Risk of respiratory hospitalization and death, readmission and subsequent mortality: scottish health and ethnicity linkage study

BACKGROUND: Limited and dated evidence shows ethnic inequalities in health status and health care in respiratory diseases.

METHODS: This retrospective, cohort study linked Scotland's hospitalization/death records on respiratory disorders to 4.65 million people in the 2001 census (providing ethnic group). For all-respiratory diseases and chronic obstructive pulmonary disease (COPD) from April 2001 to 2010 we calculated age, country of birth and Scottish Index of Multiple Deprivation (SIMD) adjusted risk ratios (RRs), by sex. We calculated hazard ratios (HRs) for death following hospitalization and for readmission. We multiplied ratios and confidence intervals (CIs) by 100, so the reference Scottish White population's RR/HR = 100.

RESULTS: RRs were comparatively low for all-respiratory diseases in Other White British (84.0, 95% CI 79.6, 88.6) and Chinese (67.4, 95% CI 55.2, 82.3) men and high in Pakistani men (138.1, 95% CI 125.5, 151.9) and women (132.7, 95% CI 108.8, 161.8). For COPD, White Irish men (142.5, 95% CI 125.3, 162.1) and women (141.9, CI 124.8, 161.3) and any Mixed Background men (161, CI 127.1, 203.9) and women (215.4, CI 158.2, 293.3) had high RRs, while Indian men (54.5, CI 41.9, 70.9) and Chinese women (50.5, CI 31.4, 81.1) had low RRs. In most non-White groups, mortality following hospitalization and readmission was similar or lower than the reference.

CONCLUSIONS: The pattern of ethnic variations in these respiratory disorders was complex and did not merely reflect smoking patterns. Readmission and death after hospitalization data did not signal inequity in services for ethnic minority groups.