Prevalence of cardiovascular risk factors among ethnic groups: Results from the Health Surveys for England

Abstract

Objective

To identify independent risk factors associated with cardiovascular disease (CVD) and diabetes for each minority ethnic group and the general population in England and explore the independent association of ethnicity and CVD and diabetes.

Participants

Nationally representative samples of 2362 Black Caribbean, 2467 Indian, 2204 Pakistanis, 1985 Bangladeshis, 1385 Chinese, 2398 Irish, and 30,744 adults from the general population living in private households.

Results

CVD was relatively more common among: Indian and Chinese men with high waist–hip ratio; Indian, Bangladeshi and Irish with diabetes; Black Caribbean, Indian and Pakistani with hypertension; Bangladeshi and Pakistani ex-smokers and Indian ex-smokers and current-smokers; Pakistani that were moderate-drinkers and Indian heavy drinkers; Black Carribean Indian, Pakistani and Irish physically inactive; Pakistani in manual social class; and Bangladeshi in low income.

Black Caribbean, Bangladeshi and Chinese participants and Indian and Pakistani women had significantly lower odds ratios of having CVD, compared with the general population. The odds of having diabetes were significantly higher for Black Caribbean, Indian, Pakistani and Bangladeshi, Chinese (men only) than participants from the general population.

Conclusions

CVD prevention through control of risk factors, especially diabetes and hypertension, should not only address the general population, but also target people from these groups.

Introduction

Cardiovascular disease (CVD), which includes coronary heart disease (CHD) and stroke, is one of the leading causes of morbidity and mortality globally. Over 190,000 deaths were attributed to CVD in England and Wales in 2004, with CHD the most common cause of death [1].

The risk of CVD is greater among people who smoke, are obese, physically inactive, have diabetes or high blood pressure or raised cholesterol. Most CVD conditions are particularly common in many minority ethnic groups [2], [3]. 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], [5], [6], [7], [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], [13], [14]. It is argued that the greater prevalence of diabetes and insulin resistance among Indian, Bangladeshi and Pakistani groups has a major impact on the increased risk of CHD [9], [15]. It has also been shown that Pakistani and Bangladeshi people with CHD have poorer access to diagnosis and treatment than Indian groups and the general population [16], [17]. Certain ethnic groups have differences in risk factor profiles such as smoking, blood pressure and total cholesterol, physical inactivity, diet, obesity and diabetes and in risk markers such as C-reactive protein (CRP) [18] and homocysteine levels [19] that may account for the differences in prevalence of CVD between ethnic groups. However, many studies have their limitations. Some look at certain ethnic groups in isolation, such as for example the Caribbean and Irish [10]; other studies combine ethnic subgroups, such as Indian, Pakistani and Bangladeshi into “South Asian” [20], [21], [22], not taking into account the heterogeneity of these populations. To date, differences in the prevalence of a wide range of CVD risk factors between minority ethnic groups and the general population have not been examined specifically in relation to CVD. It is known from local surveys [23], [24] that cardiovascular risk factors prevalence patterns have generally corresponded with ethnic CVD mortality patterns.

We aimed to explore which of the CVD risk factors are independently associated with CVD and diabetes for each of the six most common minority ethnic groups in England and for the general population. Additionally, we explored the independent association of ethnicity and CVD and diabetes, separately for men and women.