The need and demand for renal replacement therapy in ethnic minorities in England.

STUDY OBJECTIVE: The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. DESIGN/SETTING: This was a cross sectional retrospective survey of all patients accepted for renal replacement treatment in renal units in England in 1991 and 1992. PATIENTS: These comprised all 5901 patients resident in England with end-stage renal failure who had been accepted for renal replacement therapy in renal units in England and whose ethnic category was available from the units. Patients were categorised as white, Asian, black, or other. Population denominators for the ethnic populations were taken from the 1991 census. The census categories Indian, Pakistani, and Bangladeshi were aggregated to form the denominator for Asian patients, and black Caribbeans, black Africans, and black others were aggregated to form the denominator for black patients. MAIN RESULT: Altogether 7.7% of patients accepted were Asian and 4.7% were black; crude relative acceptance rates compared with whites were 3.5 and 3.2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4.2 and 3.7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5.8 and 6.5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance of rate 5.7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. CONCLUSION: Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of end-stage renal failure in ethnic minority populations.

Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales.

OBJECTIVES: To examine suicide rates and trends in people of Indian subcontinent, east African and Caribbean origin using the latest mortality data available for England and Wales. To compare suicide rates in these groups with the baseline and target rates for suicide in the Health of the Nation strategy. METHODS: Suicide data for England and Wales for 1988-1992, classified by the country of birth of the deceased, and population denominators from the 1991 Census were used for the analysis. Standardised mortality ratios (SMRs) for ages 15-64 and age-specific ratios were computed, using the age-sex specific rates for England and Wales as the standard. Trends over the preceding decade and suicide by burning were also analysed. Directly age-standardised suicide rates were derived to facilitate comparison with Health of the Nation baseline and target rates. RESULTS: Suicide ratios were significantly low (SMRs 32, 52 and 55 respectively) in Bangladeshi, Sri Lankan and Pakistani born men at all ages, but raised in young Indian and east African men. Ratios were significantly high in Indian and east African women (143 and 154), with a 2-3 fold excess at ages 15-34 years. Ratios were low in Pakistani and Bangladeshi women overall, but elevated at 15-24 years. For the Caribbean-born, ratios were low overall but raised at ages 25-34. 20% of Asian female suicides were by burning. Indians are a high risk group in terms of the Health of the Nation suicide targets. Suicide trends in the minority ethnic groups reflect national trends. CONCLUSIONS: This study confirms previous findings of high suicide rates in young Asian women. A new finding is the raised suicide rate in young Caribbeans. High suicide risks among young people from some ethnic minority communities are significant in the context of both the Health of the Nation strategy and recent governmental concern about the need to tackle health variations in the UK. Such deaths are indicative of larger numbers of young ethnic minority adults at risk of mental distress and self harm.

Population need for renal replacement therapy in Thames regions: ethnic dimension.

OBJECTIVES: To determine the use of renal replacement therapy by ethnic origin and to ascertain the variation in provision of such therapy and to relate this to the distribution of ethnic minority populations. DESIGN: Analysis of retrospective and cross sectional data from 19 renal units. SETTING: All four Thames regional health authorities. SUBJECTS: Patients resident in the Thames regions who were accepted as new patients for renal replacement therapy during 1991 and 1992 and the patients who were already undergoing such treatment between December 1992 and April 1993. MAIN OUTCOME MEASURES: Rates of acceptance for and prevalence of renal replacement therapy among white, black, and Asian people. RESULTS: The average annual acceptance rates per million in 1991-2 were 61 for white people, 175 for black people, and 178 for Asians, and the prevalences per million were 351, 918, and 957 respectively. The relative risks increased with age. A threefold increase in the acceptance rate occurred in people aged under 55 in both the black and Asian populations, suggesting that the higher rates are probably not due to factors related to access alone. Treatment rates varied considerably among districts, reflecting both the distribution of ethnic minority populations and access to services. CONCLUSION: Black and Asian people receive and have a greater need for renal replacement therapy, and the need will increase as these populations age. These findings have important implications for the provision of renal services in districts with a high proportion of ethnic minorities and for the management of diabetes mellitus and hypertension, two important causes of end stage renal failure in these populations.

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.