Acute asthma in asian patients: Hospital admissions and duration of stay in a district with a high immigrant population

doi:10.1016/0007-0971(86)90059-8

British Journal of Diseases of the Chest

Volume 80, 1986, Pages 242-248

https://doi.org/10.1016/0007-0971(86)90059-8 Get rights and content

Abstract

Acute asthma admissions to a District General Hospital in the East District of Birmingham from 1972 to 1982 show that 20% of admissions are in Asian patients who comprise only 9.7% of the population. Annual admissions for acute asthma have risen from 240 to 377 (+57%) for non-Asians and from 60 to 100 (+67%) for Asians in that time although the proportion of readmissions has remained unchanged. For 1981, admission rates for acute asthma per 100 000 population, assuming equal asthma prevalence rates, was 198 for Asians compared to 79 for non-Asians, a relative risk of 2.5. Mean duration of hospital stay has fallen from 13.6 days to 6.7 days but there is no difference when comparing Asian to non-Asian populations at each age level, duration of stay rising with increasing age. The reasons for the higher admission rates for Asians are probably multifactorial but poor asthma education due to language problems and poor compliance may be significant causes, although this remains to be confirmed.

References (12)

M. Alderson
An Introduction to Epidemiology
(1983)
L.J. Donaldson et al.
Patterns of Asian and non-Asian morbidity in hospitals
Br. med. J.
(1983)
I. Filby
Ethnic Minorities in the West Midlands Health Region
(1984)
I. Gregg
Epidemiological aspects of asthma
A. Henley
Asian Patients in Hospital and at Home
A. Khot et al.
Seasonal variation and time trends in childhood asthma in England and Wales 1975–1981
Br. med. J.
(1984)

There are more references available in the full text version of this article.

Cited by (30)

Ethnic variations in UK asthma frequency, morbidity, and health-service use: A systematic review and meta-analysis
2005, Lancet
Citation Excerpt :
Ethnic minorities with low incomes might regard asthma as less serious than other pressing problems of life.35 There is no evidence for a difference in severity of asthma between ethnic groups,36 but ethnic minorities, especially south Asians, could adopt negative attitudes towards the disease that discourage use of prophylactic medication.26,28,37 Adverse socioeconomic circumstances of such minority groups generally result in difficulties in accessing high-quality asthma care.38,39
The frequency of asthma varies between countries, and may also vary between ethnic groups in more geographically confined areas. We sought evidence of such ethnic variations in the UK for asthma frequency, morbidity, and health-services use, and to understand possible reasons for any differences.
We searched MEDLINE, EMBASE, CINAHL, PSYCHInfo, PREMEDLINE, HEALTHSTAR, Cambridge Register of Conference Abstracts, the Dissertation and Thesis Database, and the National Registry of Research. Additionally, we searched the bibliographies of reports identified and websites of health authorities, and contacted experts in this discipline. Our main outcomes were comparisons of asthma rate, morbidity, and health-services use. We did meta-analyses using random-effects models.
13 studies contained relevant data. All prevalence studies were of children and showed that south Asian children had a lower frequency of symptoms suggestive of asthma compared with black and white children (pooled rate of history of wheeze in the previous 12 months: south Asians 9·6% [95%CI 8·0–11·2%], black people 16·2% [12·8–19·6%], white people 14·6% [11·5–17·8%]). The pooled frequency of clinician-diagnosed asthma in children followed a similar pattern (south Asians 7·6% [3·7–11·4%], black people 15·0% [3·5–26·5%], white people 10·6% [4·6–16·7%]. However, relative to white people, the risk of admission for asthma in children and adults was higher for south Asians (odds ratio 2·9 [2·4–3·4]) and black people (2·1 [1·8–2·5]).
The differences in admission are not explained by differences in asthma frequency between groups; they could relate to ethnic variations in asthma severity, differences in health-seeking behaviour, or difficulties in accessing high-quality primary care services.
Perceptions of asthma in South Asians and their views on educational materials and self-management plans: A qualitative study
2002, Patient Education and Counseling
Asians with asthma have higher hospital admission rates than whites without any evidence of increased asthma severity. There is limited information as to whether these differences are due to language or communication difficulties, variable knowledge and cultural attitudes to asthma or deficiencies of medical care. A qualitative study with 60 participants (12 participants with asthma for semi-structured interviews and 48 participants for focus groups) was designed to explore knowledge about asthma, attitudes, perceptions, health beliefs and health needs of those from Pakistan and India (South Asians). Overall, most of the patients with asthma were aware of the symptoms and trigger factors of asthma and were well informed about the ‘reliever’ and ‘preventer’ properties of their inhalers. They were also well informed about alternative/complementary therapies and were willing to try them should the treatment provided by their general practitioner (GP) fail to resolve their symptoms. Most were dissatisfied with the asthma care provided by their GPs e.g. delays in making the diagnosis and deficiencies in providing both verbal and written information on asthma. There was lack of awareness about self-management plans although when explained, the concept of self management was well received and there was approval for the concept of written action plans. All the focus group participants seemed to know something about asthma and amongst those with the condition (or with relatives with the condition), knowledge of the disease and its treatment seemed to be good. It was concluded that improved dissemination of written and verbal information on all aspects of asthma and increased awareness, training and support for adoption of written self-management (action) plans is needed to provide a more efficient and effective service for South Asian patients with asthma.
Possible increased risk of hospital admission for asthma in women in Zaria, northern Nigeria
1999, Transactions of the Royal Society of Tropical Medicine and Hygiene
Betel nut: A common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands
1999, Annals of Emergency Medicine
Betel nut is a common masticatory drug used in Far East Asia, India, and the South Pacific. It is used daily by 600 million people worldwide, yet is unknown to most Western physicians. As the world becomes more culturally and ethnically interconnected, emergency physicians will encounter the use of betel nut. Significant illness can be associated with its use, including asthma exacerbation, cholinergic crisis, cardiac arrhythmias, acute psychosis, milk-alkali syndrome, and oropharyngeal tumors. We describe its source, pharmacology, composition, presentation, and treatment in the emergency department. [Nelson BS, Heischober B: Betel nut: A common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med August 1999;34:238-243.]
High rate of asthma among immigrants
1998, Medical Hypotheses
Articles dealing with the epidemiological aspects of asthma were carefully reviewed in order to support or reject our clinical impression of increased rate of asthma among immigrants. Particular emphasis was put on data on very high or very low rates of asthma. The proposed theories to explain these differences were critically examined.
The prevalence of asthma in China and in Africa is 1–2% and 0.5–5%, respectively. The prevalence of the disease in other indigenous populations ranges between 0.5% and 12%. On the other hand, asthma is much more frequently seen in Australia and in New Zealand (approximately 20–25%), where peoples' ancestors immigrated from distant areas. Statistical meta-analysis found a significant difference between the rates of asthma in the two groups of populations (P< 0.001).
Immunoglobulin E levels of immigrants in Sweden are higher than those of native Swedes. Similarly, cord blood immunoglobulin E concentrations are more elevated in neonates whose mothers emigrated to Germany from Eastern countries than in those of native German mothers. There is an increased rate of IgE-mediated asthma among immigrant populations.
Adult Asian acute asthma admissions reassessed: Blackburn 1991-1992
1995, Respiratory Medicine
Two hundred and fifty-five admissions for acute asthma with a minimum 25% PEFR improvement in patients aged 15–44 years were studied in 1991–1992. Two hundred of these patients were in the white ethnic group (84 male; 116 female) with 33 (17·4%) being readmissions (15 male; 18 female). Fifty-five admissions (19 male; 36 female) were in the Indian subcontinent (ISC) ethnic group with 3 (5·5%; all female) readmissions. The readmission rate was significantly higher in the white ethnic group (χ²=4·83; 0·05<P<0·01). Admission rates per thousand population in 5-yr cohorts were calculated from the 1991 Census data. The admission rate was higher in the ISC ethnic group in all cohorts except females aged 15–19 years, and was significantly higher in males aged 15–19 years and 40–44 years, and in all four cohorts between 25–44 years in females. Initial PEFR and % initial PEFR/highest PEFR did not suggest increased severity of asthma in the ISC ethnic group.

View all citing articles on Scopus

View full text

General articleAcute asthma in asian patients: Hospital admissions and duration of stay in a district with a high immigrant population

Abstract

An Introduction to Epidemiology

Patterns of Asian and non-Asian morbidity in hospitals

Br. med. J.

Ethnic Minorities in the West Midlands Health Region

Epidemiological aspects of asthma

Asian Patients in Hospital and at Home

Seasonal variation and time trends in childhood asthma in England and Wales 1975–1981

Br. med. J.

General article
Acute asthma in asian patients: Hospital admissions and duration of stay in a district with a high immigrant population