Cardiovascular risk profiles in UK-born Caribbeans and Irish living in England and Wales
Introduction
For at least 20 years, cardiovascular disease, including type 2 diabetes, has been the leading cause of morbidity and mortality among Caribbeans and Irish living in England and Wales [1], [2], [3], [4], [5]. The most recent data still showed that the mortality of migrant Caribbeans from coronary heart disease (CHD) was lower than the national average (in women by 29%, men 54%), but stroke deaths were higher (in women by 57%, men 68%). The Irish experience higher mortality from both CHD (in women by 20%, men 24%) and strokes (in women by 23%, men 38%) [5]. Very little, however, is known about the health of the children of these migrants living in the UK, partly because they cannot be identified in national data sources or surveys [6]. Transmission of health risks between generations is clearly an important public health as well as an etiological issue, which should throw light on how rapidly new environments affect disease risk.
Only one study has reported on mortality of UK-born Black Caribbeans [7]. Small numbers precluded firm inferences, but there was little difference in all-cause mortality between foreign-born and UK-born Black Caribbeans. However, the UK-born generation experienced more limiting long-term illness than foreign-born Caribbeans [8]. The Irish are the only minority ethnic group for whom there are reliable data on mortality of their children (UK-born Irish with Irish-born parentage). More than a 20% excess in all-cause mortality (relative to the UK average) has persisted in the second (parents born in Ireland) and third (grandparents born in Ireland but parents born in the UK) generations [9], [10], in spite of intergenerational improvements in socio-economic position [10]. We know very little about CHD or stroke mortality among UK-born Irish, mainly because of the small number of deaths in surveys. Cardiovascular disease mortality has been reported for men with Irish names (likely to be fourth and fifth generation) living in Scotland, and was found to be elevated by 51% [11].
Cardiovascular risk factor prevalence patterns have generally corresponded with ethnic mortality patterns, as reported in local surveys [2], [12], [13], [14], [15], [16]. The ethnically boosted Health Survey for England (HSE) 1999 contains data on ethnic risk factor prevalence and morbidity and included the Irish for the first time. In this paper we use the HSE 1999 to compare the cardiovascular risk profiles of UK-born Irish and Caribbeans with that of the UK-born general population. We could not investigate intergenerational differences because the age distribution for the foreign-born Caribbeans and Irish were distinctly different from those born in the UK, with sparse numbers in common age groups.
Section snippets
Methods
UK-born Caribbeans aged 35–44 and Irish aged 35–44 and 45–54 years were identified using country of birth and self-reported ethnicity. The choice of age censoring was made because respondents at younger ages did not have required blood measurements and at older ages there were insufficient numbers of UK-born Caribbeans. The final sample used in the analysis contained 206 UK-born Caribbeans aged 35–44 (75 men and 131 women) and 435 UK-born Irish (104 men and 145 women at ages 35–44, 94 men and
Results
Table 1 shows physiological and anthropometric measures unadjusted and adjusted for smoking and socio-economic confounders for 35–44-year-old UK-born Caribbean, Irish and general population men and women. There were few statistically significant differences. Caribbean men were less likely to have a degree, more likely to smoke and had higher mean HDL cholesterol than men in the general population. Caribbean women were more likely to be in partly or unskilled jobs, had lower incomes, were
Discussion
The data here from the HSE 1999 provide cardiovascular risk profiles for UK-born Caribbeans and Irish. Small sample sizes may have resulted in a lack of statistical power to detect differences and make firm inferences, but this represents a first attempt at presenting cardiovascular risk profiles for UK-born ethnic minorities. Previous studies have shown consistently favourable lipid profiles for migrant Black Caribbeans. We did not find this to be the case for those born in the UK. Apart from
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2007, AtherosclerosisCitation Excerpt :A higher risk of premature death and poor health attributed to CHD has been reported in Irish, Scottish, and South Asian groups, particularly Pakistani and Bangladeshi populations: [4–8] CHD mortality is 50% higher in people born in Bangladesh, India and Pakistan than among the general population [9]. Black Caribbean people have lower premature death rates of CHD than the general population [10]. The causes of ethnic inequalities in CVD incidence and mortality are complex and may include factors such as deprivation, adverse lifestyle factors, poorer access to healthcare, and others such as genetic, environmental, psychosocial [11], and cultural factors; many are not completely understood [12–14].
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