How To Find Out What Ethnicity Is In A Hospital

Transcription

1 Hospitals ethnicity data in four Scottish Health Boards: Acute Myocardial Infarction and Coronary Heart Disease Drew Millard, Colin Fischbacher, Charles Guthrie, Joan Jamieson

2 Background, Historic low levels of ethnicity completeness in routine health data SMR completeness rates for ethnicity field Need to see whether routine data on ethnicity is worth collecting in the NHS

3 Aims Demonstrate usefulness of routine collection of ethnicity in hospitals by analysing differences between groups Compare with census-linked ethnic analysis (Fischbacher et al 2007) Linked 85-88% of South Asians

4 Methods Used routine data from four NHSBoards with above 50% completeness for 8 months plus (representing over half the Scottish population) First admissions Arbitrary cut off for completeness threshold Age standardised rates and Poisson regression modelling, CHD, AMI and PCI/CABG. Poisson to allow adjustment for Health Board

5 Ethnicity coding completeness for hospital admissions from April 2009 October 2011 (reference line shows 50%) Percentage completeness Lothian Dumfries & Galloway Lanarkshire Greater Glasgow & Clyde Month and year

6 Average completeness rates and time from 50% threshold Lothian: 75.6% (8 months) Dumfries and Galloway: 68.7% (18 months) Lanarkshire: 80.2% (24 months) Greater Glasgow and Clyde: 58.4% (21 months)

7 Number of events by ethnic group for those of all ages CHD AMI PCI & CABG Ethnic group PYAR events events events Male White Scottish 1,428,750 3,951 2,301 2,587 Other White British 79, White Irish 21, Other White 23, Mixed/multiple 4, Pakistani 20, Other SA 11, Chinese 6, Black/African 3, Other 3, Female White Scottish 1,577,448 2,639 1, Other White British 86, White Irish 23, Other White 25, Mixed/multiple Pakistani 19, Other SA 10, Chinese Black/African Other 3,

8 Incidence Rate Ratios for hospital admission for Coronary Heart Disease (age 45+) by ethnicity adjusted for age and NHSBoard for four Scottish NHSBoards Incidence Rate Ratio Male Female 0 White Scottish Other White British White Irish Other White Pakistani Other SA Chinese Black/African Other

9 Poisson regression modelling results for AMI: IRRs* for South Asians compared to non South Asians and (whole population) South Asian Male Non South Asian Male South Asian Female Non South Asian Female 1.45 (1.17, 1.78) 2.17 (1.57, 3.01) , (1.31, 2.48) 1.54 (0.87, 2.74) 1 1 *Incidence Rate Ratio

10 Poisson regression modelling results for CHD: IRRs for Pakistani people compared to other South Asians (over 45 s) Other South Asian Male Pakistani Male White Scottish Male Other South Asian Female Pakistani Female White Scottish Female 1.74 ( ) 2.21 ( ) ( ) 3.35 ( ) 1

11 Main findings Reference study and current study gave similar higher risk of hospital admission with heart attack for South Asians Higher CHD risk for South Asians especially Pakistani women in relation to Scottish women Higher White Other rates in than for Unexpectedly low rates for Irish currently

12 Strengths and weaknesses Comparison of and Deaths in the community in (not included in ) Younger age group in (over 44 in ) Differing time periods and geographies Completeness statistics are overall, not for AMI/CHD only Ethnic differences No adjustment for deprivation

13 Fit with other work High risk of AMI and CHD for South Asian people in the UK is well documented. Not clear whether Pakistani women in Pakistan would show the same effects in relation to Scottish women Lower admission rates for White Irish were unexpected

14 Implications Why the possible difference between genders in variance from the White Scottish population rates for South Asian and Pakistani men and women? Cooking? Healthy migrant effects first generation Data issues Denominators held constant Numerators: Gypsy/travellers and Polish people explicitly included. First admissions count

15 Conclusions Larger numbers would give greater statistical power to correctly find difference where it exists, and more sensitively monitor trends. Broadly similar patterns to data Routine data are becoming sufficiently reliable and valid to provide an alternative to census linkage in some Scottish NHS Boards Findings can stimulate further questions.

16 Questions? Thank you for your attention Tel

17 Age Standardised incidence ratios for first CHD admission (age 45+) for Males compared to Age and NHSBoard adjusted IRRs (IRR scale adjusted by multiplying by 100) IRR (Adj) SIR White Scottish Other White British White Irish Other White Pakistani Other SA Chinese Black/African Other

18 Age Standardised incidence ratios for first CHD admission (age 45+) for Females compared to Age and NHSBoard adjusted IRRs (IRR scale adjusted by multiplying by 100) IRR (Adj) SIR White Scottish Other White British White Irish Other White Pakistani Other SA Chinese Black/African Other

19 Incidence Rate Ratios for hospital admission for Coronary Heart Disease (age 45+) adjusted for age and ethnicity for four Scottish NHS Boards IRR Male Female 0.00 Dumfries & Galloway Greater Glasgow & Clyde Lanarkshire Lothian

20 Crude rates for first admission for CHD for four Scottish NHSBoards by Ethnicity Crude rate per 100,000 person years at risk White Scottish Other White British White Irish Other White Mixed/multiple Pakistani Other SA male female Chinese Black/African Other

21 Poisson distribution Definition A distribution expressing probabilities per unit time. Skewed to the left. oisson-distribution.html

22 Poisson regression For low numbers, rare events, with a Poisson distribution. larget/spring2007/handouts24-2.pdf

23 Poisson Regression Analysis Uses assumptions based on Poisson distribution rather than normal distribution and extends binomial logistic regression to allow for a count outcome variable rather than a simple binomial outcome. opej/online/ma_chap13.pdf