Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.

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The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings

BMJ Open ◽

10.1136/bmjopen-2021-050647 ◽

2021 ◽

Vol 11 (9) ◽

pp. e050647

Author(s):

Katherine Woolf ◽

Carl Melbourne ◽

Luke Bryant ◽

Anna L Guyatt ◽

I Chris McManus ◽

...

Keyword(s):

Healthcare Workers ◽

Minority Groups ◽

Ethnic Minority Groups ◽

Explanatory Variables ◽

Healthcare Settings ◽

The United Kingdom ◽

Sensitive Topics ◽

Increased Risk ◽

Prospective Longitudinal

IntroductionThe COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).Methods and analysisA baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.Ethics and disseminationThe study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.Trial registration numberISRCTN11811602; Pre-results.

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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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Ethnic differences in risk of severe Covid-19: To what extent are they driven by exposure?

Journal of Public Health ◽

10.1093/pubmed/fdab347 ◽

2021 ◽

Author(s):

Rhiannon Edge ◽

Diana A van der Plaat ◽

Vaughan Parsons ◽

David Coggon ◽

Martie van Tongeren ◽

...

Keyword(s):

Ethnic Groups ◽

Sickness Absence ◽

South Asian ◽

Ethnic Differences ◽

Minority Groups ◽

Ethnic Minority Groups ◽

Short Term ◽

Black African ◽

White Ethnicity ◽

Pandemic Wave

Abstract Background This study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England. Methods We analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups. Results In comparison with White ethnic groups, the risk of short-duration Covid-19 sickness absence was modestly elevated in South Asian but not Black groups. However, all Black and ethnic minority groups were at higher risk of prolonged Covid-19 sickness absence. Odds ratios (ORs) relative to White ethnicity were more than doubled in South Asian groups (Indian OR 2.49, 95% confidence interval (CI) 2.36–2.63; Pakistani OR 2.38, 2.15–2.64; Bangladeshi OR 2.38, 1.98–2.86), while that for Black African ethnicity was 1.82 (1.71–1.93). In nursing/midwifery staff, the association of ethnicity with prolonged Covid-19 sickness absence was strong; the odds of South Asian nurses/midwives having a prolonged episode of Covid-19 sickness absence were increased 3-fold (OR 3.05, 2.82–3.30). Conclusions Residual differences in risk of short term Covid-19 sickness absences among ethnic groups may reflect differences in non-occupational exposure to SARS-CoV-2. Our results indicate ethnic differences in vulnerability to Covid-19, which may be only partly explained by medical comorbidities.

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Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter

Journal of Medical Internet Research ◽

10.2196/17048 ◽

2020 ◽

Vol 22 (8) ◽

pp. e17048

Author(s):

Yulin Hswen ◽

Jared B Hawkins ◽

Kara Sewalk ◽

Gaurav Tuli ◽

David R Williams ◽

...

Keyword(s):

United States ◽

Ethnic Groups ◽

Patient Experience ◽

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Patient Experiences ◽

Ethnic Minority Groups ◽

Twitter Users ◽

Racial And Ethnic Minority

Background Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. Objective This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. Methods In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. Results Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White. Conclusions The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

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Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter (Preprint)

10.2196/preprints.17048 ◽

2019 ◽

Author(s):

Yulin Hswen ◽

Jared B Hawkins ◽

Kara Sewalk ◽

Gaurav Tuli ◽

David R Williams ◽

...

Keyword(s):

United States ◽

Ethnic Groups ◽

Patient Experience ◽

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Patient Experiences ◽

Ethnic Minority Groups ◽

Twitter Users ◽

Racial And Ethnic Minority

BACKGROUND Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. OBJECTIVE This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. METHODS In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. RESULTS Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White. CONCLUSIONS The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

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The Electoral Effects of the Descriptive Representation of Ethnic Minority Groups in Australia and the United Kingdom

SSRN Electronic Journal ◽

10.2139/ssrn.2374914 ◽

2014 ◽

Author(s):

Joshua Zingher ◽

Benjamin D. Farrer

Keyword(s):

United Kingdom ◽

Ethnic Minority ◽

Minority Groups ◽

Descriptive Representation ◽

Ethnic Minority Groups ◽

The United Kingdom

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Do sex differences in the prevalence of ECG abnormalities vary across ethnic groups living in the Netherlands? A cross-sectional analysis of the population-based HELIUS study

BMJ Open ◽

10.1136/bmjopen-2020-039091 ◽

2020 ◽

Vol 10 (9) ◽

pp. e039091

Author(s):

Renee Bolijn ◽

C Cato ter Haar ◽

Ralf E Harskamp ◽

Hanno L Tan ◽

Jan A Kors ◽

...

Keyword(s):

Risk Factors ◽

Sex Differences ◽

Ethnic Minority ◽

Ethnic Groups ◽

South Asian ◽

Minority Groups ◽

Population Based ◽

Secondary Outcome ◽

Ethnic Minority Groups ◽

Ecg Abnormalities

ObjectivesMajor ECG abnormalities have been associated with increased risk of cardiovascular disease (CVD) burden in asymptomatic populations. However, sex differences in occurrence of major ECG abnormalities have been poorly studied, particularly across ethnic groups. The objectives were to investigate (1) sex differences in the prevalence of major and, as a secondary outcome, minor ECG abnormalities, (2) whether patterns of sex differences varied across ethnic groups, by age and (3) to what extent conventional cardiovascular risk factors contributed to observed sex differences.DesignCross-sectional analysis of population-based study.SettingMulti-ethnic, population-based Healthy Life in an Urban Setting cohort, Amsterdam, the Netherlands.Participants8089 men and 11 369 women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged 18–70 years without CVD.Outcome measuresAge-adjusted and multivariable logistic regression analyses were performed to study sex differences in prevalence of major and, as secondary outcome, minor ECG abnormalities in the overall population, across ethnic groups and by age-groups (18–35, 36–50 and >50 years).ResultsMajor and minor ECG abnormalities were less prevalent in women than men (4.6% vs 6.6% and 23.8% vs 39.8%, respectively). After adjustment for conventional risk factors, sex differences in major abnormalities were smaller in ethnic minority groups (OR ranged from 0.61 in Moroccans to 1.32 in South-Asian Surinamese) than in the Dutch (OR 0.49; 95% CI 0.36 to 0.65). Only in South-Asian Surinamese, women did not have a lower odds than men (OR 1.32; 95% CI 0.96 to 1.84). The pattern of smaller sex differences in ethnic minority groups was more pronounced in older than in younger age-groups.ConclusionsThe prevalence of major ECG abnormalities was lower in women than men. However, sex differences were less apparent in ethnic minority groups. Conventional risk factors did not contribute substantially to observed sex differences.

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The Recruitment and Retention of Members of Black and other Ethnic Minority Groups to NHS Research Ethics Committees in the United Kingdom

Research Ethics ◽

10.1177/174701610500100106 ◽

2005 ◽

Vol 1 (1) ◽

pp. 27-31 ◽

Cited By ~ 2

Author(s):

Babatunde A. Gbolade

Keyword(s):

United Kingdom ◽

Ethnic Minority ◽

Research Ethics ◽

Minority Groups ◽

Ethics Committees ◽

Research Ethics Committees ◽

Ethnic Minority Groups ◽

Recruitment And Retention ◽

Ethical Implications ◽

The United Kingdom

The publication ‘Governance arrangements for NHS Research Ethics Committees’ is clear in its recommendations about the composition of National Health Service research ethics committees in the United Kingdom. It highlights the need for a sufficiently broad range of experience and expertise, balanced age and gender distribution and every effort to be made to recruit members from black and ethnic minority backgrounds, as well as people with disabilities. It was considered that this composition would make it possible for the scientific, clinical and methodological aspects of a research proposal to be reconciled with the welfare of research participants, and with broader ethical implications. Black and other ethnic minorities constitute 7.9 per cent of the UK population. Ideally, in any research ethics committee with a maximum of 18 members, at least one would be a member of the black or other ethnic minority groups. However, this does not appear to be the case; some committees having more than one, while most do not have any. This paper looks at the present position and suggests ways of improving recruitment and retention of members of these groups.

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