Elsevier

Atherosclerosis

Volume 175, Issue 2, August 2004, Pages 295-303
Atherosclerosis

Cardiovascular risk profiles in UK-born Caribbeans and Irish living in England and Wales

https://doi.org/10.1016/j.atherosclerosis.2004.03.019Get rights and content

Abstract

Cardiovascular disease is the leading cause of morbidity and mortality among Caribbean and Irish origin people living in England and Wales. Yet mortality from coronary heart disease (CHD) of migrant Caribbeans is lower than the national average, while stroke mortality is higher. The Irish experience higher than average mortality from both diseases. Little is known about the health of the children of these migrants.

The Health Survey for England (HSE) 1999 was used to investigate for the first time cardiovascular risk factors in UK-born Caribbeans aged 35–44 and Irish aged 35–44 and 45–54 years. Caribbean men were more likely to smoke but had higher mean HDL-cholesterol than men in the general population. Caribbean women had greater body mass indices and lower mean triglyceride levels. Irish men in both age groups smoked more than men in the general population, but in the younger group had lower diastolic blood pressure (BP). At age 35–44 only, Irish women were shorter than women in the general population. These findings were independent of differences in socio-economic position.

Previously, Caribbean-born migrants to Britain had generally favourable lipid profiles in line with lower CHD rates, despite obesity and diabetes. The nationally representative but small-scale data presented here suggest that UK-born Caribbeans appear to be losing this more favourable lipid pattern and among men smoking rates are now higher compared with general population men, suggesting that an increase in CHD rates can be expected. Further research should examine how improved education and specific intervention programs could be used to reduce smoking among UK-born Irish and Caribbean men, and obesity among UK-born Caribbean women. The next HSE also needs to include adequate numbers of younger people of different ethnic origins to allow time trends in these anthropometric, behavioural and metabolic risk factors to be examined reliably and fully.

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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      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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