The frequency of asthma varies between countries and may vary between ethnic groups within a country. However, reliable data on ethnic variations in UK asthma frequency have been lacking.
Aziz Sheikh (University of Edinburgh, UK) and colleagues did a comprehensive search of published and unpublished data on UK asthma frequency and health service use, between January 1981 and March 2002.
The investigators combined the results of 13 relevant studies and found that south Asian people had a lower frequency of asthma symptoms than white people, while black people had a similar frequency. However, compared to white people, south Asians were three times more likely and black people twice more likely to have an emergency hospital admission for the condition.
The disparity could be due to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services. Lack of awareness of the underlying disease process and self-management among ethnic minorities and a tendency towards crisis management in primary care are also possible explanations.
Professor Sheikh concludes: "This review fills a major gap in knowledge about asthma in ethnic minorities in the UK. It also shows more conclusively than before the complex nature of asthma care for black and ethnic minorities in the UK. The disparity between frequency of asthma and asthma-related use of health services needs careful study. Underlying this paradox might be health service organisational factors such as different ethnic groups' responses to institutional deficiencies in primary care, whereby ethnic minorities receive different amounts of care to white patients.
"Our findings prompt questions about whether ethnic minorities receive less preventative, or more emergency treatment than their white counterparts. These questions urgently need further and critical examination and research."
Contact: Professor Aziz Sheikh, Division of Community Heath Sciences: GP Section, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX, UK. T) 44-131-651-4151 aziz.sheikh@ed.ac.uk
Journal
The Lancet