title: Ethnic variations in morbidity and mortality from lower respiratory tract infections: a retrospective cohort study.
abstract: OBJECTIVE
  There is evidence of substantial ethnic variations in asthma morbidity and the risk of hospitalisation, but the picture in relation to lower respiratory tract infections is unclear. We carried out an observational study to identify ethnic group differences for lower respiratory tract infections.
  
  
  METHODS
  A retrospective, cohort study.
  
  
  METHODS
  Scotland.
  
  
  METHODS
  4.65 million people on whom information was available from the 2001 census, followed from May 2001 to April 2010.
  
  
  METHODS
  Hospitalisations and deaths (any time following first hospitalisation) from lower respiratory tract infections, adjusted risk ratios and hazard ratios by ethnicity and sex were calculated. We multiplied ratios and confidence intervals by 100, so the reference Scottish White population's risk ratio and hazard ratio was 100.
  
  
  RESULTS
  Among men, adjusted risk ratios for lower respiratory tract infection hospitalisation were lower in Other White British (80, 95% confidence interval 73-86) and Chinese (69, 95% confidence interval 56-84) populations and higher in Pakistani groups (152, 95% confidence interval 136-169). In women, results were mostly similar to those in men (e.g. Chinese 68, 95% confidence interval 56-82), although higher adjusted risk ratios were found among women of the Other South Asians group (145, 95% confidence interval 120-175). Survival (adjusted hazard ratio) following lower respiratory tract infection for Pakistani men (54, 95% confidence interval 39-74) and women (31, 95% confidence interval 18-53) was better than the reference population.
  
  
  CONCLUSIONS
  Substantial differences in the rates of lower respiratory tract infections amongst different ethnic groups in Scotland were found. Pakistani men and women had particularly high rates of lower respiratory tract infection hospitalisation. The reasons behind the high rates of lower respiratory tract infection in the Pakistani community are now required.
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK c.simpson@ed.ac.uk.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Simpson
authors.affiliation: Department of Child Health, School of Medicine, University of Aberdeen, Aberdeen, UK.
authors.forename: Markus Fc
authors.initials: MF
authors.lastname: Steiner
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Cezard
authors.affiliation: Cardiovascular Epidemiology Unit, The Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Narinder
authors.initials: N
authors.lastname: Bansal
authors.affiliation: NHS National Services, Edinburgh, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Fischbacher
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Douglas
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Bhopal
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston MA, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D001208:Asia / Q000208:ethnology; D002681:China / Q000208:ethnology; D003431:Cross-Cultural Comparison; D005006:Ethnicity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010154:Pakistan / Q000208:ethnology; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000208:ethnology* / Q000401:mortality; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors
keywords: Respiratory tract infections; death; ethnic groups; hospital readmission; hospitalisation; incidence; secondary care