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

Background Chronic obstructive pulmonary disease (COPD) remains amajor cause ofmortality and hospital use. Little is known in the UK about the variation in COPD prevalence, severity, andmanagement 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 fromgeneral 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 from140 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). Bothminority ethnic groups had low referral rates to pulmonary rehabilitation. In Tower Hamlets, black patients weremore 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-drugmanagement 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.