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Ethnic inequalities in the treatment and outcome of diabetes in three English Primary Care Trusts
File(s)
Author(s)
Soljak, M
Majeed, A
Eliahoo, J
Dornhorst, A
Type
Journal Article
Abstract
BACKGROUND:Although the prevalence of diabetes is three to five times higher in UK South Asians than Whites, there are no reports of the extent of ethnicity recording in routine general practice, and few population-based published studies of the association between ethnicity and quality of diabetes care and outcomes. We aimed to determine the association between ethnicity and healthcare factors in an English population.METHODS:Data was obtained in 2002 on all 21,343 diabetic patients registered in 99% of all computerised general practitioner (GP) practices in three NW London Primary Care Trusts (PCTs), covering a total registered population of 720,000. Previously practices had been provided with training, data entry support and feedback. Treatment and outcome measures included drug treatment and blood pressure (BP), total cholesterol and haemoglobin A1c (HbA1c) levels.RESULTS:Seventy per cent of diabetic patients had a valid ethnicity code. In the relatively older White population, we expected a smaller proportion with a normal BP, but BP differences between the groups were small and suggested poorer control in non-White ethnic groups. There were also significant differences between ethnic groups in the proportions of insulin-treated patients, with a smaller proportion of South Asians - 4.7% compared to 7.1% of Whites - receiving insulin, although the proportion with a satisfactory HbA1c was smaller- 25.6% compared to 37.9%.CONCLUSION:Recording the ethnicity of existing primary care patients is feasible, beginning with patients with established diseases such as diabetes. We have shown that the lower proportion of South Asian patients with good diabetes control, and who are receiving insulin, is at least partly due to poorer standards of care in South Asians, although biological and cultural factors could also contribute. This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences, and to consider more intensive management of diabetes and education about the disease in South Asian patients
Date Issued
2007
Citation
2007, 6 (1), pp.8-
URI
URL
DOI
ISSN
1475-9276
Start Page
8
Volume
6
Issue
1
Copyright Statement
© 2007 Soljak et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor
Department of Health
Identifier
http://www.equityhealthj.com/content/6/1/8%20file://P:/NSFs/Diabetes/References/Soljak%20M%20Ethnic%20inequalities%20in%20the%20treatment%20and%20outcome%20of%20diabetes%20in%20three%20English%20PCTs%20Int%20J%20Equity%20Health%202007%206%208.pdf
Grant Number
SDO/209/2007
Subjects
1117 Public Health And Health Services
Public Health
Notes
BACKGROUND:Although the prevalence of diabetes is three to five times higher in UK South Asians than Whites, there are no reports of the extent of ethnicity recording in routine general practice, and few population-based published studies of the association between ethnicity and quality of diabetes care and outcomes. We aimed to determine the association between ethnicity and healthcare factors in an English population.METHODS:Data was obtained in 2002 on all 21,343 diabetic patients registered in 99% of all computerised general practitioner (GP) practices in three NW London Primary Care Trusts (PCTs), covering a total registered population of 720,000. Previously practices had been provided with training, data entry support and feedback. Treatment and outcome measures included drug treatment and blood pressure (BP), total cholesterol and haemoglobin A1c (HbA1c) levels.RESULTS:Seventy per cent of diabetic patients had a valid ethnicity code. In the relatively older White population, we expected a smaller proportion with a normal BP, but BP differences between the groups were small and suggested poorer control in non-White ethnic groups. There were also significant differences between ethnic groups in the proportions of insulin-treated patients, with a smaller proportion of South Asians - 4.7% compared to 7.1% of Whites - receiving insulin, although the proportion with a satisfactory HbA1c was smaller- 25.6% compared to 37.9%.CONCLUSION:Recording the ethnicity of existing primary care patients is feasible, beginning with patients with established diseases such as diabetes. We have shown that the lower proportion of South Asian patients with good diabetes control, and who are receiving insulin, is at least partly due to poorer standards of care in South Asians, although biological and cultural factors could also contribute. This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences, and to consider more intensive management of diabetes and education about the disease in South Asian patients