title: Ethnic variations in heart failure: Scottish Health and Ethnicity Linkage Study (SHELS).
abstract: OBJECTIVE
  Ethnic variations in heart failure are, apparently, large (eg, up to threefold in South Asians compared with White populations in Leicestershire, UK) but data are limited and conflicting. The incidence of first occurrence of heart failure hospitalisation or death by ethnic group in Scotland was studied. DESIGN, SETTING, POPULATIONS AND OUTCOMES: A retrospective cohort study was developed of 4.65 million people using non-disclosive, computerised methods linking the Scottish 2001 census (providing ethnic group) to community death and hospital discharge/deaths data (SMR01). Annual, directly age standardised incidence rates per 100,000, incidence rate ratios (RRs) and risk ratios using Poisson regression were calculated. Ratios were multiplied by 100. Risk ratios were adjusted for age and highest education qualification. Statements of difference imply the 95% CI excludes 100 (reference), otherwise the CI is given.
  
  
  RESULTS
  In men, other White British (RR=86.4) and Chinese (RR=54.2) had less heart failure than White Scottish (100) populations while Pakistani men had more (RR=134.9). In women, the pattern was similar to men. Adjustment for highest educational qualification attenuated differences in risk ratios in other White British men (risk ratio=75.8 to 85.4) and women (66.2 to 74.6), made little difference to Pakistani men (146.9 to 142.1) and women (177.4 to 158.1), and augmented them in Indian men (115.4 (95% CI 93.1 to 143.0) to 131.7 (107.4 to 161.5)).
  
  
  CONCLUSIONS
  Ethnic variations in heart failure were important in this population setting and not abolished by adjusting for highest education, one important indicator of socioeconomic differences. The ethnic variations were substantial but did not support other studies showing 3-20-fold differences between ethnic groups.
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Studies, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK. raj.bhopal@ed.ac.uk
authors.forename: R S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: N
authors.initials: N
authors.lastname: Bansal
authors.forename: C M
authors.initials: CM
authors.lastname: Fischbacher
authors.forename: H
authors.initials: H
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Capewell
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology