• Colin M Fischbacher, Geneviève Cezard, Raj S Bhopal, Jamie Pearce, Narinder Bansal, and Scottish Health and Ethnicity Linkage Study.
• Information Services Division, NHS National Services Scotland, Edinburgh, UK, Ethnicity and Health Research Group, Centre for Population Health Studies, University of Edinburgh, Edinburgh, UK and Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.
• Int J Epidemiol. 2014 Feb 1;43(1):129-39.

BackgroundEthnic health inequalities are substantial. One explanation relates to socioeconomic differences between groups. However, socioeconomic variables need to be comparable across ethnic groups as measures of socioeconomic position (SEP) and indicators of health outcomes.MethodsWe linked self-reported SEP and ethnicity data on 4.65 million individuals from the 2001 Scottish Census to hospital admission and mortality data for cardiovascular disease (CVD). We examined the direction, strength and linearity of association between eight individual, household and area socioeconomic measures and CVD in 10 ethnic groups and the impact of SEP adjustment.ResultsThere was wide socioeconomic variation between groups. All eight measures showed consistent, positive associations with CVD in White populations, as did educational qualification in non-White ethnic groups. For other SEP measures, associations tended to be consistent with those of White groups though there were one or two exceptions in each non-White group. Multiple SEP adjustment had little effect on relative risk of CVD for most groups. Where it did, the effect varied in direction and magnitude (for example increasing adjusted risk by 23% in Indian men but attenuating it by 11% among Pakistani women).ConclusionsAcross groups, SEP measures were inconsistently associated with CVD hospitalization or death, with effect size and direction of effect after adjustment varying across ethnic groups. We recommend that researchers systematically explore the effect of their choice of SEP indicators, using standard multivariate methods where appropriate, to demonstrate their cross-ethnic group validity as potential confounding variables for the specific groups and outcomes of interest.

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