scholarly journals Ethnic differences in guideline-indicated statin initiation for people with type 2 diabetes in UK primary care, 2006–2019: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003672
Author(s):  
Sophie V. Eastwood ◽  
Rohini Mathur ◽  
Naveed Sattar ◽  
Liam Smeeth ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
South Asian ◽  
Ethnic Differences ◽  
Asian Ethnicity ◽  
African Caribbean ◽  
South Asian Ethnicity ◽  
Ascvd Risk ◽  
The Uk ◽  
To Receive

Background Type 2 diabetes is 2–3 times more prevalent in people of South Asian and African/African Caribbean ethnicity than people of European ethnicity living in the UK. The former 2 groups also experience excess atherosclerotic cardiovascular disease (ASCVD) complications of diabetes. We aimed to study ethnic differences in statin initiation, a cornerstone of ASCVD primary prevention, for people with type 2 diabetes. Methods and findings Observational cohort study of UK primary care records, from 1 January 2006 to 30 June 2019. Data were studied from 27,511 (88%) people of European ethnicity, 2,386 (8%) people of South Asian ethnicity, and 1,142 (4%) people of African/African Caribbean ethnicity with incident type 2 diabetes, no previous ASCVD, and statin use indicated by guidelines. Statin initiation rates were contrasted by ethnicity, and the number of ASCVD events that could be prevented by equalising prescribing rates across ethnic groups was estimated. Median time to statin initiation was 79, 109, and 84 days for people of European, South Asian, and African/African Caribbean ethnicity, respectively. People of African/African Caribbean ethnicity were a third less likely to receive guideline-indicated statins than European people (n/N [%]: 605/1,142 [53%] and 18,803/27,511 [68%], respectively; age- and gender-adjusted HR 0.67 [95% CI 0.60 to 0.76], p < 0.001). The HR attenuated marginally in a model adjusting for total cholesterol/high-density lipoprotein cholesterol ratio (0.77 [95% CI 0.69 to 0.85], p < 0.001), with no further diminution when deprivation, ASCVD risk factors, comorbidity, polypharmacy, and healthcare usage were accounted for (fully adjusted HR 0.76 [95% CI 0.68, 0.85], p < 0.001). People of South Asian ethnicity were 10% less likely to receive a statin than European people (1,489/2,386 [62%] and 18,803/27,511 [68%], respectively; fully adjusted HR 0.91 [95% CI 0.85 to 0.98], p = 0.008, adjusting for all covariates). We estimated that up to 12,600 ASCVD events could be prevented over the lifetimes of people currently affected by type 2 diabetes in the UK by equalising statin prescribing across ethnic groups. Limitations included incompleteness of recording of routinely collected data. Conclusions In this study we observed that people of African/African Caribbean ethnicity with type 2 diabetes were substantially less likely, and people of South Asian ethnicity marginally less likely, to receive guideline-indicated statins than people of European ethnicity, even after accounting for sociodemographics, healthcare usage, ASCVD risk factors, and comorbidity. Underuse of statins in people of African/African Caribbean or South Asian ethnicity with type 2 diabetes is a missed opportunity to prevent cardiovascular events.

scholarly journals Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK

Diabetologia ◽  
2021 ◽  
Author(s):  
Aliki-Eleni Farmaki ◽  
Victoria Garfield ◽  
Sophie V. Eastwood ◽  
Ruth E. Farmer ◽  
Rohini Mathur ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
South Asian ◽  
First Generation ◽  
Second Generation ◽  
African Caribbean ◽  
First Generation Migrants ◽  
The Uk ◽  
Mixed Ethnicity ◽  
Second Generation Migrants

Abstract Aims/hypothesis Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. Methods Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40–69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. Results Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis. Conclusions/interpretation Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk. Graphical abstract

scholarly journals Explanations for less small fibre neuropathy in South Asian versus European subjects with type 2 diabetes in the UK

2018 ◽  
Vol 34 (7) ◽  
pp. e3044 ◽  
Author(s):  
Hassan Fadavi ◽  
Mitra Tavakoli ◽  
Philip Foden ◽  
Maryam Ferdousi ◽  
Ioannis N. Petropoulos ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
South Asian ◽  
Small Fibre Neuropathy ◽  
Small Fibre ◽  
The Uk

scholarly journals Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE)

2010 ◽  
Vol 104 (2) ◽  
pp. 276-285 ◽  
Author(s):  
A. S. Donin ◽  
C. M. Nightingale ◽  
C. G. Owen ◽  
A. R. Rudnicka ◽  
M. C. McNamara ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Total Energy ◽  
Energy Intake ◽  
South Asian ◽  
Saturated Fat ◽  
Nutritional Composition ◽  
Total Energy Intake ◽  
Black African ◽  
African Caribbean

In the UK, South Asian adults have increased risks of CHD, type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity but lower CHD risk. There is growing evidence that these risk differences emerge in early life and that nutritional factors may be important. We have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 h recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. In all, 2209 children aged 9–10 years took part, including 558 of South Asian, 560 of black African-Caribbean and 543 of white European ethnicity. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein (both absolute and as proportions of total energy intake) were higher and their intakes of carbohydrate as a proportion of energy (particularly sugars), vitamin C and D, Ca and haem Fe were lower. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat (both absolute and as proportions of energy intake), NSP, vitamin D and Ca. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional composition of children's diets, which may contribute to future differences in chronic disease risk.

Effects of White European, African Caribbean and South Asian ethnicity on homocysteine levels in patients with systolic heart failure

2008 ◽  
Vol 129 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Michael D. Sosin ◽  
Jeetesh V. Patel ◽  
Gurbir S. Bhatia ◽  
Elizabeth A. Hughes ◽  
Russell C. Davis ◽  
...  
Keyword(s):  
Heart Failure ◽  
South Asian ◽  
Systolic Heart Failure ◽  
Asian Ethnicity ◽  
African Caribbean ◽  
South Asian Ethnicity

scholarly journals ‘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

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.

scholarly journals Early Emergence of Ethnic Differences in Type 2 Diabetes Precursors in the UK: The Child Heart and Health Study in England (CHASE Study)

PLoS Medicine ◽  
2010 ◽  
Vol 7 (4) ◽  
pp. e1000263 ◽  
Author(s):  
Peter H. Whincup ◽  
Claire M. Nightingale ◽  
Christopher G. Owen ◽  
Alicja R. Rudnicka ◽  
Ian Gibb ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Differences ◽  
Health Study ◽  
Early Emergence ◽  
The Uk
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