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BackgroundSocial gradients and ethnic disparities have been reported in some forms of intellectual and developmental disabilities. However, information on the association between area deprivation, ethnicity and other forms of intellectual and developmental disabilities are inconclusive.AimTo estimate the independent association between household disadvantage, local area deprivation, ethnicity and the identification of intellectual and developmental disability.MethodsCross-sectional survey involving multilevel multivariate analyses of data extracted from educational records on household disadvantage, local area deprivation, ethnicity and identified intellectual and developmental disability in a sample of English children aged 7–15 years (n=5.18 million).ResultsLower household socio-economic position was associated with increased rates of identification of intellectual and developmental disabilities especially less severe forms of intellectual disability. Higher area deprivation was independently associated with increased rates of identification of less severe forms of intellectual disability but decreased rates of identification of profound multiple intellectual disability and autism spectrum disorder. Minority ethnic status was, in general, associated with lower rates of identification of intellectual and developmental disabilities. Exceptions to this general pattern included higher rates of identification of less severe forms of intellectual disability among Gypsy/Romany and Traveller children of Irish heritage, and higher rates of identification of more severe forms of intellectual disability among children of Pakistani and Bangladeshi heritage.ConclusionsChildren whose development is already compromised (and especially children with less severe intellectual disabilities) are at increased risk of exposure to social conditions that are themselves inimical to healthy development.

ObjectiveTo assess whether neighbourhood socioeconomic status (NSES) is independently associated with disparities in biological ‘wear and tear’ measured by allostatic load in a nationally representative sample of US adults.DesignCross-sectional study.SettingPopulation-based US survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with US census data describing respondents' neighbourhoods.Participants13 184 adults from 83 counties and 1805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts.Main outcome measuresA summary measure of biological risk, incorporating nine biomarkers that together represent allostatic load across metabolic, cardiovascular and inflammatory subindices.ResultsBeing male, older, having lower income, less education, being Mexican-American and being both black and female were all independently associated with a worse allostatic load. After adjusting for these characteristics, living in a lower NSES was associated with a worse allostatic load (coefficient −0.46; CI −0.079 to −0.012). The relationship between NSES and allostatic load did not vary significantly by gender or race/ethnicity.ConclusionsLiving in a lower NSES in the USA is associated with significantly greater biological wear and tear as measured by the allostatic load, and this relationship is independent of individual SES characteristics. Our findings show that where one lives is independently associated with allostatic load, thereby suggesting that policies that improve NSES may also yield health returns.

BackgroundEthnic disparities in perinatal mortality are well known. This study aimed to explore the contribution of demographic, socioeconomic, health behavioural and pre-existent medical risk factors among different ethnic groups on fetal and early neonatal mortality.MethodsWe assessed perinatal mortality from 24.0 weeks' gestation onwards in 554 234 singleton pregnancies of nulliparous women in the linked Netherlands Perinatal Registry over the period 2000–2006. Logistic regression modelling was used.ResultsConsiderable ethnic differences in perinatal mortality exist especially in fetal mortality. Maternal age, socioeconomic status and pre-existent diseases could not explain these ethnic differences. Late booking visit could explain some differences. Compared with the Dutch, African women had an increased fetal mortality risk of OR 1.7 (95% CI 1.4 to 2.1); South Asian women, 1.8 (1.4 to 2.3); other non-Western women, 1.3 (1.1 to 1.6) and Turkish/Moroccan women, 1.3 (1.1 to 1.4). The risk on early neonatal mortality was only increased in other non-Western women, OR 1.3 (1.0 to 1.8). Ethnic differences were even present in the women without risk factors including preterm births. Mortality risk for East Asian and other Western women was lower or comparable with the Dutch.ConclusionImportant ethnic differences in fetal mortality exist, especially among women of African and South Asian origin. Ethnic minorities should be more acquainted with the significance of early start of prenatal care. Tailored prenatal care for women with African and South Asian origin seems necessary. More research on underlying cause of deaths is needed by ethnic group.

The literature on migration and health is quite heterogeneous in how migrants are labelled and how the relation between migration and health is conceptualised. A narrative review has been carried out. This glossary presents the most commonly used terms in the field of migration and health, along with synonyms and related concepts, and discusses the suitability of their use in epidemiological studies. The terminology used in migrant health is ambiguous in many cases. Studies on migrant health should avoid layman terms and strive to use internationally defined concepts.

BackgroundDisparities in health among blacks and Hispanics compared to whites individuals exist for a number of health measures; however, the health profile of individuals who are both black and Hispanic is not well known. We sought to determine whether race and ethnicity have synchronous or independent effects on health-related outcomes.MethodsWe combined the National Health Interview Survey for 2000–2007 to identify 896 black Hispanics. We selected health-related outcomes where white Hispanics and non-Hispanic blacks significantly differed. We computed adjusted prevalence estimates for black Hispanics and compared them to determine whether their health-related outcomes more closely resemble white Hispanics or non-Hispanic blacks. All prevalence estimates were adjusted for age, sex, education, marital status, income and survey year.ResultsBlack Hispanics' health behaviours resembled white Hispanics or were similar to both white Hispanics and non-Hispanic blacks. For health services outcomes, they resembled non-Hispanic blacks. However, their health status was influenced by both race and ethnicity, with black Hispanics resembling both white Hispanic and non-Hispanic black people.ConclusionWe conclude that health behaviour interventions incorporating knowledge of Hispanic cultures may be sufficient to reach black Hispanics. However, health services or health status, interventions targeted broadly to Hispanic people may not be sufficient. In some respects black Hispanic people comprise a distinct subgroup that may require targeted attention in public health interventions.

BackgroundThe mean birth weight of offspring of Bangladeshi, Indian and Pakistani women tends to be among the lowest of any ethnic groups regardless of country of residence. However, it is unclear whether the mean birth weight of South Asian offspring born in England and Wales is higher among those whose mothers were themselves born in England and Wales compared to those whose mothers were born in the Indian sub-continent.MethodsWe used cross-sectional data from a unique linkage of routine records for the whole of England and Wales (2005–2006, n=861 654) to estimate mean birth weights of the live singleton offspring of Bangladeshi, Indian, Pakistani or White British ethnicity according to whether maternal place of birth was England and Wales or the Indian sub-continent.ResultsOffspring of women born in the Indian sub-continent were slightly heavier at birth than offspring of South Asian women born in England and Wales even after adjustment for gestational age, maternal age and parity (Bangladeshi 28 g, 95% CI 10 to 46; Indian 31 g, 95% CI 20 to 42; Pakistani 21 g, 95% CI 12 to 29).ConclusionsThere is no indication that the mean birth weight of South Asian offspring of women born in England and Wales is higher than the mean birth weight of those whose mothers were born in the Indian sub-continent. This suggests a shared physiological tendency for down-regulation of fetal growth transmissible across generations. Within the UK, there is unlikely to be any appreciable increase in mean birth weight of South Asian babies over the next few decades.

BackgroundAlthough the prevalence of prenatal smoking among minority women exceeds the projected 2010 national objective, data on the determinants of prenatal smoking among minorities remain sparse.MethodsWe examined associations between self-reported experiences of racial discrimination on prenatal smoking among urban black and Hispanic women aged 18–44 years (n=677). Our main independent variable was created from the Experiences of Discrimination (EOD) scale. Multivariable logistic regression models were estimated to examine the relationship between EOD (moderate EOD as the referent group) and smoking for the entire sample and then separately by race/ethnicity adjusted for sociodemographic variables. We also examined the role of ethnic identity (EI) as a buffer to racial discrimination (n=405).ResultsThe prevalence of smoking was 18.1% versus 10% for black and Hispanic women, respectively (p=0.002). There were no significant differences in the level of EOD based on race. In multivariate regressions, compared to those reporting moderate EOD, women reporting high discrimination (OR 2.64, 95% CI 1.25 to 5.60) had higher odds of smoking. In stratified analyses, this relationship remained significant only in black women. Results suggest that foreign-born Hispanic women with higher EI were less likely to smoke compared to their low-EI counterparts (3.5 vs 10.1%; p=0.08).ConclusionThese are the first data in pregnant minority women showing an association between discrimination and increased risk of smoking particularly among black women. Ethnic identity and nativity status were also associated with smoking risk. Smoking cessation programmes should consider such factors among childbearing minority women.

BackgroundThe aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down's syndrome and to examine the contribution of background and decision-making variables.MethodsPregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the ‘Multidimensional Measure of Informed Choice’ that has been developed and applied in the UK.ResultsIn total, 71% of the Dutch women were classified as informed decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation.ConclusionWomen from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.

Background Despite lower alcohol drinking rates of UK ethnic minority people (excluding Irish) compared with those of the white majority, events of racial discrimination expose ethnic minorities to unique stressors that elevate the risk for escapist drinking. Studies of ethnic density, the geographical concentration of ethnic minorities in an area, have found racism to be less prevalent in areas of increased ethnic density, and this study hypothesises that ethnic minority people living in areas of high ethnic density will report less alcohol use relative to their counterparts, due to decreased experienced racism and increased sociocultural norms. Methods Multilevel logistic regressions were applied to data from the 1999 and 2004 Health Survey for England linked to ethnic density data from 2001 census. Results Respondents living in non-White area types and areas of higher coethnic density reported decreased odds of being current drinkers relative to their counterparts. A statistically significant reduction in the odds of exceeding sensible drinking recommendations was observed for Caribbeans in Black area types, Africans in areas of higher coethnic density and Indian people living in Indian area types. Conclusion Results confirmed a protective ethnic density effect for current alcohol consumption, but showed a less consistent picture of an ethnic density effect for adherence to sensible drinking guidelines. Previous research has shown that alcohol use is increasing among ethnic minorities, and so a greater understanding of alcohol-related behaviour among UK ethnic minority people is important to establish their need for preventive care and advice on safe drinking practices.

BackgroundPeriodontitis has been shown to be associated with allostatic load, a measure of physiological instability across biological systems from cumulative or repeated adaptation to stressors. Minority racial/ethnic and low socioeconomic groups tend to have higher prevalence of periodontitis and are more likely to be exposed to stress. The association between periodontitis and allostatic load and whether this association differed by race/ethnicity, education, income and age among US adults were examined.MethodsUsing data from the National Health and Nutrition Examination Survey 1999–2004, prevalence ratios were calculated using logistic regression to estimate the strength of the association between allostatic load and the prevalence of periodontitis before and after adjusting for selected characteristics.ResultsAfter adjustment for selected characteristics, including race/ethnicity, income and education, US adults with a high allostatic load were 55% (95% CI 1.05 to 2.29) more likely to have periodontitis than their counterparts with low allostatic load. This association varied by race/ethnicity where Mexican Americans with a high allostatic load were almost five (PR 4.62; 95% CI 2.52 to 8.50) times more likely to have periodontitis than their counterparts with low allostatic load.ConclusionsThese data suggest that stress may be associated with periodontitis in the USA, with Mexican Americans exhibiting the strongest association. Furthermore, this group may lack appropriate coping responses to process chronic stressors that other groups may have historically been conditioned to handle. More research is needed to understand allostatic load in Mexican Americans and its influence on periodontitis.