Background and aims: Sex differences in ethnic minority risk of coronary heart disease (CHD) are often overlooked. Here we aim to explore sex-by-ethnicity differences in CHD outcomes and the contribution of risk factors. Methods: Incident CHD events were identified for Europeans, and South Asian and African/African Caribbean first generation migrants in the UK-based Southall and Brent Revisited (SABRE) cohort. Cardiovascular risk factors were assessed at baseline (1988-91). Cox proportional hazards models quantified group differences in CHD incidence and risk factor contribution. Population attributable fractions (PAFs) described risk factor contribution to group differences. Results: Among 4,754 participants followed for 40.8 years, 1,710 CHD first events occurred. Cumulative incidence of CHD was highest in South Asian males (65% by age 90) and females (55%), compared with 52% in European males and 24-31% in other groups. Sex differences in CHD incidence were pronounced in Europeans (female versus male HR=0.45, 95% CI [0.37,0.55]) but attenuated in South Asians (0.68 [0.56,0.82]) and African/African Caribbeans (0.79 [0.57,1.10]). CHD risk was higher in South Asian compared to European men (1.80 [1.63,1.99]). This ethnic difference was greater in females (2.44 [1.88,3.17]). PAFs for diabetes (PAF=18.0%, 95% CI [6.2,29.8]), hypercholesterolemia (44.2% [20.4,68.1]), and hypertriglyceridemia (22.4% [7.9,37.0]) made a greater contribution to the risk of CHD in South Asian females compared to all other groups. Conclusions: Ethnic minority female participants do not have the same protection from CHD as Europeans. Greater cardiometabolic burden may drive this elevated CHD risk and loss of female protection.
D. Smeeth, S. Eastwood, A. Wong et al.· medRxiv· 0 citations
Background: Young people who are Not in Education, Employment, or Training (NEET) represent a major public health and societal challenge. Existing evidence has linked adolescent mental health problems and health risk behaviours to NEET but has largely treated NEET as a static, rather than longitudinal outcome and overlooked the combined effects of multiple health conditions. Methods: Using data from 5,262 participants born between 1993 and 2000 in the UK Household Longitudinal Study, this study examined the independent and combined associations of adolescent mental health problems (emotional symptoms, conduct problems, hyperactivity) and health risk behaviours (regular smoking, drug use, alcohol use, and high social media use) with ever-NEET status, NEET chronicity, and NEET trajectories from ages 16 to 24, using modified Poisson, proportional odds, and multilevel logistic regression models, respectively. Findings: All mental health problems were associated with ever-NEET status (RRs 1.24-1.27) and NEET chronicity (ORs 1.41-1.98); emotional symptoms showed a widening disadvantage with age, while the disadvantages associated with conduct problems and hyperactivity remained stable. Among health risk behaviours, regular smoking showed the strongest and most persistent relationships with NEET (ever-NEET RR 1.54; chronicity OR 1.64); drug use was related to ever-NEET status (RR 1.37) and an increasing disadvantage after age 21-22, while alcohol use and social media use showed limited associations. NEET risk generally increased with the number of co-occurring conditions, but for recurrent NEET (three or more occasions), risk was only elevated at three or more co-occurring conditions. Interpretation: Adolescent health exposures were associated with NEET risk during ages 16-24, but the strength and pattern varied by exposure and outcome, offering potential insights into the timing and emphasis of any interventions.
Z. Li, J. Wels, N. Chaturvedi et al.· medRxiv· 0 citations
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