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Public health implications of differentials in morbidity and mortality despite same access to cardiac investigations and treatment
- Anthony Lwegaba (9 August 2004)
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A new trend?
- Nazim Ghouri (31 August 2004)
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Anthony Lwegaba, Lecturer, Social & Preventive Medicine UWI SCMR Barbados, West Indies
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Dear Editor, In response to Britton et al, BMJ, doi:10.1136/bmj.38156.690150.AE (published 5 July 2004). The question that could be restated as can ethnic or social differences in cardiac morbidity and mortality be due to differences in access to cardiac disease treatment procedures – during secondary and tertiary prevention? In which case it is still possible that ethnic and social differences in access to health and other services essential for primary prevention could have pre-existed. Using the web of health determinants model, the biological, physical, social & economic and health system environments interact and influence individuals and populations to states of normal, sub-clinical, clinical, and complications. There are two important public health messages hidden in the study. First, despite equal access, secondary and tertiary prevention were less helpful to the ethnic minority. Secondly, unless proven otherwise, the good news that should be communicated to mobilize ethnic minority is that they need not suffer disproportionately provided appropriate,(especially primary) prevention measures are implemented lifelong from pre-conception. In short, if the disparity exists but not at the secondary and tertiary prevention; it must be at primary prevention. Competing interests: None declared |
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Nazim Ghouri, Medical PRHO Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh. EH16 4SA
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Dear Editor This paper by Britton et al(1) was extremely interesting as it looked to see whether ethnicity was a factor when investigating or treating CHD patients in relation to clinical need. It is encouraging to note that South Asians perhaps had a degree of ‘overtreatment’ after several studies in the past suggested that the converse was more likely.(2-5) I would like to add to my support to the finding that South Asians receive good follow-up post myocardial infarction (MI) compared to whites. Just over a year ago, as an undergraduate, I undertook a pilot study with Professor Raj Bhopal and Dr Sonja Hunt department of Public Health, University of Edinburgh, and Dr David Newby, Department of Cardiology, Royal Infirmary of Edinburgh looking at the management and follow-up of south Asians post MI compared to whites of European origin in Edinburgh. The study involved 24 subjects and management was audited at several stages over a 15-month period after the initial MI. The results showed that there were no major differences in the acute management of the initial MI, except for the rates of rescue percutaneous intervention, which was much higher in south Asians. Also more South Asians were under review after 15-months. I hope that positive trend has been noticed elsewhere. 1. BMJ. Doi:10.1136/bmj.38156.690150.AE (published 5 July 2005). 2. Lowry PJ, Glover DR, Mace PJ, Littler WA. Coronary artery disease in Asians in Birmingham. Br Heart J 1984; 526: 610-13. 3. Shaukat N, de Bono DP, Cruikshank JK. Clinical features, risk factors and referral delay in British patients of Indian and European origin with angina matched for age, and extent of coronary atheroma. BMJ 1993; 307: 717-18. 4. Goldsmith I, Lip GY, Tsang G, Patel RL. Comparison of primary coronary bypass surgery in a British Indo-Asian and white Caucasian population. Eur Heart J 1999; 20: 1094-100. 5. Feder GG, Crook AM, Magee P, et al. Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. BMJ 2002; 324: 511-16. Competing interests: None declared |
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