Article Text

Download PDFPDF
Original article
Ethnic variations in heart failure: Scottish Health and Ethnicity Linkage Study (SHELS)
  1. R S Bhopal1,
  2. N Bansal1,
  3. C M Fischbacher1,2,
  4. H Brown1,
  5. S Capewell3 on behalf of the Scottish Health and Ethnicity Linkage Study
  1. 1Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  2. 2Information Services Division, NHS Scotland National Services, Gyle Crescent, Edinburgh, UK
  3. 3Division of Public Health, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor R Bhopal, Edinburgh Ethnicity and Health Research Group, Centre for Population Health Studies, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK; raj.bhopal{at}


Objective Ethnic variations in heart failure are, apparently, large (eg, up to threefold in South Asians compared with White populations in Leicestershire, UK) but data are limited and conflicting. The incidence of first occurrence of heart failure hospitalisation or death by ethnic group in Scotland was studied.

Design, setting, populations and outcomes A retrospective cohort study was developed of 4.65 million people using non-disclosive, computerised methods linking the Scottish 2001 census (providing ethnic group) to community death and hospital discharge/deaths data (SMR01). Annual, directly age standardised incidence rates per 100 000, incidence rate ratios (RRs) and risk ratios using Poisson regression were calculated. Ratios were multiplied by 100. Risk ratios were adjusted for age and highest education qualification. Statements of difference imply the 95% CI excludes 100 (reference), otherwise the CI is given.

Results In men, other White British (RR=86.4) and Chinese (RR=54.2) had less heart failure than White Scottish (100) populations while Pakistani men had more (RR=134.9). In women, the pattern was similar to men. Adjustment for highest educational qualification attenuated differences in risk ratios in other White British men (risk ratio=75.8 to 85.4) and women (66.2 to 74.6), made little difference to Pakistani men (146.9 to 142.1) and women (177.4 to 158.1), and augmented them in Indian men (115.4 (95% CI 93.1 to 143.0) to 131.7 (107.4 to 161.5)).

Conclusions Ethnic variations in heart failure were important in this population setting and not abolished by adjusting for highest education, one important indicator of socioeconomic differences. The ethnic variations were substantial but did not support other studies showing 3–20-fold differences between ethnic groups.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The work was funded by the Chief Scientist's Office (grant CZH/4/432). NHS Health Scotland provided a supplementary grant. ISD and the General Register Office for Scotland both supported this work. The researchers acted independently of the funding body and the study sponsor (the University of Edinburgh) at all stages of the work.

  • Competing interests None.

  • Ethics approval The work was approved by the Multicentre Research Ethics Committee (for Scotland) and the Privacy Advisory Committee of NHS National Services Scotland.

  • Provenance and peer review Not commissioned; externally peer reviewed.