The potential for measuring ethnicity and health in a multicultural milieu - the case of type 2 diabetes in Australia

ObjectiveEthnicity influences health in many ways. For example, type 2&nbsp;diabetes (T2DM) is disproportionately prevalent among certain ethnic groups.&nbsp;Assessing ethnicity is difficult, and numerous proxy measures are used to&nbsp;capture its various components. Australian guidelines specify a set of&nbsp;variables for measuring ethnicity, and how such parameters should be&nbsp;categorised. Using T2DM data collections as an illustrative example, this&nbsp;study sought to examine how ethnicity is measured in Australian health&nbsp;databases and, by comparing current practice with Australia&rsquo;s existing&nbsp;benchmark recommendations, to identify potential areas for improvement of&nbsp;the health data landscape.DesignWe identified databases containing information from which ethnic&nbsp;group-specific estimates of T2DM burden may be gleaned. For each&nbsp;database, details regarding ethnicity variables were extracted, and compared&nbsp;with the Australian guidelines.&nbsp;ResultsData collection instruments for 32 relevant databases were reviewed.&nbsp;Birthplace was recorded in 27 databases (84%), but mode of birthplace&nbsp;assessment varied. Indigenous status was commonly recorded (78%, n=25), but&nbsp;only nine databases recorded other aspects of self-perceived race/ethnicity. Of&nbsp;28 survey/audit databases, 14 accommodated linguistic preferences other than&nbsp;English, and 11 either excluded non-English speakers or those for whom a&nbsp;translator was not available, or only offered questionnaires in English.ConclusionsConsiderable variation exists in the measurement of ethnicity in&nbsp;Australian health data- sets. While various markers of ethnicity provide&nbsp;complementary information about the ethnic profile within a data-set, nonuniform&nbsp;measurement renders comparison between data-sets difficult. A&nbsp;standardised approach is necessary, and identifying the ethnicity variables&nbsp;that are particularly relevant to the health sector is warranted. Including self identified&nbsp;ethnicity in Australia&rsquo;s set of recommended indicators and as a core&nbsp;component of the national census should be considered. Globalisation and&nbsp;increasing migration mean that these findings have implications internationally,&nbsp;including for multi-ethnic countries throughout North America and&nbsp;Europe.</div

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight:a systematic review and meta-analysis

Background: Vitamin B-12 and folate are micronutrients essential for normal embryogenesis. Vitamin B-12 insufficiency in pregnancy is high in certain parts of the world, such as India, and although this has been linked to low birth weight (LBW) in these populations, the relation between vitamin B-12 and birth weight (BW) elsewhere is unknown. Objectives: We performed a systematic review to assess 1) the worldwide prevalence of vitamin B-12 insufficiency in pregnancy and 2) its association with BW. Design: A search of 5 electronic databases was performed to identify eligible articles. Random-effects meta-analysis was conducted according to geographic regions and pregnancy trimesters for the prevalence subreview and by categorical measures of BW. Results: A total of 57 and 23 articles were included for the prevalence and BW subreviews, respectively. The pooled estimates of vitamin B-12 insufficiency were 21%, 19%, and 29% in the first, second, and third trimesters, respectively, with high rates for the Indian subcontinent and the Eastern Mediterranean. The large heterogeneity between studies was partially addressed by creating a standardized score for each study (mean vitamin B-12 insufficiency ÷ cutoff value), which internally corrected for geographic region, trimester, and assay type. Twelve of the 13 longitudinal studies included showed a decrease in mean or median vitamin B-12 across trimesters. Pooled analysis showed nonsignificantly lower maternal vitamin B-12 concentrations in LBW than in normal-BW infants and higher odds of LBW with lower vitamin B-12 values (adjusted OR: 1.70; 95% CI: 1.16, 2.50), but studies from India largely contributed to the latter. Conclusions: Our review indicates that vitamin B-12 insufficiency during pregnancy is common even in nonvegetarian populations and that concentrations of vitamin B-12 decrease from the first to the third trimester. There is no consistent association between vitamin B-12 insufficiency and LBW. However, given the long-term risks of LBW, this observation warrants further cohort studies and randomized controlled trials

An urgent call to save and protect lives of vulnerable populations in the Gaza Strip

publishersversionpublishe

Ethnic variations in five lower gastrointestinal diseases: Scottish Health and Ethnicity Linkage Study

OBJECTIVES: Our objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower gastrointestinal disorders in Scotland? SETTING: Scotland. POPULATION: This retrospective-cohort linked 4.65 (of 4.9) million people in the 2001 census of Scotland (providing data on ethnicity, country of birth and indicators of socioeconomic deprivation) to 9 years of National Health Service hospitalisation and death records. PRIMARY AND SECONDARY OUTCOME MEASURES AND ANALYSIS: For appendicitis, we studied all ages; for irritable bowel syndrome, ulcerative colitis, Crohn's disease and diverticular disease, we included those ≥20 years. Using Poisson regression (robust variance) we calculated, by ethnic group and sex, first-hospitalisation/death age-adjusted rates per 100 000 person-years, and relative risks (RRs) with 95% CIs multiplied by 100, so the White Scottish reference population had an RR=100. RESULTS: There were ethnic variations; for example, for irritable bowel syndrome, RRs (95% CIs) were comparatively high in Other White British women (128.4 (111.0 to 148.6)), and low in Pakistani women (75.1 (60.6 to 93.1)). For appendicitis, RRs were high in men in Other White British (145.2 (127.8 to 164.9)), and low in most non-White groups, for example, Pakistanis (73.8 (56.9 to 95.6)). For ulcerative colitis, RRs were high in Indian (169.8 (109.7 to 262.7)) and Pakistani (160.8 (104.2 to 248.2)) men. For Crohn's disease, the RR was high in Pakistani men (209.2 (149.6 to 292.6)). For diverticular disease, RRs were high in Irish men (176.0 (156.9 to 197.5)), and any Mixed background women (144.6 (107.4 to 194.8)), and low in most non-White groups, for example, Chinese men (47.1 (31.0 to 71.6) and women (46.0 (30.4 to 69.8)). CONCLUSIONS: Appendicitis and diverticular disease were comparatively low in most non-White groups, while ulcerative colitis and Crohn's disease were mostly higher in South Asians. Describing and understanding such patterns may help clinical practice and research internationally