Ethnic differences between South Asians and White Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review

Abstract

Background: Cardiovascular disease is the leading cause of death worldwide, with significantly worse mortality-related outcomes in ethnic minorities in developed countries. A systematic literature review and meta-analysis of observational studies was conducted to investigate cardiovascular disease-related mortality inequalities between South Asian and White Caucasian ethnic groups.

Methods: Published studies on mortality between South Asians and Whites in developed countries were retrieved from MEDLINE, PubMed, Embase, Web of Science, and grey literature sources (inception-April 2021) and critically appraised using the Quality in Prognosis Studies tool. Bayesian random-effects meta-analyses were performed for both primary and secondary outcomes. Heterogeneity was determined using the I² statistic.

Results: Of the 9879 studies screened originally, 41 were deemed eligible. A further 3 studies were included via the later search. Of these, 15 reported cardiovascular disease-related mortality, 23 reported all-cause mortality, and 6 reported both. The meta-analysis results showed that South Asians had a significantly increased risk of cardiovascular disease mortality compared to Whites (risk ratio = 1.32; 95% credible interval = 1.14 to 1.54) and a decreased risk of all-cause mortality (risk ratio = 0.95; 95% credible interval = 0.83 to 1.12).

Discussion: South Asians had statistically significantly higher odds of cardiovascular disease-related mortality compared to Whites, but not for all-cause mortality. Risk of bias was a serious concern mainly due to a lack of confounders being reported.

Systematic review registration: PROSPERO: CRD42021240865.

Keywords: Cardiovascular diseases; Ethnic groups; Mortality.

Fig. 1

Forest plot showing relative effect for CVD-related mortality between South Asians and Whites (RE < 1.00 favours South Asians)

Fig. 2

Forest plot showing relative effect for all-cause mortality between South Asians and Whites (RE < 1.00 favours South Asians)

Fig. 3

Forest plot showing relative effect of subgroup analyses for CVD-related mortality between South Asians and Whites (RE < 1.00 favours South Asians)

Fig. 4

Forest plot showing relative effect of sensitivity analyses for CVD-related mortality between South Asians and Whites (RE < 1.00 favours South Asians)

Fig. 5

Funnel plots for publication bias: (L) CVD-related mortality; (R) all-cause mortality