Ethnic variations in morbidity and mortality from lower respiratory tract infections: a retrospective cohort study

Colin R Simpson, Markus F C Steiner, Genevieve Cezard, Narinder Bansal, Colin Fischbacher, Anne Douglas, Raj Bhopal, Aziz Sheikh, SHELS Researchers

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


OBJECTIVE: There is evidence of substantial ethnic variations in asthma morbidity and the risk of hospitalisation, but the picture in relation to lower respiratory tract infections is unclear. We carried out an observational study to identify ethnic group differences for lower respiratory tract infections.

DESIGN: A retrospective, cohort study.

SETTING: Scotland.

PARTICIPANTS: 4.65 million people on whom information was available from the 2001 census, followed from May 2001 to April 2010.

MAIN OUTCOME MEASURES: Hospitalisations and deaths (any time following first hospitalisation) from lower respiratory tract infections, adjusted risk ratios and hazard ratios by ethnicity and sex were calculated. We multiplied ratios and confidence intervals by 100, so the reference Scottish White population's risk ratio and hazard ratio was 100.

RESULTS: Among men, adjusted risk ratios for lower respiratory tract infection hospitalisation were lower in Other White British (80, 95% confidence interval 73-86) and Chinese (69, 95% confidence interval 56-84) populations and higher in Pakistani groups (152, 95% confidence interval 136-169). In women, results were mostly similar to those in men (e.g. Chinese 68, 95% confidence interval 56-82), although higher adjusted risk ratios were found among women of the Other South Asians group (145, 95% confidence interval 120-175). Survival (adjusted hazard ratio) following lower respiratory tract infection for Pakistani men (54, 95% confidence interval 39-74) and women (31, 95% confidence interval 18-53) was better than the reference population.

CONCLUSIONS: Substantial differences in the rates of lower respiratory tract infections amongst different ethnic groups in Scotland were found. Pakistani men and women had particularly high rates of lower respiratory tract infection hospitalisation. The reasons behind the high rates of lower respiratory tract infection in the Pakistani community are now required.

Original languageEnglish
Pages (from-to)406-417
Number of pages12
JournalJournal of the Royal Society of Medicine
Issue number10
Early online date7 Jul 2015
Publication statusPublished - Oct 2015

Bibliographical note

© The Royal Society of Medicine.

Acknowledgements: Information Services Division and National Records Scotland made many contributions to the work. Anne Houghton, Arti Nair and Jenny Holmes gave secretarial help to prepare the paper and to general administration. Judith Fernandez prepared the figure. AS was supported by The Commonwealth Fund, a
private independent foundation based in New York City.


  • respiratory tract infections
  • secondary care
  • death
  • ethnic groups
  • incidence
  • hospital readmission
  • hospitalisation


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