Association of deprivation, ethnicity, and sex with quality indicators for diabetes: Population based survey of 53 000 patients in primary care
Hippisley-Cox J., O'Hanlon S., Coupland C.
Objectives: To determine the effect of deprivation and ethnicity on the achievement of quality indicators for patients with diabetes and the extent of any inequalities between the sexes. Design: Population based cross sectional survey using electronic general practice records. Setting: 237 UK practices contributing to the QRESEARCH database. Participants: 54 180 patients with diabetes, derived from a population of 1.8 million patients. Main outcome measures: Adjusted odds ratios for 18 indicators for diabetes from the new general medical services contract for UK general practitioners and comparisons between patients from the most deprived and most affluent fifths (areas of high and low ethnicity) and between men and women. Results: The prevalence of diabetes was 3.0%, and there was a large variation between practices in achievement of indicators. Compared with patients from affluent areas, those from deprived areas were less likely to have body mass index and smoking status recorded. They were also less likely to have records for HbA1c concentration; an HbA1c value <7.5% or <10%; retinal screening; blood pressure; testing for neuropathy or microalbuminuria, or flu vaccination. Compared with patients from areas of low ethnicity those from areas of high ethnicity were less likely to have many measures recorded. Women were significantly less likely to have records for body mass index; pulses; blood pressure values below 145/85 mm Hg; testing for microalbuminuria; serum cholesterol concentration; serum cholesterol values <5 mmol/l; and angiotensin converting enzyme inhibitors given in the presence of proteinuria or microalbuminuria. Conclusions: Practices in areas of high deprivation and high ethnicity will have to work harder to achieve the quality indicators for diabetes, and it is possible that those practices that most need the resources are the ones least likely to get them.