Mortality of third generation Irish people living in England and Wales: longitudinal study.
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Adult↗
Biomedical subjects
R Balarajan
Publications and source records attributed to R Balarajan.
Longitudinal study of socio-economic differences in mortality among South Asian and West Indian migrants.
AIM: To examine socio-economic differences in mortality of South Asian and West Indian migrants. DESIGN: ONS Longitudinal Study, a 1% sample of the population of England and Wales. PARTICIPANTS: First generation South Asian and West Indian migrants present at the 1971 and 1981 censuses, aged under 65 years in 1981, were classified by occupational class, access to cars, housing, and a deprivation score. OUTCOME MEASURES: Relative risks of mortality, 1981-1997. RESULTS: There was considerable upward social mobility but most people remained socially stable, mainly relatively disadvantaged compared to all other study members. High levels of owner occupied housing among South Asians at both censuses were an exception. Socio-economic differentials in mortality were significant with car access in 1981 (relative risk 1.32, 95% confdence interval 1.03-1.70), and housing (rented vs owner occupied relative risk 1.50, 95% confidence interval 1.08-2.08) among South Asians and, among West Indians with car access in 1981 (relative risk 1.43, 95% confidence interval 1.05-1.94). Mortality was not significantly associated with socioeconomic circumstances in 1971. CONCLUSION: The disparity between those who remained advantaged or who moved up, and those who remained persistently disadvantaged, would have been a factor underlying the stronger differentials by later socio-economic circumstances. As these migrants age an increase in health inequalities could be expected.
Adult↗
Limiting long-term illness among black Caribbeans, black Africans, Indians, Pakistanis, Bangladeshis and Chinese born in the UK.
AIM: To examine limiting long-term illness among ethnic groups born in the UK. DESIGN: Study members in the ONS Longitudinal Study, a representative 1% sample of England and Wales, present at the 1991 Census were examined. Socio-economic position was measured using housing tenure and access to cars. MAIN RESULTS: Black Caribbeans, Black Africans, Indians, Pakistanis and Bangladeshis reported more limiting long-term illness than whites, and the Chinese less. The level was higher among Black Africans than Black Caribbeans, even after adjustment for socio-economic position. Corresponding patterns were seen across the generations for all groups except Black Africans. Black Africans born in the UK reported more limiting long-term illness than did those born in Africa. Adjusting for socio-economic position lowered the risks in every group except Indians. The effect was strongest for Black Caribbeans, among whom adjustment removed the higher risks, and Bangladeshis, among whom the higher risks were no longer significant. CONCLUSION: For South Asians and Black Caribbeans poor health persisted across generations, and for Black Africans health worsened. There are over 1.5 million second- and third-generation migrants in these ethnic groups, but little is known about the consequences of having a multigenerational identity.
Africa↗
Patterns of mortality in second generation Irish living in England and Wales: longitudinal study.
OBJECTIVE: To examine the mortality of second generation Irish living in England and Wales. DESIGN: Longitudinal study of 1% of the population of England and Wales (longitudinal study by the Office of Population Censuses and Surveys (now the Office for National Statistics)) followed up from 1971 to 1989. SUBJECTS: 3075 men and 3233 women aged 15 and over in 1971. MAIN OUTCOME MEASURES: Age and sex specific standardised mortality ratios for all causes, cancers, coronary heart disease, cerebrovascular diseases, respiratory diseases, and injuries and poisonings. Deaths were also analysed by socioeconomic indicators. RESULTS: 786 deaths were traced to men and 762 to women. At working ages (men, aged 15-64; women, 15-59) the mortality of men (standardised mortality ratio 126) and women (129) was significantly higher than that of all men and all women. At ages 15-44, relative disadvantages were even greater both for men (145) and for women (164). Mortality was raised for most major causes of death. Significant excess mortality from cancers was seen for men of working age (132) and for women aged 60 and over (122). At working ages mortality of the second generation Irish in every social class and in the categories of car access and housing tenure was higher than that of all men and all women in the corresponding categories. Adjusting for these socioeconomic indicators did not explain the excess mortality. CONCLUSION: Mortality of second generation Irish men and women was higher than that of all men and all women and for most major causes of death. While socioeconomic factors remain important, cultural and lifestyle factors are likely to contribute to this adverse mortality.
Adolescent↗
Ethnicity and health: the challenges ahead.
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Causality↗
Public health and the 1991 census.
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Data Collection↗
Deprivation and general practitioner workload.
OBJECTIVES: To examine general practitioner consultations by demographic and socioeconomic variables and to derive a method of measuring the impact of relative deprivation on general practitioner workload. DESIGN: The study was based on general practitioner consultations reported in the general household surveys of 1983-7, covering a sample of 129,987 individuals in Great Britain. Odds ratios for general practitioner consultations were obtained for selected variables among children (0-15 years), men (16-64), women (16-64), and elderly people (greater than or equal to 65). These were then used to derive deprivation indices specific to electoral wards for use in general practice. SETTING: Great Britain, with particular findings illustrated by English electoral wards and the conurbations of London, Manchester, Merseyside, and the West Midlands. RESULTS: Council tenure increased the likelihood of consultation significantly in all four groups. Odds ratios were raised in children, men, and women with no access to a car. Birth in the New Commonwealth or Pakistan yielded high odds ratios in men, women, and elderly people but not in children. Marginally increased consultation rates were evident in the manual socioeconomic groups in women, elderly people, and children with a single parent mother. The deprivation indices for general practice derived using these odds ratios varied substantially among English electoral wards with, for example, anticipated general practitioner consultations in the electoral ward of Hulme, Manchester, being 24% higher than the average ward in England as a result of local attributes, and consultations in the Cheam South ward of Sutton, London, 11% lower than average. CONCLUSION: This deprivation index for general practice overcomes several shortcomings expressed about the underprivileged area score, which has been adopted in the 1990 contract as a basis for allocating deprivation supplements to general practitioners. The proposed index can be applied nationwide.
Adolescent↗
Suicide and self-burning among Indians and West Indians in England and Wales.
Suicide levels in England and Wales during 1979-83 were low among males from the Indian subcontinent (SMR 73) and significantly high in young Indian women (age-specific ratios 273 and 160 at ages 15-24 and 25-34 respectively). Suicide levels were low in Caribbeans (SMRs 81 and 62 in men and women respectively) and high in East Africans (SMRs 128 and 148 in men and women respectively). The excess in East Africans (most of whom are of Indian origin) was largely confined to younger ages. Immigrant groups had significantly higher rates of suicide by burning, with a ninefold excess among women of Indian origin. The pressures leading to higher suicide levels among young women of Indian origin highlight the need for making appropriate forms of support and counselling available to this community.
Adolescent↗
Health risks associated with bathing in sea water.
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Adolescent↗
Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales.
OBJECTIVE: To examine mortality from ischaemic heart disease and cerebrovascular disease in England and Wales by country of birth of the deceased. DESIGN: Standardised mortality ratios were computed by country of birth groups for ischaemic heart disease and cerebrovascular disease for 1979-83 and 1970-2 by using the five year age-sex specific rates for England and Wales for 1979-83 as standard. SETTING: England and Wales 1970-2 and 1979-83. RESULTS: In 1979-83 mortality from ischaemic heart disease was highest in men and women born in the Indian subcontinent (standardised mortality ratio 136 and 146 respectively). Young Indian men suffered the greatest excess (313 at ages 20-29). Other groups with raised mortality included Irish, Scottish, and Polish born immigrants. Those born in the Caribbean, the old Commonwealth, west Europe, and the United States had low death rates. In England and Wales mortality from ischaemic heart disease declined by 5% in men and 1% in women between 1970-2 and 1979-83, with greatest percentage declines in immigrants born in the United States, South Africa, the old Commonwealth, the Caribbean, and France. immigrant groups with raised mortality in the earlier period showed little improvement, and mortality from ischaemic heart disease increased among Indians (6% in men and 13% in women). In 1979-83 mortality from cerebrovascular disease was highest in Caribbeans (standardised mortality ratios 176 in men and 210 in women), followed by Africans, Indians, and Irish. Rates were low in west Europeans. Mortality from stroke declined by 28% overall in this period, a rate of decline shared by most groups. Men from the Indian subcontinent showed a decline of only 3%. CONCLUSION: In the 1980s mortality from ischaemic heart disease and cerebrovascular disease differed significantly between ethnic groups in England and Wales. In general, ethnic groups that experienced lower mortality from ischaemic heart disease in the 1970s showed the greatest improvement over the following decade.
Adult↗
Hospital care among ethnic minorities in Britain.
This study examined ethnic differences in the levels of inpatient admission and outpatient attendance in Great Britain using the latest national data available from the General Household Surveys of 1983-87. Inpatient admissions in immigrants (Indian, Pakistani and West Indian) did not differ significantly from whites, except for a marked excess in Pakistani women of childbearing ages. The pattern was quite different for outpatient attendance, with immigrant children and young adults having lower attendance rates than whites, and middle-aged immigrant adults showing higher rates. Levels of hospital-based care among immigrant groups may be lower than expected. As monitoring of the health status of ethnic groups, and their use of services, receives increasing recognition, it is important that information on ethnic origin is included in routine health information systems.
Data Collection↗
Inequalities in health: socioeconomic differences in self-reported morbidity.
Socioeconomic differences in self-reported chronic and acute illness were investigated in men and women using data from the General Household Surveys (1981-4). Logit models were used to investigate the influence of age, socioeconomic group, tenure, access to cars, area of residence and marital status on these measures of morbidity. For both measures local authority tenants, whether male or female, reported the most morbidity as did those with no access to cars. Both males and females reported increasing levels of illness the lower their socioeconomic group but similar patterns were not observed with acute illness. The significance of these present day inequalities is discussed.
Adolescent↗
Suicides among immigrants from the Indian subcontinent.
Suicides in England and Wales among immigrants of Indian ethnic origin were analysed for the period 1970-78. There were excess suicides among young Indian women, these being disproportionately more among the married. Burning was a common method of suicide among Indian women. Suicide rates were low in Indian men and the Indian elderly. A large proportion of the male suicides were among doctors and dentists.
Adolescent↗
Ethnic differences in general practitioner consultations.
OBJECTIVE: To examine the levels of general practitioner consultations among the different ethnic groups resident in Britain. DESIGN: The study was based on the British general household surveys of 1983-5 and included 63,966 people aged 0-64. Odds ratios were derived for consultation by ethnic group by using logistic regression analysis adjusting for age and socioeconomic group. SETTING: The results relate to people living in private households in England, Scotland, and Wales. RESULTS: After adjustment for age and socioeconomic class, consultation among adults aged 16-64 was highest among people of Pakistani origin with odds ratios of 2.82 (95% confidence interval 1.86 to 4.28) for men and 1.85 (1.22 to 2.81) for women. Significantly higher consultations were also seen for men of West Indian and Indian origin (odds ratios 1.65 and 1.53 respectively). Ethnic differences were greatest at ages 45-64, when consultation rates in people of Pakistani, Indian, and West Indian origin were much higher in both sexes compared with white people. CONCLUSIONS: The ethnic composition of inner cities is likely to influence the workload and case mix of general practitioners working in these areas.
Adolescent↗
Inequalities in health within the health sector.
Mortality among men employed in the health sector was examined using data surrounding the 1971 (1970-2) and 1981 (1979-83) censuses to assess the differences between social classes in the health service and to study changes over a decade. Relative to men in England and Wales, mortality in the 1980s was significantly lower among dentists (standardised mortality ratio 66), doctors (69), opticians (72), and physiotherapists (79) and significantly higher among hospital porters (151), male nurses (118), and ambulancemen (109). Mortality from lung cancer among hospital porters (185) was more than fivefold that seen in doctors (33) and dentists (37). Ischaemic heart disease varied twofold, being lowest in dentists (60) and doctors (70) and highest in hospital porters (138). Over the decade mortality from lung cancer and ischaemic heart disease declined in all groups except hospital porters, ambulancemen, and orderlies. Most groups showed excess deaths from suicides and cirrhosis of the liver. Differences in mortality between health workers in social class I and those in social class IV widened between the 1970s and 1980s and to a greater extent than among the general population. The high mortality of some groups within the NHS, and the fact that differentials between social classes have widened more than in the general population, suggest that the NHS needs to pay more attention to the health of its own staff.
Adolescent↗
Unemployment and patterns of consultation with the general practitioner.
The relation between unemployment and consultations with the general practitioner was investigated among 13,275 economically active men aged 18-64 by using the British general household surveys. Men who were unemployed but seeking work consulted with doctors significantly more (odds ratio 1.83; 95% confidence interval 1.61 to 2.09) than those in employment, the highest consultation rate being among those who had been out of work for five years or more (odds ratio 2.12; 95% confidence interval 1.12 to 3.78). The high consultation rates persisted even after adjustment for self reported longstanding illness (odds ratio 1.53; 95% confidence interval 1.34 to 1.76). These findings suggest that in areas with high unemployment general practitioner workload is likely to be high.
Adolescent↗
Sudden infant death syndrome and postneonatal mortality in immigrants in England and Wales.
To examine ethnic differences in postneonatal mortality and the incidence of sudden infant death in England and Wales during 1982-5 records were analysed, the mother's country of birth being used to determine ethnic group. Postneonatal mortality was highest in infants of mothers born in Pakistan (6.4/1000 live births) followed by infants of mothers born in the Caribbean (4.5) and the United Kingdom and Republic of Ireland (4.1). Crude rates were lower in infants of mothers born in India (3.9/1000), east and west Africa (3.0), and Bangladesh (2.8) than in infants of mothers born in the United Kingdom despite less favourable birth weights. Mortality ratios standardised separately for maternal age, parity, and social class were significantly higher in infants of mothers born in Pakistan and lower in those of mothers born in Bangladesh. The ratio for infants of Caribbean mothers was significantly higher when adjusted for maternal age. Ratios for infants of Indian and east African mothers did not show significant differences after standardisation. An important finding was a low incidence of sudden infant death in infants of Asian origin. This was paralleled by lower mortality from respiratory causes. During 1975-85 postneonatal mortality in all immigrant groups except Pakistanis fell to a similar or lower rate than that in the United Kingdom group; Pakistanis showed a persistent excess. During 1984-5 several immigrant groups (from the Republic of Ireland, India, west Africa, and the Caribbean) recorded an increase in postneonatal mortality. Surveillance of postneonatal mortality among ethnic communities should be continued, and research is needed to identify the causes underlying the differences.
Birth Weight↗
Mortality from congenital malformations in England and Wales: variations by mother's country of birth.
Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126), and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous system anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences.
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