Chaturvedi N, Rai H, Ben-Shlomo Y
EURODIAB, Department of Epidemiology and Public Health, University College London, UK.
Lancet. 1997 Nov 29;350(9091):1578-83. doi: 10.1016/S0140-6736(97)06243-0.
South Asian people in the UK experience greater delays than Europeans in obtaining appropriate specialist management for heart disease, but the causes are not known. We investigated whether south Asians and Europeans interpret and act upon anginal symptoms differently.
We randomly selected 2000 people from general practitioners' (family physicians) lists in London, UK, to receive a questionnaire that included a short fictional case history of an individual with possible anginal pain and asked how respondents would react to experiencing it. A second questionnaire seeking information on medical history, attitudes to health, and demography was sent later. The main outcome measure was the proportion who said they would seek immediate care (hospital emergency department or general practitioner) for the pain described in the case scenario.
The rate of response to both questionnaires was 60.2% (903 of 1500 who received both), 553 responders were of European origin, 124 were Hindu, and 235 were Sikh. There were no differences between the ethnic groups in the proportion identifying the pain as cardiac, but south Asians would be more anxious about the pain than would Europeans. Of the men, 55 (23%) Europeans, 20 (38%) Hindus, and 52 (47%) Sikhs said they would seek immediate care (p < 0.0001 for heterogeneity); of women, 77 (24%), 25 (35%), and 58 (46%), respectively, would seek immediate care (p < 0.0001). After adjustment for confounding variables the odds ratio for seeking immediate care in Hindus compared with Europeans was 2.67 (95% CI 1.49-4.73) and that for Sikhs compared with Europeans was 3.18 (1.98-5.12).
Hindus and Sikhs reported a greater likelihood of seeking immediate care for anginal symptoms than Europeans; this finding indicates that barriers to cardiology services for south Asians are unrelated to difficulties in interpretations of symptoms or willingness to seek care. Improvement of awareness of heart disease may not decrease delays in obtaining care. Service-related explanations must be explored, such as general practitioners' difficulties in arriving at a diagnosis or differences in management because of ethnic origin.
在英国，南亚裔人群在获得心脏病的适当专科治疗方面比欧洲裔人群面临更大的延误，但原因尚不清楚。我们调查了南亚裔和欧洲裔人群对心绞痛症状的理解和应对方式是否存在差异。
我们从英国伦敦全科医生（家庭医生）的名单中随机抽取2000人，让他们填写一份问卷，问卷包含一个关于可能患有心绞痛的人的简短虚构病史，并询问受访者如果自己出现这种情况会如何应对。随后又发放了一份寻求病史、健康态度和人口统计学信息的问卷。主要观察指标是表示会针对病例中描述的疼痛寻求即时治疗（医院急诊科或全科医生）的人群比例。
两份问卷的回复率为60.2%（收到两份问卷的1500人中903人回复），553名回复者为欧洲裔，124名是印度教徒，235名是锡克教徒。不同种族群体在将疼痛识别为心脏病方面的比例没有差异，但南亚裔人群对疼痛会比欧洲裔人群更加焦虑。在男性中，55名（23%）欧洲裔、20名（38%）印度教徒和52名（47%）锡克教徒表示会寻求即时治疗（异质性p<0.0001）；在女性中，分别有77名（24%）、25名（35%）和58名（46%）会寻求即时治疗（p<0.0001）。在对混杂变量进行调整后，印度教徒与欧洲裔相比寻求即时治疗的比值比为2.67（95%置信区间1.49 - 4.73），锡克教徒与欧洲裔相比为3.18（1.98 - 5.12）。
印度教徒和锡克教徒报告称比欧洲裔更有可能针对心绞痛症状寻求即时治疗；这一发现表明，南亚裔获得心脏病学服务的障碍与症状理解困难或寻求治疗的意愿无关。提高对心脏病的认识可能不会减少获得治疗的延误。必须探索与服务相关的解释，例如全科医生在做出诊断方面的困难或因种族不同而在治疗上的差异。
