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

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.

A scoping review of academic and grey literature on migrant health research conducted in Scotland

“…Funding sources were not declared for 35 (35%) of reports. The Scottish Government funded 20 reports (20%) [ 13 , 27 , 32 , 39 , 45 – 47 , 66 , 77 , 88 , 99 – 102 , 113 , 116 , 119 , 121 , 129 , 134 ]. Other common sources of funding included Government funded public bodies ( n = 13) [ 45 , 48 – 53 , 104 , 107 , 113 , 116 , 131 , 136 ], the Scottish Health Service ( n = 18) (either the National Health Service (NHS) [ 13 , 54 , 56 – 59 , 102 , 113 , 116 ], local NHS trusts [ 45 , 60 , 61 , 77 , 102 , 103 , 112 ] or by Public Health Scotland [ 13 , 113 ]) Eleven reports (11%) were funded by Universities.…”

“…The Scottish Government funded 20 reports (20%) [ 13 , 27 , 32 , 39 , 45 – 47 , 66 , 77 , 88 , 99 – 102 , 113 , 116 , 119 , 121 , 129 , 134 ]. Other common sources of funding included Government funded public bodies ( n = 13) [ 45 , 48 – 53 , 104 , 107 , 113 , 116 , 131 , 136 ], the Scottish Health Service ( n = 18) (either the National Health Service (NHS) [ 13 , 54 , 56 – 59 , 102 , 113 , 116 ], local NHS trusts [ 45 , 60 , 61 , 77 , 102 , 103 , 112 ] or by Public Health Scotland [ 13 , 113 ]) Eleven reports (11%) were funded by Universities. The charity sector financed 15 (15%) reports [ 53 , 63 , 66 , 69 – 74 , 103 , 111 , 123 , 125 , 132 , 138 ] and the EU and Scottish local authorities funded four reports each [ 45 , 62 , 75 – 77 , 102 , 125 , 135 ].…”

Reducing the impact of the coronavirus on disadvantaged migrants and ethnic minorities

“…As previous UK studies have shown, anonymous linkage of the census to health and death records provides a powerful means of exploring the complex relationships between ethnic group, place of birth and health. 39 An expert group in Scotland recently concluded that this type of linkage would provide the most robust and publicly acceptable means of examining the interaction between COVID-19, ethnicity, country of birth and other inter-related factors. 40 Other countries should consider adopting similar methods as well as improve data of migrants within health information systems.…”

New data strategy for England: Scotland provides an exemplar for achieving public trust

“…We linked data, including data from the census, mortality records,4 hospital admissions databases,5 infection registers,6 cancer registration,7 bowel and breast cancer screening registers,89 electronic general practice and primary care records,10 and the sensitive data of the Mental Welfare Commission for Scotland, including on compulsory admission to psychiatric hospital 11. These linkages won the support of professionals, professional bodies, ethical committees, funders, and the public, and to date there have been no complaints and no data breaches.…”