Effect of ethnicity on the prevalence, severity, and management of COPD in general practice.

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) remains a major cause of mortality and hospital use. Little is known in the UK about the variation in COPD prevalence, severity, and management depending on ethnicity. AIM: To examine differences by ethnicity in COPD prevalence, severity, and management. DESIGN & SETTING: Cross-sectional study using routinely collected computerised data from general practice in three east-London primary care trusts (Newham, Tower Hamlets, and City and Hackney) with multiethnic populations of people who are socially deprived. METHOD: Routine demographic, clinical, and hospital admission data from 140 practices were collected. RESULTS: Crude COPD prevalence was 0.9%; the highest recorded rates were in the white population. Severity of COPD, measured by percentage-predicted forced expiratory volume in 1 second, did not vary by ethnicity. South Asians and black patients were less likely than white patients to have breathlessness, indicated by a Medical Research Council dyspnoea grade of ≥4 (odds ratio [OR] 0.7 [95% confidence interval (CI) = 0.6 to 0.9] and 0.6 [95% CI = 0.4 to 0.8]). Black patients were less likely than white patients to receive inhaled medications. Influenza and pneumococcal vaccine rates were highest among groups of South Asians (OR 3.0 [95% CI = 2.1 to 4.3] and 1.8 [95% CI = 1.4 to 2.3] respectively). Both minority ethnic groups had low referral rates to pulmonary rehabilitation. In Tower Hamlets, black patients were more likely to be admitted to hospital for respiratory causes. CONCLUSION: Differences in COPD prevalence and severity by ethnicity were identified, and significant differences in drug and non-drug management and hospital admissions observed. Systematic ethnicity recording in general practice is needed to be able to explore such differences and monitor inequalities in healthcare by ethnicity.