Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53 000 patients in primary care
Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53 000 patients in primary care
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DOI：
10.1136/bmj.38279.588125.7c
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发表时间：
2004-11-27
影响因子：
--
通讯作者：
Coupland, C
中科院分区：
文献类型：
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作者：
Hippisley-Cox, J;O'Hanlon, S;Coupland, C
目的确定剥夺和种族对糖尿病患者质量指标实现的影响，以及性别之间不平等的程度。设计基于人口的横断面调查，使用电子全科实践记录。设置237个英国实践为QRESEARCH数据库做出贡献。参与者54 180名糖尿病患者，来自180万患者。主要结果测量调整了英国全科医生新普通医疗服务合同中18项糖尿病指标的优势比，比较了最贫困和最富裕的五分之一地区（高和低种族地区）患者之间以及男性和女性之间的比较。结果各地区糖尿病患病率为3.0%，各地区指标实现情况差异较大。与富裕地区的患者相比，贫困地区的患者不太可能记录体重指数和吸烟状况。他们也不太可能有HbA（1c）浓度记录；HbA（1c）值< 7.5%或< 10%；视网膜筛查;血压;检测神经病变或微量蛋白尿，或接种流感疫苗。与来自低种族地区的患者相比，来自高种族地区的患者不太可能有许多测量记录。女性有身体质量指数记录的可能性明显较低；脉冲;血压值低于145/85 mm Hg；微量白蛋白尿检测；血清胆固醇浓度；血清胆固醇值< 5 mmol/l；在蛋白尿或微量白蛋白尿时给予血管紧张素转换酶抑制剂。结论：在高贫困和高种族的地区，实践将不得不更加努力地实现糖尿病的质量指标，并且有可能那些最需要资源的实践是最不可能得到资源的。
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 HbA(1c) concentration; an HbA(1c) 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.