SES）混杂变量，出生在英国或爱尔兰共和国（UK/RoI）是一个相互作用和混杂变量。吸烟和糖尿病数据来自初级保健子样本（约53，000人）。在大多数少数民族群体中，男性和女性的年龄调整死亡率RR低于苏格兰白色群体。95% CI提供了良好的证据，证明以下种族群体的RR低于10%以上：其他白色英国人（男性72.3 [95% CI 64.2，81.3]，女性75.2 [68.0，83.2]）;其他白色（男性80.8 [72.8，89.8]，女性76.2 [68.6，84.7]）;印度人（男性62.6 [51.6，76.0]，女性60.7 [50.4，73.1]）;巴基斯坦人（男性66.1 [57.4，76.2]，女性73.8 [63.7，85.5]）;孟加拉国男性（50.7 [32.5，79.1]）;加勒比女性（57.5 [38.5，85.9]）;和中国人（男性52.2 [43.7，62.5]，女性65.8 [55.3，78.2]）。在调整UK/RoI出生和SES变量后，差异有所减少，但没有消除。在国外出生的12个少数民族群体中，死亡率优势明显，但在联合王国/爱尔兰共和国出生的男性群体中，只有6/12的男性群体和5/12的女性群体。在初级保健子样本中，调整年龄、英国/RoI出生、SES、吸烟和糖尿病后，印度男性（114.7 [95% CI 78.3，167.9]）和巴基斯坦女性（103.9 [73.9，145.9]）的RR分别不低于苏格兰白色男性和女性。主要的局限性是无法包括国外的死亡人数，以及一些少数民族群体的死亡人数很少，特别是在联合王国/爱尔兰共和国出生的人。许多少数民族群体的死亡率相对较低相比，白色苏格兰多数。死亡率的优势是不太明显，在英国/RoI出生的少数群体的后代比移民。这些差异需要解释，与健康有关的行为似乎很重要。国际上需要进行类似的分析，以实现监测、了解和改善多族裔社会健康状况的商定目标，并将其应用于卫生政策，特别是关于卫生不平等和不公平的政策。利用苏格兰健康和种族联系研究的数据，Raj Bhopal和同事研究了种族，出生国和死亡率之间的关系。一个重要的问题是，少数民族人口的健康状况是否比他们居住的国家的大多数人口更差或更好。关于这个问题的有限的国际证据，包括来自英国的证据，尚不清楚。研究人员使用死亡率（一种国际公认的人口健康指标）比较了苏格兰各民族的健康状况。他们通过匿名将苏格兰12年（2001-2013年）462万人的死亡记录与2001年的苏格兰人口普查联系起来，从而创建了一项回顾性队列研究。他们几乎包括了整个苏格兰人口，并使用了个人在人口普查中提供的族裔群体类别。大多数少数族裔群体中的男性和女性的死亡率都比大多数苏格兰白色人口相对较低，即使考虑到后者的平均年龄较高。华人群体的死亡率最低。出生在英国或爱尔兰共和国以外的族裔群体成员与占多数的苏格兰白色相比，死亡率通常相对较低，但这种模式在英国或爱尔兰共和国境内出生的人中并不明显。这项研究表明，以死亡率衡量，苏格兰少数民族群体的健康状况相对较好。究竟为什么会这样，目前还不清楚，可能有很多原因。通过更详细的研究，例如，我们可以从中国人的健康状况出发，找到提高全体人民健康水平的途径。与不平等、不公平和健康的社会决定因素有关的政策、研究和公共卫生实践应考虑纳入种族健康观点。
Migrant 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. We 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. There 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. Using data from the Scottish Health and Ethnicity Linkage Study, Raj Bhopal and colleagues examine the associations between ethnicity, country of birth, and mortality. There is an important question of whether ethnic minority populations have worse or better health than the majority population of the country they live in. The limited international evidence on this question, including from the UK, is unclear. Using death rates, an internationally accepted measure of population health, the researchers compared the health of ethnic groups in Scotland. They did this by anonymously linking Scottish death records for 4.62 million people for 12 years (2001–2013) to the Scotland census for 2001, thus creating a retrospective cohort study. They included almost the whole Scottish population and used the ethnic group categories that individuals had provided in the census. Both males and females in most ethnic minority groups had relatively lower death rates than the majority White Scottish population, even when the older average age of the latter was accounted for. The Chinese ethnic group had the lowest death rates. Members of ethnic groups born outside the UK or Republic of Ireland generally had comparatively low mortality compared to the White Scottish majority, but this pattern was not clear cut in those born within the UK or Republic of Ireland. This study shows that, as measured by death rates, ethnic minority groups in Scotland have relatively good health. Exactly why this is remains unclear and probably has many reasons. By more detailed studies, e.g., of the Chinese ethnic group, we may be able to find ways of improving the health of the whole population. Policy, research, and public health practice in relation to inequalities, inequities, and the social determinants of health should consider incorporating an ethnic health perspective.
登录
查看更多内容
影响因子：
5.2
作者：
McCartney, G.;Collins, C.;Batty, G. D.
通讯作者：
Batty, G. D.
影响因子：
2.7
作者：
Fischbacher, C. M.;Steiner, M.;Povey, C.
通讯作者：
Povey, C.
影响因子：
4.4
作者：
Rafnsson, Snorri B.;Bhopal, Raj S.
通讯作者：
Bhopal, Raj S.
影响因子：
7.7
作者：
Barbieri, Magali;Wilmoth, John R.;Winant, Celeste
通讯作者：
Winant, Celeste
影响因子：
6.3
作者：
Gruer, Laurence;Cezard, Genevieve;Bhopal, Raj
通讯作者：
Bhopal, Raj