Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations:: Findings from controlled interrupted time series analysis of UK primary care data

Munerah Almulhem; Rasiah Thayakaran; Shahjehan Hanif; Tiffany Gooden; G Neil Thomas; Jonathan Hazlehurst; Abd A Tahrani; Wasim Hanif; Krishnarajah Nirantharakumar

doi:10.1371/journal.pone.0262530

Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data

Munerah Almulhem, Rasiah Thayakaran, Shahjehan Hanif, Tiffany Gooden, G Neil Thomas, Jonathan Hazlehurst, Abd A Tahrani, Wasim Hanif, Krishnarajah Nirantharakumar

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Abstract

BACKGROUND: The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan.

METHOD: Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively.

FINDINGS: Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988-1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999-1.013, p = 0.082).

INTERPRETATION: In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.

Original language	English
Article number	e0262530
Number of pages	15
Journal	PLoS ONE
Volume	17
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0262530
Publication status	Published - 13 Jan 2022

Bibliographical note

Funding Information:
Our thanks to Tom Taverner for discussions on statistical analysis.

Publisher Copyright:
Copyright: © 2022 Almulhem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Arabs
Communicable Disease Control/methods
Communicable Diseases/drug therapy
Disease Susceptibility/metabolism
Electronic Health Records
Fasting/adverse effects
Female
Humans
Interrupted Time Series Analysis/methods
Islam
Male
Middle Aged
Practice Patterns, Physicians'
Primary Health Care/trends
Retrospective Studies
United Kingdom/epidemiology
Whites

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1371/journal.pone.0262530Licence: Creative Commons: Attribution (CC BY)

AlmulhemM2022RamadanFinal published version, 1.79 MBLicence: Creative Commons: Attribution (CC BY)

Cite this

Almulhem, M., Thayakaran, R., Hanif, S., Gooden, T., Thomas, G. N., Hazlehurst, J., Tahrani, A. A., Hanif, W., & Nirantharakumar, K. (2022). Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data. PLoS ONE, 17(1), Article e0262530. https://doi.org/10.1371/journal.pone.0262530

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abstract = "BACKGROUND: The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan.METHOD: Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively.FINDINGS: Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988-1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999-1.013, p = 0.082).INTERPRETATION: In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.",

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note = "Funding Information: Our thanks to Tom Taverner for discussions on statistical analysis. Publisher Copyright: Copyright: {\textcopyright} 2022 Almulhem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Almulhem, M, Thayakaran, R, Hanif, S, Gooden, T , Thomas, GN, Hazlehurst, J, Tahrani, AA, Hanif, W & Nirantharakumar, K 2022, 'Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data', PLoS ONE, vol. 17, no. 1, e0262530. https://doi.org/10.1371/journal.pone.0262530

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AU - Tahrani, Abd A

AU - Hanif, Wasim

AU - Nirantharakumar, Krishnarajah

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N2 - BACKGROUND: The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan.METHOD: Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively.FINDINGS: Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988-1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999-1.013, p = 0.082).INTERPRETATION: In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.

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