title: Ethnic variations in chest pain and angina in men and women: Scottish Ethnicity and Health Linkage Study of 4.65 million people.
abstract: BACKGROUND
  European research on ethnic variations in cardiovascular disease has mostly examined mortality endpoints using country of birth as a proxy for ethnicity. We report on chest pain and angina by ethnic group.
  
  
  METHODS
  Retrospective cohort linking the Census 2001 for Scotland (providing 14 ethnic group categories) and hospital discharge/community and hospital deaths data. Directly age-standardized rates and rate ratios were calculated. Risk ratios were adjusted for age and then highest educational qualification of the individual using Poisson regression. Ratios were multiplied by 100 and 95% confidence intervals (CI) were calculated. The reference was the White Scottish population (100). In the results below, the 95% CI excludes 100.
  
  
  RESULTS
  There was raised chest pain mortality/hospital discharge risk in Indian men (rate ratio 141.2), Other South Asian women (rate ratio 140.9), and Pakistanis (rate ratio 216.2 in men, 243.0 in women). Rate ratios were lowest in other White British (rate ratio 76.1 in men, 73.7 in women) and Chinese (rate ratio 67.6 in men, 76.7 in women). Adjustment for age and education attenuated, but did not abolish, differences in other White British (risk ratio from 73.5 to 83.5) and Pakistani (risk ratio from 209.0 to 198.2) male populations and increased them in most others, e.g. other South Asian men (from risk ratio of 128.9 to 140.1). Pakistani populations had the highest risk of angina (rate ratio 189.3 in men, 159.7 in women). Other White British (rate ratio 81.4 for men, 78.0 for women), Other White (rate ratio 89.6 men, 85.2 women), and Chinese (rate ratio 60.5 men, 67.4 women) had the lowest risk. Adjustment for education did not greatly alter these patterns.
  
  
  CONCLUSIONS
  There were important ethnic variations. The results call for replication elsewhere in Europe and targeted prevention programmes and vigilant diagnosis and management by clinicians.
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK. Raj.Bhopal@ed.ac.uk
authors.forename: Raj S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: Narinder
authors.initials: N
authors.lastname: Bansal
authors.forename: Colin
authors.initials: C
authors.lastname: Fischbacher
authors.forename: Helen
authors.initials: H
authors.lastname: Brown
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D044466:Asian People / Q000706:statistics & numerical data*; D019352:Censuses; D002637:Chest Pain / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D002681:China / Q000208:ethnology; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007194:India / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan / Q000208:ethnology; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*