Background There is a paucity of data assessing ethnic variations in upper gastrointestinal (GI) disease: we sought to study the incidence of upper GI diseases using adequate measure of ethnicity in Scotland.

Methods Using the Scottish health and ethnicity linkage study (SHELS), linking NHS hospital admissions and mortality to the Scottish census 2001, we explored ethnic differences in incidence (2001-2010) of specific upper GI diseases (peptic ulcer disease, oesophagitis, gastritis, gallstones and pancreatitis) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender, adjusted for age and subsequently country of birth. The White Scottish population was the standard reference population (100). 95% confidence intervals (CI) were calculated to enable comparison and exclude 100 in the results below.

Results The total numbers of first events within the 9 years period of interest (over almost 29 million of Person-Year (PY) at risk) was 44,612 for peptic ulcer, 102,706 for oesophagitis, 141,235 for gastritis, 87,556 for gallstones and 17,177 for pancreatitis. Looking at risk ratios for all specific upper GI diseases and compared to respectively White Scottish men and women, other White British and other White had a lower risk of upper GI diseases even after adjustment for country of birth. White Irish had an increased risk of upper GI diseases but not significant after adjustment for country of birth. There were consistent ethnic variations in non–White minority ethnic group even after adjustment for country of birth. Chinese men and other South Asian (SA) men and women had a 1.5 to 1.7 fold increased risk of peptic ulcer disease. Pakistani and Bangladeshi had a 1.3 to 2 fold increased risk of oesophagitis whereas Chinese had a lower risk (RR 63.5 [95% CI 50.2, 80.2] for men, 67.4 [51.6, 88.1] for women). South Asian had a 1.2 to 1.5 fold increased risk of gastritis whereas it was lower for men of African origin (65.6 [49.3, 87.3]). Gallstones was more incident in Chinese men (140.2 [117.5, 167.2]) and Pakistani women (131.3 [115,4, 149.4]). The later also had an increased risk of pancreatitis (151.7 [123.3, 186.6]).

Conclusion This unique data allowing the comparison of specific upper GI diseases incidences between ethnic groups has shown major differences. Further exploration on risk factors and understanding of differences is needed to promote health equality.