Britt drew attention to anaemia in Punjabi women in Southall nearly 20 years ago.1 Representative population data on anaemia in adults from ethnic minorities in the United Kingdom have not been published since then. We used data from the Newcastle heart project2,3 to assess the prevalence of anaemia in South Asian (Indian, Pakistani, and Bangladeshi) and Chinese ethnic groups.
Methods and results
The Newcastle heart project was a stratified random sample of 1889 Newcastle residents of European (n=825), Indian (259), Pakistani (305), Bangladeshi (120), and Chinese (380) ethnic origin, studied during 1991-7. Chinese respondents were aged 25-64 years; the others were aged 25-74 years. Full details have been published elsewhere.2,3 Haemoglobin and red cell indices were determined with a Coulter STKS analyser. We defined anaemia as a haemoglobin <130 g/l in men and <120 g/l in women. We compared respondents who ate beef, pork, lamb, chicken, or fish with those who rarely or never did. Women were asked about their menstrual history, though this information was not available for Chinese respondents. Odds ratios were estimated from logistic regression using Stata 6.0 (Stata Corporation, College Station, TX).
Haemoglobin was lowest in men of European origin and highest in those of Chinese origin, whereas haemoglobin was lower in South Asian and Chinese women than in European women (table). The prevalence of anaemia was similar among men of all ethnic groups. However, anaemia was 3.0 (95% confidence interval 2.0 to 4.4) times more prevalent in South Asian women than in European women and 2.1 (1.3 to 3.3) times more prevalent in Chinese women than in European women. The findings were similar when the analysis was confined to non-smokers. One per cent (0.3% to 2.6%) of European women and 4.0% (2.2% to 6.6%) of South Asian women had haemoglobin <100 g/l. Anaemia was less prevalent after the menopause in European women but remained common after the menopause among Indian and Bangladeshi women.
Of Indian respondents, 32% rarely or never ate meat compared with less than 2% of other ethnic groups. Among Indian respondents, 23% of those who did not eat meat and 13% of those who did were anaemic. The numbers who did not eat meat were too small for analysis by any other ethnic group. The odds ratio for anaemia in those who did not eat meat, adjusted for sex, menopausal status, and ethnic group, was 1.86 (0.96 to 3.62) for all ethnic groups combined.
Among the 54 Europeans, 98 South Asians, and 37 Chinese respondents with anaemia, 10%, 41%, and 62% respectively had microcytic anaemia (mean cell volume <76 fl). The mean cell haemoglobin was <27 pg (suggesting the need for screening for thalassaemia4) in 3% of Europeans, 22% of South Asians, and 15% of Chinese respondents.
Comments
Our findings show that anaemia remains common among women of South Asian and Chinese ethnic origin in the United Kingdom, occurring much more commonly than in women of European ethnic origin. Anaemia in South Asian and Chinese respondents was predominantly microcytic and, although we lack confirmatory data, may be related to iron deficiency. Around 4% of South Asians and 8% of Chinese people in the United Kingdom carry sickling or thalassaemia genes, so these conditions are unlikely to explain a large part of the anaemia we observed.4 Anaemia tended to be more common in those who rarely or never ate meat; 87% of British Indians described themselves as vegetarians in a recent survey.5 Awareness of the link between anaemia and diet may be low; in a national lifestyle survey less than 1% of respondents mentioned anaemia as a problem related to diet.5
Table.
Number of respondents, percentage with anaemia,* and mean haemoglobin by sex, menopausal status, and ethnic group
| European | South Asian† | Indian | Pakistani | Bangladeshi | Chinese‡ | |
|---|---|---|---|---|---|---|
| Men | ||||||
| No | 423 | 322 | 104 | 155 | 63 | 180 |
| Percentage (95% CI) with anaemia | 5.7 (3.7 to 8.3) | 6.2 (3.8 to 9.4) | 6.7 (2.7 to 13.4) | 5.8 (2.7 to 10.7) | 6.3 (1.8 to 15.5) | 4.4 (1.9 to 8.6) |
| Mean (SD) haemoglobin (g/l) | 148 (11) | 149 (12) | 149 (12) | 150 (12) | 149 (12) | 151 (12) |
| All women | ||||||
| No | 396 | 349 | 153 | 147 | 49 | 191 |
| Percentage (95% CI) with anaemia | 7.6 (5.2 to 10.6) | 22.3 (18.1 to 27.1) | 22.2 (15.9 to 29.6) | 19.0 (13.0 to 26.3) | 32.7 (19.9 to 47.5) | 15.7 (10.9 to 21.7) |
| Mean (SD) haemoglobin (g/l) | 133 (11) | 128 (13) | 126 (13) | 130 (13) | 124 (11) | 131 (13) |
| Premenopausal women | ||||||
| No | 144 | 171 | 68 | 81 | 22 | Not available |
| Percentage (95% CI) with anaemia | 10.4 (5.9 to 16.6) | 25.7 (19.4 to 33.0) | 20.6 (11.7 to 32.1) | 28.4 (18.9 to 39.5) | 31.8 (13.9 to 54.9) | |
| Mean (SD) haemoglobin (g/l) | 131 (13) | 126 (14) | 125 (15) | 128 (14) | 125 (10) | |
| Postmenopausal women | ||||||
| No | 215 | 158 | 78 | 58 | 22 | Not available |
| Percentage (95% CI) with anaemia | 5.6 (2.9 to 9.5) | 20.3 (14.3 to 27.4) | 25.6 (16.4 to 36.8) | 6.9 (1.9 to 16.7) | 36.4 (17.2 to 59.3) | |
| Mean (SD) haemoglobin (g/l) | 135 (10) | 129 (12) | 126 (11) | 133 (13) | 124 (11) | |
Haemoglobin <130 g/l in men, <120 g/l in women.
Indian, Pakistani, and Bangladeshi respondents are included in the total for South Asians.
Age range 25-64 years (25-74 years in all other respondents).
Acknowledgments
We thank all those mentioned in the acknowledgements of our second and third references, Louise Hayes for help with data management, Mark R D Johnson for comments, and the department of haematology at the Freeman Hospital, Newcastle, for performing the laboratory analyses.
Footnotes
Funding: Barclay Trust, British Diabetic Association, Newcastle Health Authority, research and development directorate of the Northern Regional Health Authority, Department of Health, and British Heart Foundation.
Competing interests: None declared.
References
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