Education and debate

Ethnicity as a variable in epidemiological research

Department of Epidemiology and Public Health, The Medical School, Newcastle upon Tyne NE2 4HH Correspondence to: Dr Senior c/o Professor Bhopal.

Ethnicity is used increasingly as a key variable to describe health data, and ethnic monitoring in the NHS will further stimulate this trend. We identify four fundamental problems with ethnicity in this type of research: the difficulties of measurement, the heterogeneity of the populations being studied, lack of clarity about the research purpose of the research, and ethnocentricity affecting the interpretation and use of data. Ethnicity needs to be used carefully to be a useful tool for health research. We make nine recommendations for future practice, one of which is that ethnicity and race should be recognised and treated as distinct concepts.

Epidemiology is the study of the distribution and determinants of disease. The main method of study, particularly for investigating the causes of disease, is to compare populations with different risks of disease. Ethnicity is a variable that is used increasingly to define populations for epidemiological studies. . . . [Full text of this article]

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• Sorenson, S. B. (1998). Identifying Hispanics in Existing Databases: Effect of Three Methods on Mortality Patterns of Hispanics and Non-Hispanic Whites. Eval Rev 22: 520-534 [Abstract]  
• Hilton, C. (1996). For Debate: Collecting ethnic group data for inpatients: is it useful?. BMJ 313: 923-925 [Full text]  
• McAuley, J., De Souza, L., Sharma, V., Robinson, I., Main, C. J, Frank, A O (1996). Self defined ethnicity is unhelpful. BMJ 313: 425b-426 [Full text]  
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• Raleigh, V S, Balarajan, R (1994). Public health and the 1991 census. BMJ 309: 287-288 [Full text]  
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