Objectives To determine if African Americans, Pacific Islanders and Gurkhas have a different incidence and severity of peripheral cold injury when compared to Caucasians in the British Army.

Method The design was a retrospective analysis of those British male army personnel aged over 18 assessed at the Institute of Naval Medicine Cold Injury Clinic. The participants were 311 patients assessed on first attendance at the UK Institute of Naval Medicine.

Results After excluding those classed as normal, African Americans had a relative incidence of 30.36 (95% CI 25.82 – 35.70) when compared to Caucasians; Pacific Islanders a relative incidence of 2.58 (CI 1.24 – 5.38), again against Caucasians. Being of Gurkha ethnicity proved protective, with no abnormal cases found on assessment. The African Americans were more severely affected than Caucasians, with mean scores of 5.39 (SD 1.767) against 4.24 (SD 1.994) for Caucasians. The severity of Pacific Islanders were similar to Caucasians. The ages of African Americans, Pacific Islander and Caucasians had similar means of 26.05, 26.30 and 26.68 respectively, but with a broader age range for Caucasians; SDs 3.428, 2.958 and 7.735.

Conclusion Young male African Americans in the British Army are at 30 times greater chance of developing peripheral cold injury and are more severely affected than their Caucasian counterparts following similar climatic exposure, using similar clothing and equipment. Pacific Islanders are at a 2.6 times increased risk, while being a Gurkha is protective.