Risk of respiratory hospitalization and death, readmission and subsequent mortality: Scottish health and ethnicity linkage study

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

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


BACKGROUND:  Limited and dated evidence shows ethnic inequalities in health status and health care in respiratory diseases.  METHODS:  This retrospective, cohort study linked Scotland's hospitalization/death records on respiratory disorders to 4.65 million people in the 2001 census (providing ethnic group). For all-respiratory diseases and chronic obstructive pulmonary disease (COPD) from April 2001 to 2010 we calculated age, country of birth and Scottish Index of Multiple Deprivation (SIMD) adjusted risk ratios (RRs), by sex. We calculated hazard ratios (HRs) for death following hospitalization and for readmission. We multiplied ratios and confidence intervals (CIs) by 100, so the reference Scottish White population's RR/HR = 100.  RESULTS:  RRs were comparatively low for all-respiratory diseases in Other White British (84.0, 95% CI 79.6, 88.6) and Chinese (67.4, 95% CI 55.2, 82.3) men and high in Pakistani men (138.1, 95% CI 125.5, 151.9) and women (132.7, 95% CI 108.8, 161.8). For COPD, White Irish men (142.5, 95% CI 125.3, 162.1) and women (141.9, CI 124.8, 161.3) and any Mixed Background men (161, CI 127.1, 203.9) and women (215.4, CI 158.2, 293.3) had high RRs, while Indian men (54.5, CI 41.9, 70.9) and Chinese women (50.5, CI 31.4, 81.1) had low RRs. In most non-White groups, mortality following hospitalization and readmission was similar or lower than the reference.  CONCLUSIONS:  The pattern of ethnic variations in these respiratory disorders was complex and did not merely reflect smoking patterns. Readmission and death after hospitalization data did not signal inequity in services for ethnic minority groups.

Original languageEnglish
Pages (from-to)769-774
Number of pages6
JournalEuropean Journal of Public Health
Issue number5
Early online date17 Apr 2015
Publication statusPublished - 1 Oct 2015

Bibliographical note

ISD (Information Services Division) and National Records Scotland (NRS) made many contributions to the work. Anne Houghton, Arti Nair and Jenny Holmes gave secretarial help to prepare the article and to general administration. Judith Fernandez prepared the figure. AS is currently supported by The Commonwealth Fund, a private independent foundation based in New York City. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. The researchers acted independently of the funding body and the study sponsor (the University of Edinburgh) at all stages of the work. Other Contributions: These contributors served on the Steering Group and some on other important subgroups of SHELS, so gave general direction that helped this analysis. Chris Povey was a coapplicant
and the originator of the idea of linking the census data to the data held by ISD and he performed most of the linkage work including developing linkage methods. Prof. Jamie Pearce (coapplicant) advised especially on socio-economic adjustment. Duncan Buchanan (co-applicant) chaired the analysis subgroup.
Ganka Mueller (part study), Alex Stannard (part study) and Kirsty MacLachlan advised particularly in relation to NRS contributions. These important contributions did not meet ICMJE authorship requirements.

Access to data:
The data are not open access. They are only available with restricted access at National Records Scotland, and governed by strict ethical and other restrictions. Individual consent for linking these records was not sought. Access to SHELS is under consideration but researchers wishing to utilize the data should write to Prof. RB with a brief proposal.

We thank the Chief Scientist’s Office for the primary grant (CZH/4/648), and British Lung Foundation (RHotN12/) and NHS Health Scotland (no number) for Supplementary grants.

© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


  • Respirartory diseases
  • Respiratory hospitalizaton
  • death
  • Scottish health
  • ethnicity
  • ethnic minority


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