Letters

Differences in mortality between African Caribbean and European people with non-insulin dependent diabetes

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7076.303a (Published 25 January 1997) Cite this as: BMJ 1997;314:303

Authors' method of assigning ethnic group was wrong

  1. Ikechukwu Obialo Azuonye, Consultant psychiatrista
  1. a Adult Mental Health Unit, Lambeth Healthcare NHS Trust, London SW9 9NT
  2. b National Institute of Epidemiology, Surrey Research Park, Guildford GU2 5YD
  3. c Wessex Institute for Health Research and Development, Southampton General Hospital, Southampton SO16 6YD
  4. d Division of Public Health Sciences, UMDS, Guy's and St Thomas's Medical and Dental Schools, London SE1 7EH
  5. e EURODIAB, Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  6. f London SE26 4PA
  7. g Bedford Hospital, Bedford MK42 9DJ
  8. h Unit for Metabolic Medicine, Guy's Hospital, London SE1 9RT

    Editor–The methodology of Nish Chaturvedi and colleagues' 20 year follow up of patients with non-insulin dependent diabetes mellitus is worrying.1 The authors compared mortality and morbidity in African Caribbeans and Europeans. Their first mistake was in taking it upon themselves to assign people to ethnic groups: ethnicity is a self designation that, in many cases, changes over time. They made the further error of assigning the subjects to an ethnic group “on the basis of appearance and country of birth.” They give no indication of the physical characteristics that led to a person being assigned to the African Caribbean or the European group, and they assume that two or more people looking at the same person will agree completely about that person's appearance.

    The African Caribbean group are said to be those “people of black African descent who either were born in the Caribbean or were descendants of those born in the Caribbean”–that is to say, two different populations. This assertion contradicts the authors' statement that “all [their] participants were first generation migrants.” And who, in any case, are Europeans?

    It is unfortunate that anyone wishing to replicate this study cannot do so because of the poor selection of the sample population, a situation that reflects the problems I addressed in the BMJ a few weeks ago.2

    References

    1. 1.
    2. 2.

    Lack of ethnic differences in renal complications of diabetes is puzzling

    1. Veena Soni Raleigh, Senior research fellowb,
    2. Paul Roderick, Senior lecturer in public health medicinec
    1. a Adult Mental Health Unit, Lambeth Healthcare NHS Trust, London SW9 9NT
    2. b National Institute of Epidemiology, Surrey Research Park, Guildford GU2 5YD
    3. c Wessex Institute for Health Research and Development, Southampton General Hospital, Southampton SO16 6YD
    4. d Division of Public Health Sciences, UMDS, Guy's and St Thomas's Medical and Dental Schools, London SE1 7EH
    5. e EURODIAB, Department of Epidemiology and Public Health, University College London, London WC1E 6BT
    6. f London SE26 4PA
    7. g Bedford Hospital, Bedford MK42 9DJ
    8. h Unit for Metabolic Medicine, Guy's Hospital, London SE1 9RT

      Editor–Nish Chaturvedi and colleagues' study shows that low rates of coronary heart disease in African Caribbeans persist in those with diabetes.1 Two other findings are puzzling.

      The first is the low risk of death from all causes in African Caribbean diabetic patients compared with their European counterparts (it is about half). An analysis based on the 1991 census for England and Wales shows a 3.5-fold higher mortality from diabetes in African Caribbean born men …

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