TY - JOUR
T1 - Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care
T2 - A Cross-Sectional Analysis of A Large Primary Care Database
AU - Phillips, Katherine
AU - Hazlehurst, Jonathan M
AU - Sheppard, Christelle
AU - Bellary, Srikanth
AU - Hanif, Wasim
AU - Karamat, Muhammad Ali
AU - Crowe, Francesca L
AU - Stone, Anna
AU - Thomas, G Neil
AU - Peracha, Javeria
AU - Fenton, Anthony
AU - Sainsbury, Christopher
AU - Nirantharakumar, Krishnarajah
AU - Dasgupta, Indranil
N1 - © 2023 Diabetes UK.
PY - 2023/5/24
Y1 - 2023/5/24
N2 - OBJECTIVE: To determine differences in the management of Diabetic Kidney Disease (DKD) relevant to patient sex, ethnicity and socioeconomic group in UK primary care.RESEARCH DESIGN AND METHODS: A cross-sectional analysis as of 1
st January 2019 was undertaken using IQVIA Medical Research Data (IMRD) dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity, and social deprivation.
RESULTS: Of the 2.3 million participants in the database, 161,278 had type 1 or 2 diabetes of whom 32,905 had DKD. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), albumin creatine ratio (ACR): aRR 0.94 (0.92-0.96), blood pressure (BP): aRR 0.98 (0.97-0.99), glycosylated haemoglobin (HbA1c): aRR 0.99 (0.98-0.99), and serum total cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP (<140/80 mmHg): aRR 0.95 (0.94-0.98) or total cholesterol (< 5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed renin-angiotensin-aldosterone system (RAAS) inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95) in the previous year. Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP (<140/80 mmHg): aRR 0.91 (0.8-0.95) or HbA1c (< 58 mmol/mol): aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95), but were 8% more likely to be prescribed a statin: aRR 1.08 (1.06-1.11). Compared to patients of white ethnicity; patients of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97).CONCLUSIONS: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
AB - OBJECTIVE: To determine differences in the management of Diabetic Kidney Disease (DKD) relevant to patient sex, ethnicity and socioeconomic group in UK primary care.RESEARCH DESIGN AND METHODS: A cross-sectional analysis as of 1
st January 2019 was undertaken using IQVIA Medical Research Data (IMRD) dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity, and social deprivation.
RESULTS: Of the 2.3 million participants in the database, 161,278 had type 1 or 2 diabetes of whom 32,905 had DKD. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), albumin creatine ratio (ACR): aRR 0.94 (0.92-0.96), blood pressure (BP): aRR 0.98 (0.97-0.99), glycosylated haemoglobin (HbA1c): aRR 0.99 (0.98-0.99), and serum total cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP (<140/80 mmHg): aRR 0.95 (0.94-0.98) or total cholesterol (< 5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed renin-angiotensin-aldosterone system (RAAS) inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95) in the previous year. Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP (<140/80 mmHg): aRR 0.91 (0.8-0.95) or HbA1c (< 58 mmol/mol): aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95), but were 8% more likely to be prescribed a statin: aRR 1.08 (1.06-1.11). Compared to patients of white ethnicity; patients of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97).CONCLUSIONS: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
KW - DKD
KW - inequality
KW - diabetes
KW - ethnicity
U2 - 10.1111/dme.15153
DO - 10.1111/dme.15153
M3 - Article
C2 - 37223892
SN - 0742-3071
JO - Diabetic Medicine
JF - Diabetic Medicine
M1 - e15153
ER -
