Acute myocardial infarction in Asians and whites in Birmingham.

Acute myocardial infarction in Asians and whites in Birmingham There is evidence that immigrant Asians suffer worse coronary artery disease than Asians remaining in their own countries and the indigenous population of the country of adoption.'-3 Asians may make poor use of National Health Service provisions.4 This study compares Asians and indigenous whites admitted to our coronary care unit from the casualty department with a history of acute chest pain due to suspected myocardial infarction. Methods and results The records of 3208 admissions to the coronary care unit from June 1976 to December 1981 were examined and 169 Asians were identified by their names. Their original case notes were retrieved and scrutinised; 27 Asians had not been admitted to the unit directly from the casualty department, and these were excluded from analysis. A further 14 sets of records were untraceable or inadequate. The remaining 128 Asian patients were then matched for age, sex, month of referral, and time of arrival in the casualty department (morning, afternoon, or evening) with indigenous whites. It proved impossible to match four Asians, who were exceptionally young (18 to 22 years), leaving 124 matched pairs for the final analysis. Sixty per cent of the Asians had been born in Pakistan, the remainder coming from east Africa, Bangladesh, and India. With few exceptions these patients were Moslem and at least half spoke no English. Differences between the two groups were assessed by Student's t test for paired data; where subgroup comparisons were made, the X' test was used. Of 124 Asian patients, 52 had been seen by their own general practitioners and sent into hospital; the remainder had been sent by a deputising doctor or had dialled 999. Sixty four of the whites had been seen by their own general practitioner, the remainder being admitted either by a deputising service or a 999 call. The patients were well matched for age (Asians 52-6 (SD 7 8) years, whites 52-9 (7 9) years). There were 111 men and 13 women in each group of 124 patients. The mean time from the onset of chest pain to arrival in the casualty department was 301 (30) minutes for Asians and 320 (33) minutes for whites, but the mean time from arrival in the casualty department to srrival in the coronary care unit was significantly longer in Asians (117 (94) v 84 (50) minutes; p<0 001). The main comparisons concerning …