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Physical Activity Behaviour and Coronary Heart Disease Mortality Among South Asian People in the UK: An Observational Longitudinal Study
Study Questions:
Is there a contribution of physical inactivity to the excess mortality from coronary heart disease (CHD) observed in the United Kingdom (UK) South Asian population?
Methods:
An observational longitudinal study was conducted using the Health Survey from England obtained from 1999 to 2004. A total of 13,293 white and 2,120 South Asian participants ages ≥35 years consented to mortality follow-up that was obtained from NHS registries. Frequency of leisure time physical activities in the 4 weeks prior to the interview was assessed. A binary variable was created to compare those performing physical activity of at least moderate intensity for a minimum of 30 minutes/week compared to those reporting none.
Results:
Those who refused follow-up were more likely to be younger (p < 0.001), male (p < 0.001), of South Asian origin (p < 0.001), and to have lower levels of education (p < 0.001). In addition, they had an increased hypertension (p < 0.001) and existing cardiovascular disease (p < 0.001), but had lower adiposity (p < 0.001). Mean age of whites was 56 years, Asian Indians was 49 years, and Pakistani/Bangladeshis was 48.5 years (p < 0.001). Self-reported good health was reported more frequently in whites than South Asians. South Asian participants were more likely to be physically inactive than white participants (47.0% vs. 28.1%, p < 0.001). Deaths from CHD were more common in UK South Asian participants, particularly among Pakistani and Bangladeshi groups (hazard ratio, 2.87; 95% confidence interval, 1.74-4.73), than in UK white participants, and South Asian people experienced an event at an age on average 10 years younger than white people. Physical inactivity explained >20% of the excess CHD mortality in the South Asian sample, even after adjustment for potential confounding variables (including socioeconomic position, smoking, diabetes, and existing cardiovascular disease).
Conclusions:
Physical inactivity makes a significant contribution to the excess CHD mortality observed in the South Asian population in the UK. This highlights the importance of prioritizing the promotion of physical activity in this high-risk population.
Perspective:
South Asians have been shown to have an increase in cardiovascular events throughout the diaspora. This study adds to the abundant literature demonstrating that lack of leisure time and work time physical activity is a risk factor for CHD and mortality. Physical inactivity was a major risk factor associated with myocardial infarction throughout the world in the INTERHEART study. The degree to which physical activity per se or its impact on other risk factors reduces cardiovascular risk is not clear. Nevertheless, it is good for children through seniors.
Keywords: United Kingdom, Myocardial Infarction, Follow-Up Studies, European Continental Ancestry Group, Leisure Activities, Motor Activity, Coronary Disease, England, Health Surveys
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