Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases

L.D. Gruer*, G.I. Cézard, L.A. Wallace, S.J. Hutchinson, A.F. Douglas, D. Buchanan, S.V. Katikireddi, A.D. Millard, D.J. Goldberg, A. Sheikh, R.S. Bhopal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
74 Downloads (Pure)

Abstract

Background
Ethnicity can influence susceptibility to infection, as COVID-19 has shown. Few countries have systematically investigated ethnic variations in infection.

Methods
We linked the Scotland 2001 Census, including ethnic group, to national databases of hospitalizations/deaths and serological diagnoses of bloodborne viruses for 2001–2013. We calculated age-adjusted rate ratios (RRs) in 12 ethnic groups for all infections combined, 15 infection categories, and human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses.

Results
We analysed over 1.65 million infection-related hospitalisations/deaths. Compared with White Scottish, RRs for all infections combined were 0.8 or lower for Other White British, Other White and Chinese males and females, and 1.2–1.4 for Pakistani and African males and females. Adjustment for socioeconomic status or birthplace had little effect. RRs for specific infection categories followed similar patterns with striking exceptions. For HIV, RRs were 136 in African females and 14 in males; for HBV, 125 in Chinese females and 59 in males, 55 in African females and 24 in males; and for HCV, 2.3–3.1 in Pakistanis and Africans.

Conclusions
Ethnic differences were found in overall rates and many infection categories, suggesting multiple causative pathways. We recommend census linkage as a powerful method for studying the disproportionate impact of COVID-19.
Original languageEnglish
Pages (from-to)60-69
Number of pages10
JournalJournal of Public Health
Volume44
Issue number1
Early online date22 Jan 2021
DOIs
Publication statusPublished - 7 Mar 2022

Keywords

  • epidemiology
  • ethnicity
  • infectious disease
  • humans
  • male
  • COVID-19
  • Scotland/epidemiology
  • SARS-CoV-2
  • censuses
  • female
  • retrospective studies
  • cohort studies

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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