Changing socio-economic and ethnic disparities in influenza/A/H1N1 infection early in the 2009 UK epidemic: a descriptive analysis

Abstract Background Higher incidence of and risk of hospitalisation and death from Influenza A(H1N1)pdm09 during the 2009 pandemic was reported in ethnic minority groups in many high-income settings including in the United Kingdom (UK). Many of these studies rely on geographical and temporal aggregation of cases and can be difficult to interpret due to the spatial and temporal factors in outbreak spread. Further, it can be challenging to distinguish between disparities in health outcomes caused by variation in transmission risk or disease severity. Methods We used anonymised laboratory confirmed and suspected case data, classified by ethnicity and deprivation status, to evaluate how disparities in risk between socio-economic and ethnic groups vary over the early stages of the 2009 Influenza A(H1N1)pdm09 epidemic in Birmingham and London, two key cities in the emergence of the UK epidemic. We evaluated the relative risk of infection in key ethnic minority groups and by national and city level deprivation rank. Results We calculated higher incidence in more deprived areas and in people of South Asian ethnicity in both Birmingham and London, although the magnitude of these disparities reduced with time. The clearest disparities existed in school-aged children in Birmingham, where the most deprived fifth of the population was 2.8 times more likely to be infected than the most affluent fifth of the population. Conclusions Our analysis shows that although disparities in reported cases were present in the early phase of the Influenza A(H1N1)pdm09 outbreak in both Birmingham and London, they vary substantially depending on the period over which they are measured. Further, the development of disparities suggest that clustering of social groups play a key part as the outbreak appears to move from one ethnic and socio-demographic group to another. Finally, high incidence and large disparities between children indicate that they may hold an important role in driving inequalities.

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Ethnic Disparities in Dental Caries among Six-Year-Old Children in the Netherlands

Caries Research ◽

10.1159/000448663 ◽

2016 ◽

Vol 50 (5) ◽

pp. 489-497 ◽

Cited By ~ 15

Author(s):

Justin T. van der Tas ◽

Lea Kragt ◽

Jaap J.S. Veerkamp ◽

Vincent W.V. Jaddoe ◽

Henriette A. Moll ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Ethnic Minority ◽

Minority Groups ◽

Ethnic Disparities ◽

Caries Experience ◽

Caries Prevalence ◽

Ethnic Minority Groups ◽

Oral Health Behaviour ◽

Dutch Children

The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.

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Ethnic Disparities in Dental Caries among Adolescents in China

Journal of Dental Research ◽

10.1177/0022034520976541 ◽

2020 ◽

pp. 002203452097654

Author(s):

S.C. Wu ◽

X.X. Ma ◽

Z.Y. Zhang ◽

E.C.M. Lo ◽

X. Wang ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Ethnic Minority ◽

Minority Groups ◽

Negative Binomial ◽

Economic Status ◽

Ethnic Disparities ◽

Caries Experience ◽

Ethnic Minority Groups ◽

Sugary Beverages

Comprehensive research on ethnic disparities in dental caries in China is limited. The aims of this cross-sectional study were to compare the levels of dental caries in adolescents between the Han ethnic group and ethnic minority groups in China and to explore the risk indicators for dental caries within ethnic subgroups. Data from the Fourth National Oral Health Survey in 2015, which covered all 31 province-level administrative divisions in mainland China, were used. The dental caries status in the permanent dentition of adolescents aged 12, 13, 14, and 15 y was measured using the decayed, missing, and filled teeth (DFMT) score, and sociodemographic characteristics and oral health–related behaviors were also collected. A total of 118,601 adolescents were included, with ethnic minority groups accounting for 13.15%. Of the Han and minority groups, the standardized prevalence of dental caries experience was 40.58% and 47.67%, and the mean DMFT scores were 0.97 and 1.28, respectively. According to the multivariate zero-inflated negative binomial regression analysis, the caries status of minorities was more severe than Han adolescents (adjusted prevalence rate ratio [PRR], 1.14; 95% confidence interval [CI], 1.10–1.18). This disparity was greater among adolescents who lived in rural areas, had mid-level economic status, and frequently consumed sugary beverages. After propensity score matchings, Uygur (PRR, 1.44; 95% CI, 1.25–1.67), Tibetan (PRR, 1.39; 95% CI, 1.3–1.48), and Yi (PRR, 1.24; 95% CI, 1.04–1.48) adolescents were significantly more likely to have caries than Han adolescents. Subgroup analyses revealed that gender, age, location of residence, economic status, region, consumption of sweet snacks and sugary beverages, and dental visit pattern were significantly associated with dental caries within ethnic minorities.

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‘It’s possibly made us feel a little more alienated’: How people from ethnic minority communities conceptualise COVID-19 and its influence on engagement with testing

Journal of Health Services Research & Policy ◽

10.1177/13558196211054961 ◽

2022 ◽

pp. 135581962110549

Author(s):

Tushna Vandrevala ◽

Lailah Alidu ◽

Jane Hendy ◽

Shuja Shafi ◽

Aftab Ala

Keyword(s):

Ethnic Minority ◽

South Asian ◽

Minority Groups ◽

Cultural Beliefs ◽

Ethnic Minority Groups ◽

Structured Interviews ◽

Asian Ethnicity ◽

Black African ◽

South Asian Ethnicity ◽

The Uk

Objectives The cultural beliefs, practices and experiences of ethnic minority groups, alongside structural inequalities and the political economy play a critical, but overlooked role in health promotion. This study aimed to understand how ethnic minority groups in the United Kingdom conceptualised COVID-19 and how this influenced engagement in testing. Method Black (African and Caribbean) and South Asian (Indian, Pakistani and Bangladeshi) community members were purposefully recruited from across the UK. Fifty-seven semi-structured interviews were conducted and analysed using principles of grounded theory. Results We found that people of Black and South Asian ethnicity conceptualised COVID-19 as a disease that makes them visible to others outside their community and was seen as having more severe risk and suffering worse consequences, resulting in fear, stigmatisation and alienation. Views about COVID-19 were embedded in cultural beliefs, relating to culturally specific ideas around disease, such as ill-health being God’s will. Challenges brought about by the pandemic were conceptualised as one of many struggles, with the saliency of the virus contextualised against life experiences. These themes and others influenced engagement with COVID-19 testing. Testing was less about accessing timely and effective treatment for themselves and more about acting to protect the family and community. Testing symbolised a loss of income, anxiety and isolation, accentuated by issues of mistrust of the system and not being valued, or being treated unfairly. Conclusion Health communications should focus on counterbalancing the mistrust, alienation and stigmatisation that act as barriers to testing, with trust built using local credible sources.

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Abstract P169: Ethnic Disparities In Short- And Long-term Prognosis After A First Cardiovascular Hospitalization

Circulation ◽

10.1161/circ.129.suppl_1.p169 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Louise Van Oeffelen ◽

Charles Agyemang ◽

Carla Koopman ◽

Karien Stronks ◽

Michiel Bots ◽

...

Keyword(s):

Ethnic Minority ◽

Minority Groups ◽

Ethnic Disparities ◽

Ethnic Minority Groups ◽

Readmission Rates ◽

Majority Population ◽

Short And Long Term ◽

Migrant Groups ◽

Long Term Mortality

Introduction: Ethnic disparities in prognosis after a cardiovascular event have been reported. We investigated differences in mortality and readmission after a first hospital admission for total cardiovascular disease (CVD), AMI, CVA, peripheral arterial disease (PAD), and congestive heart failure (CHF) between several ethnic minority groups and the Dutch majority population. Methods: A nationwide prospective cohort of CVD patients hospitalized between 1998 and 2010 was constructed (N=776,574). Differences in short- and long-term mortality and readmission (0-28 days after admission and 28 days-5 years after admission respectively) between first generation ethnic minority groups (henceforth: migrants) and the Dutch majority population were calculated using multivariable Cox proportional hazard models . Results: In particular mortality after AMI and CVA was higher in migrants compared to the Dutch majority population, except for Moroccans. Short- (HR 1.36; 1.07-1.74) and long-term ( HR 1.45; 1.20-1.75) mortality after CVD was the highest in Chinese migrants. Short-term readmission rates were similar between migrants and the Dutch majority population, except after AMI where mainly lower rates were found (HR:0.37-1.26). Long-term readmission rates were also similar to the Dutch majority population, except after CHF where readmission rates were lower (HR varies between 0.67-0.95), and after AMI where readmission rates for AMI were higher (HR varies between 1.24-1.83). Conclusion: Short- and long-term mortality after CVD is higher in migrant groups than in the Dutch majority population, except after CHF. Differences in readmission rates were more similar to the Dutch majority population, with some fluctuations between sub diseases and migrant groups.

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Ethnic disparities in prevalence and patterns of smoking and nicotine dependence in rural southwest China: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-028770 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028770 ◽

Cited By ~ 1

Author(s):

Xu-Ming Wang ◽

Chao Wu ◽

Allison Rabkin Golden ◽

Cai Le

Keyword(s):

Ethnic Minority ◽

Ethnic Groups ◽

Nicotine Dependence ◽

Southwest China ◽

Minority Groups ◽

Ethnic Disparities ◽

Lower Probability ◽

Ethnic Minority Groups ◽

Cross Sectional ◽

Current Smoking

ObjectivesThis study examines ethnic disparities in prevalence and patterns of smoking and nicotine dependence in rural southwest China.DesignThis was a cross-sectional design.SettingThis study was conducted in rural Yunnan Province of China.Participants7027 consenting individuals aged ≥35 years among Han majority and four ethnic minority groups (Na Xi, Li Shu, Dai and Jing Po) participated in this study. Information about participants’ demographic characteristics as well as smoking habits and an assessment of nicotine dependence with the Fagerstrom Test for Nicotine Dependence (FTND) was obtained using a standard questionnaire.ResultsMales had significantly higher prevalence of current smoking than females (64.8% and 44.4%, p<0.01). Among current smokers, the prevalence of nicotine dependence was significantly higher in males compared with females (19.9% and 7.1%, p<0.01). Jing Po men and women had the highest prevalence of current smokers (72.2% vs 23.1%, p<0.01), whereas the highest prevalence of nicotine dependence was found in male Dai current smokers and female Li Shu current smokers (44.8% vs 32.5%, p<0.01). Filtered cigarettes were the most popular form of tobacco used across all five ethnic groups. Over 75% of tobacco users initiated smoking and regularly smoked during adolescence, and those of minority ethnicity smoked regularly at a younger age than those of Han descent (p<0.05). Individuals in all five ethnic groups with higher levels of education had a lower probability of current smoking status (p<0.05), whereas a negative association of level of education with nicotine dependence was only observed in current smokers in the Han majority and Dai ethnic minority groups. Among Han majority current smokers, higher annual household income was associated with a higher risk of nicotine dependence (p<0.05).ConclusionFuture interventions to control tobacco use should be tailored to address ethnicity and socioeconomic factors.

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Ethnic disparities in incident SARS-CoV-2 infections became wider during the second wave of SARS-CoV-2 in Amsterdam, the Netherlands: a population-based longitudinal study

10.1101/2021.07.21.21260956 ◽

2021 ◽

Author(s):

Liza Coyer ◽

Anders Boyd ◽

Janke Schinkel ◽

Charles Agyemang ◽

Henrike Galenkamp ◽

...

Keyword(s):

The Netherlands ◽

Ethnic Minority ◽

Ethnic Groups ◽

Minority Groups ◽

Markov Models ◽

Ethnic Disparities ◽

Population Based ◽

Prevention Measures ◽

Ethnic Minority Groups ◽

Second Wave

Background Surveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands. Methods We analyzed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modeled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups. Findings 2,497 participants were tested after the first wave; 2,083 (83.4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56.6% were female. Compared to Dutch-origin participants (15.9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25.0%; adjusted hazard ratio [aHR]=1.66;95%CI=1.16-2.40), African Surinamese (28.9%;aHR=1.97;95%CI=1.37-2.83), Turkish (37.0%;aHR=2.67;95%CI=1.89-3.78), Moroccan (41.9%;aHR=3.13;95%CI=2.22-4.42), and Ghanaian (64.6%;aHR=6.00;95%CI=4.33-8.30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p for interaction<0.05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups. Interpretation SARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups.

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