Providing national vital health statistics by ethnic group at low cost: SHELS
INTRODUCTION: increasing international migration is producing ethnically diverse societies, with population groups exhibiting important differences in health status and health care utilisation. Legislation, policy, professional standards and business efficiency requires data by ethnic group but these are sparse.
METHODS: The Scottish Health and Ethnicity Linkage Study (SHELS ) is a retrospective cohort of 4.65 million people created using name, address, sex and date of birth for probability-linkage of the 2001 Census population for Scotland (reporting 14 ethnic group categories) to the National Health Service Scotland identification number (CHI). Subsequently, CHI permitted linkage to hospitalisation, mortality, compulsory psychiatric detention, breast cancer screening and other databases. Eight indicators of socio-economic position were available as potential confounding variables.
RESULTS: Ethical and privacy advisory committee permissions were achieved after resolving technical problems especially on minimising risk of inadvertent disclosure of identity. Analyses include those on cardiovascular diseases, cancers, breast cancer screening, maternal and child health, mental health including compulsory detention (all published or about to be). For example, compared to the White Scottish population (reference value 100) men in the Pakistani ethnic group had the following age-adjusted risks (95% confidence intervals exclude 100): colorectal cancer 45.6 and myocardial infarction 164.1. For Pakistani women the risk of non-attendance for breast cancer screening was 181.7. Analyses on gastrointestinal disorders and respiratory disorders are completed (papers under preparation). Analysis are planned on all-cause mortality, all-cause hospitalisation, all infections, accidents & poisoning, bowel cancer screening, hepatitis C & B and HIV. SHELS has cost about 20-30 pence (US 30-45 cents) per person in Scotland.
CONCLUSIONS: Data by ethnic group (or like-variables) can be obtained at low cost through data linkage methods wherever census (or population register) records ethnicity. SHELS offers a model for use internationally.