Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north-west England.
BACKGROUND
Diabetes and its complications are more prevalent among South Asians than people of European origin and there is some evidence that patients of South Asian origin with diabetes receive poorer quality care.


METHODS
Longitudinal study of patients with diabetes in Blackburn, UK. Processes of care indicators [measurement of blood pressure (BP), cholesterol and glycosolated haemoglobin (HbA1c)] and values of these intermediate outcomes were extracted for all patients registered on a diabetes information system for the period 1995-2001. Differences in processes of care indicators and intermediate outcomes between ethnic groups were estimated after adjusting for the potential confounding factors of sex, age and socioeconomic status (SES). Generalized estimating equations were used to model trends and to test for differences in trends over time.


RESULTS
Process of care was similar in South Asian and European patients. Mean BP and cholesterol concentration fell during the study period. South Asians had a higher level of HbA1c throughout the study period. South Asians had lower levels of BP and cholesterol in 1995 but the differences diminished or were abolished over time. SES did not explain differences between ethnic groups. Analyses stratified by baseline levels of intermediate outcomes (above or within target) demonstrated improvements among above target patients were greater among European patients.


CONCLUSIONS
Processes of care indicators are similar in diabetic patients of South Asian and European origin, irrespective of SES. However, there are worrying differences in improvements over time in the intermediate outcomes, and glycaemic control remained poorer among patients of South Asian origin patients throughout.
McElduff
P
P
Evidence for Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK. patrick.mcelduff@man.ac.uk
Edwards
R
R
Burns
J A
JA
Young
R J
RJ
Heller
R
R
Long
B
B
Jones
G
G
New
J P
JP
D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D004739:England / Q000453:epidemiology; D005060:Europe / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011787:Quality of Health Care; D012959:Socioeconomic Factors
D002784:Cholesterol; D006442:Glycated Hemoglobin