Limitations and potential of country of birth as proxy for ethnic grou
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《英国医生杂志》
EDITOR—We agree with Jarman and Aylin that recording of ethnic group on death certificates needs to be improved in the United Kingdom.1
Currently, country of birth has been included in each UK census since 1841 and is a readily available and objective, although crude, method of ethnic group classification.2 Indeed it remains a good proxy for ethnic group for the older age minority groups and is of intrinsic interest in separating environmental and genetic differences. However, it is no longer an appropriate proxy as it does not take account of the diversity of the country of origin of the individual; the number of white people born in countries, such as India, ruled by the British Empire; and children of migrants identified by this method as second generation immigrants. In the 2001 census half of the minority ethnic population was born outside the United Kingdom.
Further recording of country of birth on death certificates, which is reliant on an informant, may be less accurate than on the census, when the person is still alive to provide the information, leading to the possibility of numerator-denominator bias. Previous analyses of mortality by country of birth have grouped together countries for which this is a particular issue—South Asian countries3—but this approach obscures potentially important differences between countries of birth.2 3 4
Despite these limitations, we have documented the marked variations in mortality by age, sex, and ethnic group.5 This resource is available online and provides a wide range of data both on the morbidity and mortality by ethnic group that is of use for commissioning services for these minority communities. However, there is an urgent need to address the recording of ethnic group data on death certificates to accurately determine and address the health inequalities between ethnic groups in the United Kingdom.
Paramjit S Gill, clinical senior lecturer
University of Birmingham, Birmingham B15 2TT p.s.gill@bham.ac.uk
Raj Bhopal, professor of public health, Sarah Wild, senior lecturer
Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9AG
Joe Kai, professor of primary care
University of Nottingham, Graduate Medical School, Derby City General Hospital, Derby DE22 3DT
Competing interests: None declared.
References
Jarman B, Aylin P. Death rates in England and Wales and the United States: variation with age, sex, and race. BMJ 2004;329: 1367. (11 December.)
Aspinall PJ, Jacobson B, Polato GM. Missing record: the case for recording ethnicity at birth and death registration. www.lho.org.uk/Publications/Attachments/Word_Files/Civil_Registration_Report.doc (accessed 15 Dec 2004).
Marmot MG, Adelstein AM, Bulusu L, Shukla V. Immigrant mortality in England and Wales 1970-78. London: HMSO, 1984. (OPCS studies on population and medical subjects: No 47.)
Wild S, Mckeigue P. Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. BMJ 1997;314: 705.
Gill PS, Kai J, Bhopal RS, Wild S. Health care needs assessment: black and minority ethnic groups. In: Raftery J, Stevens A, Mant J, eds. Health care needs assessment. The epidemiologically based needs assessment reviews. 3rd series. Abingdon: Radcliffe Medical Press (in press). Available at: http://hcna.radcliffe-oxford.com/bemgframe.htm (accessed 15 Dec 2004).
Currently, country of birth has been included in each UK census since 1841 and is a readily available and objective, although crude, method of ethnic group classification.2 Indeed it remains a good proxy for ethnic group for the older age minority groups and is of intrinsic interest in separating environmental and genetic differences. However, it is no longer an appropriate proxy as it does not take account of the diversity of the country of origin of the individual; the number of white people born in countries, such as India, ruled by the British Empire; and children of migrants identified by this method as second generation immigrants. In the 2001 census half of the minority ethnic population was born outside the United Kingdom.
Further recording of country of birth on death certificates, which is reliant on an informant, may be less accurate than on the census, when the person is still alive to provide the information, leading to the possibility of numerator-denominator bias. Previous analyses of mortality by country of birth have grouped together countries for which this is a particular issue—South Asian countries3—but this approach obscures potentially important differences between countries of birth.2 3 4
Despite these limitations, we have documented the marked variations in mortality by age, sex, and ethnic group.5 This resource is available online and provides a wide range of data both on the morbidity and mortality by ethnic group that is of use for commissioning services for these minority communities. However, there is an urgent need to address the recording of ethnic group data on death certificates to accurately determine and address the health inequalities between ethnic groups in the United Kingdom.
Paramjit S Gill, clinical senior lecturer
University of Birmingham, Birmingham B15 2TT p.s.gill@bham.ac.uk
Raj Bhopal, professor of public health, Sarah Wild, senior lecturer
Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9AG
Joe Kai, professor of primary care
University of Nottingham, Graduate Medical School, Derby City General Hospital, Derby DE22 3DT
Competing interests: None declared.
References
Jarman B, Aylin P. Death rates in England and Wales and the United States: variation with age, sex, and race. BMJ 2004;329: 1367. (11 December.)
Aspinall PJ, Jacobson B, Polato GM. Missing record: the case for recording ethnicity at birth and death registration. www.lho.org.uk/Publications/Attachments/Word_Files/Civil_Registration_Report.doc (accessed 15 Dec 2004).
Marmot MG, Adelstein AM, Bulusu L, Shukla V. Immigrant mortality in England and Wales 1970-78. London: HMSO, 1984. (OPCS studies on population and medical subjects: No 47.)
Wild S, Mckeigue P. Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. BMJ 1997;314: 705.
Gill PS, Kai J, Bhopal RS, Wild S. Health care needs assessment: black and minority ethnic groups. In: Raftery J, Stevens A, Mant J, eds. Health care needs assessment. The epidemiologically based needs assessment reviews. 3rd series. Abingdon: Radcliffe Medical Press (in press). Available at: http://hcna.radcliffe-oxford.com/bemgframe.htm (accessed 15 Dec 2004).