| Summary - The Health of Minority Ethnic Groups '99 | ||||
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Adults' health
Adults were asked whether they had a longstanding illness, disability or infirmity, and if so, whether it limited their activities in any way. Among men, the prevalence of limiting longstanding illness was about 30% to 65% higher for Pakistani, Bangladeshi and Irish men (risk ratios from 1.30 to 1.65) than for men in the general population. For women, Black Caribbean and South Asian groups were about 20% to 45% more likely to report limiting longstanding illness (risk ratios 1.20 to 1.44) than women in the general population. Chinese adults in contrast were less likely than the general population (by about 40%), and less than all other minority ethnic groups, to report limiting longstanding illness.
Chinese men and women were also much less likely than the general population, and than all other minority ethnic groups, to have had an illness or injury in the past two weeks that caused them to cut down on their usual activities (risk ratios 0.62 for men, 0.55 for women). Irish women were more likely than women in general to have had such an illness (risk ratio 1.27); men and women in the other minority ethnic groups did not differ significantly from the general population.
Pakistani and Bangladeshi men and women were three to four times more likely than the general population to rate their own health as bad or very bad, with risk ratios for men and women of 2.94 and 3.57 (Pakistani), and 3.91 and 3.31 (Bangladeshi) respectively. Indian men (1.64) and women (2.63), and Black Caribbean women (1.81) were also more likely to report bad/very bad health than the general population.
Two psychosocial health measures were included in the survey: the General Health Questionnaire (GHQ12), a high score on which is an indicator of possible psychiatric morbidity, and a 'social support' scale measuring the level of support the person concerned feels they have from family and friends. Bangladeshi and Pakistani men and women were more likely than the general population to have a high GHQ12 score, indicating that they may be more likely to suffer from psychiatric illness (risk ratios Bangladeshi men 1.87, women 1.57; Pakistani men 1.34, women 1.27). Relatively high prevalence of high GHQ12 scores was also seen in Black Caribbean and Indian women (risk ratios 1.22 and 1.26 respectively). People of Chinese origin were far less likely to have a high GHQ12 score than the general population (risk ratios 0.19 for men, 0.39 for women). Among Black Caribbean and Indian men, and Irish men and women, the prevalence of high GHQ12 scores did not differ from the general population. In terms of social support, South Asian and Chinese men and women were at least twice as likely as the general population to be classified as having a severe lack of social support, while Black Caribbeans were around 30% more likely to be so classified.
South Asian and Black Caribbean men were more likely than men in the general population to have consulted their GP in the past two weeks, and to have more than one consultation over this period. The 'annual contact rate' is the number of consultations with a GP each year. The chart shows the average annual contact rate ratio (age-standardised) for the minority ethnic groups, compared with the general population. Men in the general population had an annual contact rate of 3.7. South Asian and Black Caribbean men had GP contact rates between one and a half (for Black Caribbean men) and three (for Bangladeshi men) times as high as men in the general population. The annual GP contact rate for women in the general population was 5.6. Age-adjusted contact rates were significantly higher for South Asian and Irish women (rate ratios from 1.25 for Irish women to 1.84 for Pakistani women).
Men and women were asked whether they had attended an outpatient or casualty department, or been admitted to hospital as a day patient or inpatient (overnight or longer), during the last year. Except for Chinese men and women, who had low hospital attendance rates (about 40% lower for outpatients and inpatients), rates for the other minority ethnic groups were similar to those in the general population.
In the general population, the average number of prescribed medications taken by men was 1.0 and by women it was 1.3. The level of prescribed medicine use was lower for Chinese men (ratio 0.51) and women (ratio 0.59). South Asian men were relatively high users of medication (ratios 1.36 Indian, 1.26 Pakistani, 2.04 Bangladeshi), as were Bangladeshi (ratio 1.37) and Pakistani (ratio 1.42) women. Levels of prescribed medication use for Black Caribbean and Irish adults were similar to those for the general population.
Men and women in all minority ethnic groups were significantly less likely than the general population to visit a dentist for a regular check-up. The age-standardised ratio for regular dental attendance was lowest for Bangladeshi men (0.24), with Indian, Pakistani, Black Caribbean and Chinese men being about half as likely as the general population to visit the dentist for a check-up. Minority ethnic women had similar patterns of attendance to the men.
Informants were asked whether they had ever had angina, heart attack, stroke, heart murmur, abnormal heart rhythm, 'other heart trouble' or diabetes diagnosed by a doctor. These conditions are referred to as 'CVD conditions'. High blood pressure is not included in the chart below, which shows age-standardised risk ratios for the prevalence of CVD conditions for men and women. Pakistani and Bangladeshi men had rates of CVD about 60% to 70% higher than men in the general population, while Chinese men had lower rates (risk ratio 0.63). The picture was similar for women, with Chinese women having lower rates of CVD conditions (0.71) than women in general, while Pakistani (1.45) and Bangladeshi (1.43) women had higher rates. Prevalence of CVD conditions was also higher among Black Caribbean women (1.33).
For angina, age-standardised risk ratios, relative to the general population, were significantly lower for Black Caribbean men (0.32), and for Chinese men (0.38) and women (0.20). In the general population and in all minority ethnic groups except Black Caribbean, the prevalence of angina was much lower among women than among men. Age-standardised heart attack rates showed a similar pattern to those for angina. Age-standardised rates of ischaemic heart disease (heart attack or angina) for all South Asian men combined were over 30% higher than for men in the general population.
Rates of stroke among Black Caribbean men were two-thirds higher than in the general population (age-standardised risk ratio 1.66). Indian men also had higher rates than the general population (1.42). Among women, Chinese women had low rates of stroke (risk ratio 0.29), while the other groups did not differ significantly from the general population.
South Asian men and women had the highest rates of diabetes. Pakistanis and Bangladeshis of both sexes were more than five times as likely as the general population to have diabetes, and Indian men and women were almost three times as likely. Rates of diabetes among Black Caribbeans were also significantly higher than in the general population (risk ratios 2.51 for men and 4.19 for women). Rates of diabetes among the Chinese and Irish groups were not significantly different from the general population.
Glucose, or blood sugar, was measured in a fasting blood sample taken from adults aged 35 and over. High levels of glucose are associated with a high incidence of cardiovascular disease. The age-standardised mean glucose of all minority ethnic groups, except Black Caribbean men and Irish men and women, was higher than that of the general population. The highest age-standardised ratio among men was for Bangladeshis (1.18); among women it was highest for Pakistanis (1.25).
Following World Health Organisation guidance, the term high blood pressure in the Health Survey refers to those with a systolic blood pressure (SBP) of 140 mmHg or more, or a diastolic blood pressure (DBP) of 90 mmHg or more, or taking drugs prescribed for high blood pressure (in accordance with the most up-to-date guidelines on hypertension management). Bangladeshi and Chinese men were about 25% less likely than men in the general population to have high blood pressure (age-standardised risk ratios 0.74). For women, Irish women were about 10% less likely than women in general to have high blood pressure (risk ratio 0.89), while Black Caribbean (1.21) and Pakistani (1.25) women were over 20% more likely to have high blood pressure. Among those with high blood pressure, Black Caribbean men and women were more likely to receive treatment for their high blood pressure than those in the general population (with standardised ratios of 1.73 and 2.23 respectively). Indian (1.93) and Bangladeshi (3.44) men also had higher treatment rates than the general population.
Total cholesterol and high-density lipoprotein cholesterol (HDL-cholesterol) were measured for all adults who gave a blood sample; low-density lipoprotein cholesterol (LDL-cholesterol) and triglycerides were analysed in the fasting blood sample for informants aged 35 and over. These analytes provide a lipid profile for survey informants, that is, they measure the level of fat in the blood. High levels of total cholesterol, LDL-cholesterol and triglycerides, and low levels of HDL-cholesterol, are associated with increased risk of cardiovascular disease. After age adjustment, Black Caribbean, Pakistani and Chinese men were less likely to have high total cholesterol levels (5 mmol/l or more) than men in the general population (risk ratios 0.85, 0.86 and 0.81 respectively). Among women, all minority ethnic groups except the Irish were less likely than the general population to have high levels of total cholesterol (risk ratios from 0.77 for Black Caribbean women to 0.86 for Indian women). However, by looking at the components of total cholesterol, greater differences can be seen between groups. After adjusting for age, Bangladeshi men and women were around three times as likely as the general population to have low levels of HDL-cholesterol (less than 1 mmol/l). While Bangladeshi men were also more likely to have high levels of triglycerides (at least 1.6 mmol/l) (risk ratio 1.63 for men), the levels in women were not significantly different from the general population. Prevalence of high LDL-cholesterol (3.0 mmol/l or more) in Bangladeshi men, however, was not significantly different from the general population.
Pakistani men and women were around twice as likely as the general
population to have low levels of HDL-cholesterol. They were also more
likely to have high levels of triglycerides (risk ratios 2.29 for men,
1.85 for women). Pakistani men were more likely to have high Indian men were no more likely than men in the general population to have low levels of HDL-cholesterol. However their risk of high LDL-cholesterol (risk ratio 1.63) and high triglycerides (2.56) was significantly greater than for men in the general population. Indian women were more likely than women in the general population to have low HDL-cholesterol (risk ratio 1.61), high LDL-cholesterol (1.74) and high triglycerides (2.28). Black Caribbeans were less likely than the general population to have low HDL-cholesterol levels (risk ratios 0.61 for men, 0.57 for women), and their risk of high triglycerides was no different from the general population. They were however more likely than the general population to have high LDL-cholesterol (risk ratios 1.56 for men, 1.31 for women).
Chinese men and women did not differ significantly from the general population on these measures, except that Chinese men were more likely than men in the general population to have high LDL-cholesterol (risk ratio 1.69), and Chinese women had a higher risk of high triglycerides (1.72). For Irish men and women there was no significant difference in low HDL-cholesterol levels compared with the general population. However they were more likely to have high LDL-cholesterol (risk ratios 1.74 for men, 2.08 for women) and high triglycerides (risk ratios 2.41 for men, 2.01 for women).
Physical activity is one of the key determinants of good health. A physically active lifestyle delivers significant physical and mental health benefits, notably helping to reduce cardiovascular disease and osteoporosis. Current guidance recommends that adults should take part in 30 minutes or more of moderate physical activity, at least five times a week. The chart shows the proportions of men and women meeting the guideline level of physical activity for each minority ethnic group. In the general population, a third of men met the guideline. The proportion doing so was higher among Black Caribbean men (39%), and lower among Pakistani (29%), Bangladeshi (24%) and Chinese (23%) men. Age standardisation confirmed these findings, and showed that Indian men also had a lower ratio (0.86) for meeting the guideline figure, relative to the general population. In all minority ethnic groups, as well as in the general population, women were less likely that men to meet the physical activity guideline. Compared with the 21% of women in the general population who met the guideline, 28% of Black Caribbean and 26% of Irish women did so. The proportions meeting the guideline were lower than the general population for Chinese (18%), Indian (17%), Pakistani (16%) and Bangladeshi (10%) women. Age standardisation confirmed these findings.
Obesity is a major risk factor for cardiovascular disease, diabetes, hypertension and premature death. The body mass index (BMI) is a widely-accepted measure of weight-for-height. Generalised obesity is defined as BMI greater than 30 kg/m2. However BMI does not take account of the distribution of fat around the abdomen, which has been recognised as a risk factor in relation to chronic diseases. For this, the waist-hip ratio (WHR) is used, a measure of central obesity. Central obesity is defined as a WHR of 0.95 or greater in men, and of 0.85 or greater in women. The observed prevalence of generalised obesity in men was lowest for the Bangladeshi and Chinese groups (5.4% and 6.2%). Rates of obesity in Indian (11.9%) and Pakistani (12.6%) men were about twice those of the Bangladeshi group, but still lower than the general population. Around a fifth of men in the Irish (20.4%) and Black Caribbean (18.3%) groups were obese, a similar proportion as for the general population (18.9%). The chart shows age-standardised risk ratios for obesity, and confirms these findings. The risk of obesity in the South Asian and Chinese groups ranged from 0.32 for Bangladeshi men to 0.74 for Pakistani men, all significantly lower than the general population. Among women, the proportion classified as obese was again very low in the Chinese (4.5%) and Bangladeshi (9.5%) groups. Around a fifth of women in the general population (20.9%) and in the Indian (19.6%) and Irish (21.2%) groups were obese. Levels of generalised obesity significantly higher than in the general population were found in the Pakistani (25.6%) and Black Caribbean (31.9%) groups. The age-standardised risk ratios confirm these findings. Black Caribbean and Pakistani women were around 60% more likely to be classified as obese than women in the general population (risk ratios 1.60 and 1.61), while Bangladeshi women were 40% (risk ratio 0.63) and Chinese women 80% (risk ratio 0.20) less likely to be obese. Looking at the prevalence of central obesity (raised WHR), among men it ranged from 17.9% in Chinese men to 36.1% in Indian men, compared with the general population level of 27.5%. South Asian men, although their prevalence of generalised obesity was lower, had higher levels of central obesity than men in the general population (risk ratios for raised WHR ranging from 1.33 for Bangladeshi men to 1.54 for Pakistani men). Chinese (risk ratio 0.76) and Black Caribbean (0.62) men had significantly lower rates of central obesity than the general population. Among women, all the minority ethnic groups had levels of central obesity significantly higher than in the general population (19.9%), ranging from 24.9% among Irish women to 42.8% among Bangladeshi women. Age standardisation confirmed these findings, and showed that Black Caribbean (risk ratio 2.09), Pakistani (2.79) and Bangladeshi (3.63) women were at least twice as likely as women in the general population to be centrally obese, while Chinese (1.79) and Indian (1.73) women were three-quarters more likely.
There is evidence that reducing salt intake and eating a diet rich in fruit and vegetables, with reduced saturated and total fat, can substantially lower blood pressure and help reduce the risk of cardiovascular disease. In the Health Survey, information was collected on the frequency of consumption of various types of food, looking in particular at overall fat and fibre consumption. (As the eating habits questions were collected during the nurse visit, no comparison information from the general population sample is available.) The proportion of Chinese men and women who ate fruit and vegetables six or more times a week (men 46% fruit, 53% vegetables; women 60% fruit, 69% vegetables) was much higher than corresponding proportions in the other minority ethnic groups. Bangladeshi men and women were least likely to eat fruit six or more times a week (15% men, 16% women), and Pakistani men (7%) and women (11%) were least likely to eat vegetables with this frequency. After adjustment for individual energy requirements, informants were grouped into one of three categories for fat and fibre intake low, medium or high. The chart shows the proportions of men and women in each minority ethnic group with a high fat score or a low fibre score. Among men, the proportion with a high fat consumption score was greatest among Irish and Bangladeshi men (22% and 21% respectively) and lowest among Indian men (11%). Among women, the highest proportion with a high fat score was found among Bangladeshi women (27%), followed by Irish and Pakistani women (14% and 13%). Indian (8%), Chinese (9%) and Black Caribbean (9%) women had the lowest proportions. The proportion with a low fibre score was greatest among Bangladeshis (79% of men and 82% of women had low fibre intake). Indian men (39%) and women (42%) and Irish women (41%) were less likely than other minority ethnic groups to have low fibre intake.
Compared with the 27% of men in the general population who smoked cigarettes, higher levels of cigarette smoking were reported by Bangladeshi (44%), Irish (39%) and Black Caribbean (35%) men. Prevalence was lowest among Chinese men (17%), and was similar to the general population for Pakistani and Indian men (26% and 23% respectively). Age standardisation confirmed this pattern. Irish women (33%) were more likely to smoke cigarettes than women in the general population (27%), while prevalence among Black Caribbean women was similar (25%). Among women in the other groups, cigarette smoking was very low, ranging from 1% of Bangladeshi women to 9% of Chinese women. Age standardisation did not change this picture. South Asian informants were also asked about their use of chewing tobacco. Of the three South Asian groups, Bangladeshi men and women were the most likely to report tobacco chewing: 19% of men and 26% of women, compared with between 2% and 6% for Indians and Pakistanis of both sexes. The chart shows the prevalence of all tobacco use (cigarette smoking and/or pipe or cigar smoking and/or tobacco chewing), together with prevalence of cigarette smoking. The overall prevalence of tobacco use was 32% among men and 27% among women in the general population. As the chart shows, the biggest difference between cigarette smoking prevalence and overall tobacco use was found in Bangladeshis (for men, an increase from 44% to 53%, for women, from 1% to 27%, once other forms of tobacco are included).
Men and women from all minority ethnic groups, except the Irish, were less
likely to drink alcohol than the general population, and consumed smaller
amounts. Among men in the general population, 30% usually drank more
than 21 units of alcohol a week. While the proportion of Irish men drinking
more than 21 units a week was similar (34%), estimates for men in all
other groups were much lower: 18% Black Caribbean; 14% Indian; 3% Chinese;
The proportion of women in the general population who reported drinking more than 14 units a week was 16%. Only Irish women were more likely to drink this amount (19%). Among Black Caribbean and Chinese women, the proportions were 9% and 4% respectively, while very few South Asian women exceeded this amount.
Accidents were classified as 'major' if they involved contact with medical services. The accident rate is the estimated number of accidents per 100 persons per year. The major accident rate among men in the general population was 19 per 100. This was a higher rate than for any of the minority ethnic groups, although the rates for Black Caribbean and Irish men were similar at 15 and 16 per 100 respectively. Major accident rates for the other minority ethnic groups ranged from 7 per 100 for Bangladeshi and Chinese men to 16 per 100 for Irish men. Among women, the major accident rate in the general population was 15 per 100. The rate for minority ethnic groups was consistently lower than this, ranging from 3 per 100 for Bangladeshi women to 12 per 100 for Black Caribbean and Irish women. The chart shows age-standardised risk ratios for annual major accident rates. After standardising for age, Bangladeshi men and women had the lowest rates (31% of the equivalent general population rate for men and 32% for women). Black Caribbeans and Irish had major accident rates close to those of the general population, whereas Indians, Pakistanis, and Chinese had rates between 34% and 68% of the general population.
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