Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans

Lancet. 1997 Nov 29;350(9091):1578-83. doi: 10.1016/S0140-6736(97)06243-0.


Background: South Asian people in the UK experience greater delays than Europeans in obtaining appropriate specialist management for heart disease, but the causes are not known. We investigated whether south Asians and Europeans interpret and act upon anginal symptoms differently.

Methods: We randomly selected 2000 people from general practitioners' (family physicians) lists in London, UK, to receive a questionnaire that included a short fictional case history of an individual with possible anginal pain and asked how respondents would react to experiencing it. A second questionnaire seeking information on medical history, attitudes to health, and demography was sent later. The main outcome measure was the proportion who said they would seek immediate care (hospital emergency department or general practitioner) for the pain described in the case scenario.

Findings: The rate of response to both questionnaires was 60.2% (903 of 1500 who received both), 553 responders were of European origin, 124 were Hindu, and 235 were Sikh. There were no differences between the ethnic groups in the proportion identifying the pain as cardiac, but south Asians would be more anxious about the pain than would Europeans. Of the men, 55 (23%) Europeans, 20 (38%) Hindus, and 52 (47%) Sikhs said they would seek immediate care (p < 0.0001 for heterogeneity); of women, 77 (24%), 25 (35%), and 58 (46%), respectively, would seek immediate care (p < 0.0001). After adjustment for confounding variables the odds ratio for seeking immediate care in Hindus compared with Europeans was 2.67 (95% CI 1.49-4.73) and that for Sikhs compared with Europeans was 3.18 (1.98-5.12).

Interpretation: Hindus and Sikhs reported a greater likelihood of seeking immediate care for anginal symptoms than Europeans; this finding indicates that barriers to cardiology services for south Asians are unrelated to difficulties in interpretations of symptoms or willingness to seek care. Improvement of awareness of heart disease may not decrease delays in obtaining care. Service-related explanations must be explored, such as general practitioners' difficulties in arriving at a diagnosis or differences in management because of ethnic origin.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angina Pectoris / diagnosis
  • Angina Pectoris / ethnology*
  • Angina Pectoris / psychology
  • Attitude to Health / ethnology
  • Europe / ethnology
  • Female
  • Health Behavior / ethnology*
  • Humans
  • India / ethnology
  • London
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / ethnology
  • Myocardial Infarction / psychology
  • Patient Acceptance of Health Care / ethnology*
  • Random Allocation
  • Social Class
  • Surveys and Questionnaires