title: Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care.
abstract: BACKGROUND
  The 'inverse care law' suggests that populations with the poorest health outcomes also tend to have poorer access to high-quality care. The new general practitioner (GP) contract in the UK aimed to reduce variations in care between areas by collecting information on processes and outcomes of chronic disease management. This study investigated whether, despite reductions in inequalities, primary care in deprived areas is still at a disadvantage due to the higher prevalence of chronic diseases, using chronic kidney disease (CKD) as an example.
  
  
  METHODS
  Initially, data from a hospital-based cohort of CKD patients were analysed to investigate the clustering of CKD patients across area-level deprivation using a geographical information system that employed kernel density estimation. Data from the Quality and Outcomes Framework were then analysed to explore the burden of CKD and associated non-communicable chronic diseases (NCD) and assess the potential impact on GPs' workload by area-level deprivation.
  
  
  RESULTS
  There was a significant clustering of CKD patients referred to the hospital in the most deprived areas. Both the prevalence of CKD and associated conditions and caseload per GP were significantly higher in deprived areas.
  
  
  CONCLUSIONS
  In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed.
authors.affiliation: Sheffield Kidney Institute, University of Sheffield, Sheffield, UK
authors.forename: M P
authors.initials: MP
authors.lastname: Hossain
authors.forename: D
authors.initials: D
authors.lastname: Palmer
authors.forename: E
authors.initials: E
authors.lastname: Goyder
authors.forename: A M
authors.initials: AM
authors.lastname: El Nahas
mesh_terms: D002908:Chronic Disease; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology*; D012959:Socioeconomic Factors