Abstract
BackgroundAlthough 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.MethodsData 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.ResultsSeventy 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%.ConclusionRecording 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.
Highlights
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
Data on diabetes treatment and intermediate outcomes was obtained from all computerised general practices in three North West London Primary Care Trusts (PCTs)- Ealing, Hammersmith & Fulham and Hounslow- covering a total 2001 Census resident population of 678,000- the population registered with a general practitioner (GP) situated in the three PCTs was 720,000
We have reported for the first time on the process and outcomes of diabetes care in a population-based study using ethnicity data captured during routine primary care
Summary
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. Some ethnic groups are at higher risk of developing diabetes. The same factors responsible for the higher prevalence of diabetes in some ethnic groups may affect the course and outcomes of the disease. Little is known about differences in the intermediate (metabolic) or longer term outcomes of diabetes in different ethnic groups, and whether the basis for any differences is mainly biological, cultural or related to inequalities in healthcare service delivery. The main reason is the lack of ethnicity information in epidemiological studies, clinical trials, and clinical databases
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