Cohort profile: Scottish Health and Ethnicity Linkage Study of 4.65 million people exploring ethnic variations in disease in Scotland

Many countries require health services to show that they are meeting the needs of ethnic minority populations. This requires data on health status, healthcare uptake and outcomes and population denominators. Weaknesses in routine data collection often make such requirements difficult to meet. Routine data sources in Scotland, as in most countries, may not include a patient’s ethnicity. In Scotland, the need for such data is driven by both policy and legislation responding to rapidly increasing ethnic diversity. Fair For All (2003), Scotland’s policy, provides a strategic approach to improve the health of minority ethnic groups. The UK Race Relations (Amendment) Act (2000) placed a duty on public bodies to promote racial equality. These mandates are reflected in guidance on ethnic monitoring. Appropriate service and research is undermined by the lack of data. Ethnic variations occur in all of Scotland’s national health priority areas, including coronary heart disease/stroke, cancer, maternal and child health and mental health. In view of the mismatch between need for and availability of data by ethnic group, Bhopal proposed a demonstration project to explore retrospective approaches. The project tested proposals including name search methods, analyses by country of birth, modelling/extrapolation from other nations’ datasets, and linkage methods. The demonstration project concluded that census health records linkage methods— in the context of this project first mooted by Povey— held most promise. To our knowledge, attempting matching of a national health dataset to a complete national census using demographic identifiers rather than national identity numbers had not been reported though health data linkage is well-established in the UK and internationally, including exploring ethnicity and health

Conjunctive Use of Canal Water and Groundwater:An Analysis Based on Farmers’ Practices in Ravangaon, Maharashtra

This article examines what happens when canal water is combined with groundwater. It does so by documenting the complex web of practices that are emerging around accessing, storing and transferring water in the command area of irrigation systems in Ravangaon, a village in Maharashtra, India. From mainly accessing water through field channels that are fed by the public surface irrigation system, farmers have moved to using pumps and siphons to transport water from the canal either directly to their fields or to wells and ponds for storage. Their practices are shaped by hydrogeology – most notably the location and storage capacity of the aquifer in relation to canals and farmers’ plots - as well by the political economy – most notably their relative dependence on water-intensive crops like sugarcane. Access to water has largely become a function of one’s ability to invest in advanced pumping, transporting and storage facilities. In line with other scholars, we conclude that the conjunctive use of canal water and groundwater makes it difficult, if not impossible, to trace and monitor actual water use patterns. This means that water distribution increasingly escapes formal and public forms of regulation and control. The article ends with a reflection on what this means to the advancement of water sustainability and justice.</p

A comparison of South Asian specific and established BMI thresholds for determining obesity prevalence in pregnancy and predicting pregnancy complications: findings from the Born in Bradford cohort

Objective: To describe how maternal obesity prevalence varies by established international and South Asian specific body mass index (BMI) cut-offs in women of Pakistani origin and investigate whether different BMI thresholds can help to identify women at risk of adverse pregnancy and birth outcomes. Design: Prospective bi-ethnic birth cohort study (the Born in Bradford (BiB) cohort). Setting: Bradford, a deprived city in the North of the UK. Participants: A total of 8478 South Asian and White British pregnant women participated in the BiB cohort study. Main outcome measures: Maternal obesity prevalence; prevalence of known obesity-related adverse pregnancy outcomes: mode of birth, hypertensive disorders of pregnancy (HDP), gestational diabetes, macrosomia and pre-term births. Results: Application of South Asian BMI cut-offs increased prevalence of obesity in Pakistani women from 18.8 (95% confidence interval (CI) 17.6–19.9) to 30.9% (95% CI 29.5–32.2). With the exception of pre-term births, there was a positive linear relationship between BMI and prevalence of adverse pregnancy and birth outcomes, across almost the whole BMI distribution. Risk of gestational diabetes and HDP increased more sharply in Pakistani women after a BMI threshold of at least 30 kg m−2, but there was no evidence of a sharp increase in any risk factors at the new, lower thresholds suggested for use in South Asian women. BMI was a good single predictor of outcomes (area under the receiver operating curve: 0.596–0.685 for different outcomes); prediction was more discriminatory and accurate with BMI as a continuous variable than as a binary variable for any possible cut-off point. Conclusion: Applying the new South Asian threshold to pregnant women would markedly increase those who were referred for monitoring and lifestyle advice. However, our results suggest that lowering the BMI threshold in South Asian women would not improve the predictive ability for identifying those who were at risk of adverse pregnancy outcomes

Low levels of cardiovascular risk factors and coronary heart disease in a UK Chinese population.

OBJECTIVE: To compare the prevalence of cardiovascular risk factors and coronary heart disease in Chinese and Europid adults. DESIGN: Population based, cross sectional survey. SETTING: Newcastle upon Tyne, UK, 1991-93. SUBJECTS: Altogether 380 Chinese and 625 Europid adults, aged 25-64 years. MAIN OUTCOME MEASURES: Fasting lipid levels, blood pressure, body mass index (BMI), the proportions who smoked, and the prevalence of coronary heart disease based on the Rose angina questionnaire and major electrocardiographic abnormalities on resting 12 lead electrocardiogram (Minnesota codes 1.1-1.2). All figures were age adjusted to the 1991 England and Wales population. RESULTS: Altogether 183 and 197 Chinese, and 310 and 315 Europid men and women respectively were seen. Compared with Europid men, Chinese men had a lower mean total cholesterol concentration (5.1 versus 5.6 mmol/l, p 0.05) and diastolic (75 versus 68 mmHg, p < 0.001) blood pressures. The prevalence of coronary heart disease was significantly lower in Chinese than Europid men (4.9% versus 16.6%, p < 0.001) but not significantly different in women (7.3% versus 11.1%, p = 0.16). CONCLUSION: Strategies for UK Chinese are needed to maintain this favourable risk factor profile and prevent any potential increase in the risk of coronary heart disease associated with increasing acculturation

Ethnic differences in Glycaemic control in people with type 2 diabetes mellitus living in Scotland

Background and Aims: Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland.&lt;p&gt;&lt;/p&gt; Methods: We used a 2008 extract from the population-based national electronic diabetes database of Scotland. The association between ethnicity with mean glycaemic control in type 2 diabetes mellitus was examined in a retrospective cohort study, including adjustment for a number of variables including age, sex, socioeconomic status, body mass index (BMI), prescribed treatment and duration of diabetes.&lt;p&gt;&lt;/p&gt; Results: Complete data for analyses were available for 56,333 White Scottish adults, 2,535 Pakistanis, 857 Indians, 427 Chinese and 223 African-Caribbeans. All other ethnic groups had significantly (p&#60;0.05) greater proportions of people with suboptimal glycaemic control (HbA1c &#62;58 mmol/mol, 7.5%) compared to the White Scottish group, despite generally younger mean age and lower BMI. Fully adjusted odds ratios for suboptimal glycaemic control were significantly higher among Pakistanis and Indians (1.85, 95% CI: 1.68–2.04, and 1.62,95% CI: 1.38–1.89) respectively.&lt;p&gt;&lt;/p&gt; Conclusions: Pakistanis and Indians with type 2 diabetes mellitus were more likely to have suboptimal glycaemic control than the white Scottish population. Further research on health services and self-management are needed to understand the association between ethnicity and glycaemic control to address ethnic disparities in glycaemic control.&lt;p&gt;&lt;/p&gt

Mid-Career academic women and the prestige economy

Drawing on 30 semi-structured interviews with women academics based in London higher education institutions in the UK, this paper investigates the gendered nature of the prestige economy in academia. We explore how mid-career academic women strategise their career development and the opportunities and barriers they perceive, particularly in relation to the accrual of academic esteem. Concept maps were used to facilitate dialogue about career plans and provided an artefact from the interviewee’s own perspective. The analysis draws on the concept of prestige, or the indicators of esteem that help advance academic careers, against the backdrop of a higher education context which increasingly relies on quantitative data to make judgements about academic excellence. The interviews indicated that women generally feel that men access status and indicators of esteem more easily than they do. Many women also had ambivalent feelings about gaining recognition through prestige: they understood the importance of status and knew the ‘rules of the game’, but were critical of these rules and sometimes reluctant to overtly pursue prestige. The findings are valuable for understanding how women’s slow access to the highest levels of higher education institutions is shaped by the value that organisations place on individual status

Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, UK.

OBJECTIVE: To compare the prevalence of glucose intolerance (impaired glucose tolerance and diabetes), and its relationship to body mass index (BMI) and waist-hip ratio in Chinese and Europid adults. DESIGN: This was a cross sectional study. SETTING: Newcastle upon Tyne. SUBJECTS: These comprised Chinese and Europid men and women, aged 25-64 years, and resident in Newcastle upon Tyne, UK. MAIN OUTCOME MEASURES: Two hour post load plasma glucose concentration, BMI, waist circumference, and waist-hip ratio. METHODS: Population based samples of Chinese and European adults were recruited. Each subject had a standard WHO oral glucose tolerance test. RESULTS: Complete data were available for 375 Chinese and 610 Europid subjects. The age adjusted prevalences of glucose intolerance in Chinese and Europid men were 13.0% (p = 0.04). Mean BMIs were lower in Chinese men (23.8 v 26.1) and women (23.5 v 26.1) than in the Europids (p values < 0.001), as were waist circumferences (men, 83.3 cm v 90.8, p < 0.001; women, 77.3 cm v 79.2, p < 0.05). Mean waist-hip ratios were lower in Chinese men (0.90 v 0.91, p = 0.02) but higher in Chinese women (0.84 v 0.78, p < 0.001) compared with Europids. In both Chinese and Europid adults, higher BMI, waist circumference, and waist-hip ratio were associated with glucose intolerance. CONCLUSIONS: The prevalence of glucose intolerance in Chinese men and women, despite lower BMIs, is similar to or higher than that in local Europid men and women and intermediate between levels found in China and those in Mauritius. It is suggested that an increase in mean BMI to the levels in the Europid population will be associated with a substantial increase in glucose intolerance in Chinese people