Country of birth, ethnicity and race: providing insights into the causes and consequences of (cardiovascular) disease

Transcription

1 Coutry of birth, ethicity ad race: providig isights ito the causes ad cosequeces of (cardiovascular) disease Raj Bhopal CBE, DSc (ho), MD, MPH Professor of Public Health, Uiversity of Ediburgh Hoorary cosultat, NHS Lothia Ediburgh Migratio, Ethicity ad Health Research Group, Usher Istitute for Populatio Health Sciece ad Iformatics Presetatio to MLGH coferece, March 2017

2 Europea perspective o migratio, ethicity ad race: preset

3 First priciples thikig o CVD i South Asias (pre-1984) South Asias (Idias, Pakistais, Sri Lakas, Nepalese) should have low rates of coroary heart disease, ad maybe stroke Reaso: low smokig prevalece (especially wome), much vegetariaism, low blood pressure especially i Bagladeshis ad Pakistais etc Wrog!

4 Data cotradictig first priciples CVD Adelstei (1963, South Africa) Marmot 1984; Balaraja 1991; Wild & McKeigue 1997; Bhopal 1999; Rafsso 2012; Basal 2013 Diabetes Mather ad Kee for diabetes (Southall 1985) ad New Delhi, 1986)

5 Europea Migrat Ethic Health Observatory: cross-coutry aalysis Total circulatory disease mortality (rate per 100,000 perso years) by coutry of birth i years old me Coutry of birth Scotlad E & W Frace Swede Netherlads Demark Europe - bor Chia Idia Pakista Eur J Public Health 2011 May 20.

6 Scottish Health ad Ethicity Likage Study: Cesus likage to health service ad mortality databases First myocardial ifarctio age ad educatio adjusted risk ratios with 95% CI, 01/05/ /04/2008 (Basal et al BMJ Ope 2013 September 1;3(9) 250 RR Male RR Female 95% CI Risk ratio White Scottish Other White British Irish Other White Mixed Idia Pakistai Other South Asia Africa Chiese Other Ethic Group Ethic Group

7 Explaatios o why South Asias at greater risk compared to Europeas? Artefacts / Iappropriate diagostic criteria Geetic/evolutioary hypotheses e.g.thrifty geotype, mitochodrial efficiecy, Adipocyte tissue distributio, Soldier to diplomat Thrifty pheotype (developmetal/fetal origis hypothesis) Social ad ecoomic deprivatio Psychosocial e.g. stress of migratio Lifestyle factors e.g. physical iactivity ad eatig patters Culture e.g. cuisie 7

8 Classic migratio study: risk factors i Idias ad their sibligs i Pujab (Bhatagar, Lacet 1995) Which colum is the Lodo oe? Serum cholesterol (mmol/l) HDL cholesterol (mmol/l) Systolic blood pressure (mm Hg) Also higher blood glucose

9 Multi-ethic Newcastle Heart Project (Bhopal et al, BMJ 1999;319: Diabetes & impaired glucose itolerace(%) (25-74 years) Me Wome Europea Idia Pakistai Baglad'

10 Why so much diabetes? Adiposity? Yudki has 9% ad Yajik 21% fat same BMI of 22.3 Adipose tissue or muscle? 10 Yajik & Yudki (2004) Lacet.

11 Services developig e.g. cardiovascular risk cotrol project for South Asias (Matthews et al JPH, 2007) The Khush Dil Project - Ediburgh 2002 Culturally sesitive service for South Asias 140 people had screeig 6 moths after baselie Risk factor profiles improved, e.g. reductio i cholesterol, ad reported chages i behaviour Amazigly, these are still amog the best data i the world i South Asias It is time for major trials

12 Prevetio of diabetes ad obesity i South Asias (PODOSA) i Scotlad (Lacet Diabetes ad Edocriology 2013)

13 Stimulus to research: major cohort studies of migrat ad ethic health Bradford Birth Cohort Lodo adolescets health West of Lodo CVD cohort (LOLIPOP) Amsterdam CVD study US ow followig Europe

14 New opportuities ad ideas - high heat cookig (Kakde et al Nutritio 2017) Cookig at >170 degrees cetigrade (338 F) accelerates productio of eoformed cotamiats South Asia Idia ad Chiese cuisies While traditioal South Asia food preparatio techiques produce large quatities of advace glycatio ed products ad tras-fatty acids, this is further exacerbated by the icreased cosumptio of fast foods.

15 Trasferece of kowledge What happeed i the UK i the 1980s is happeig i South Asia ow ad is beig demostrated i the US Iteratioal collaboratio to tackle the South Asia pademic of CVD ad type 2 diabetes is eeded Studies of miorities ca also help the populatio as a whole q q Very low cacer rates i South Asia populatios Very low cardiovascular rates i Chiese populatios Catalyses ew studies, data, scietific hypotheses ad advacemet of kowledge Grasp the opportuity!