title: Socioeconomic deprivation independently predicts painful diabetic neuropathy in type 2 diabetes.
abstract: OBJECTIVE
  Painful peripheral neuropathy in people with type 2 diabetes is a disabling complication. We explored associations of this condition with socioeconomic deprivation.
  
  
  METHODS
  The Townsend index of socioeconomic deprivation was examined in the pseudonymised GP records of 15388 (44.1% female) individuals with type 2 diabetes in the Cheshire county of England, and related to prevalence of drug treated painful diabetic neuropathy. We also analysed prescription trends with respect to pharmacotherapy for neuropathy pain relief.
  
  
  RESULTS
  Treatment for neuropathic pain was initiated in 3 266 (21.2%) of patients. Those on treatment were older [68.2 (95% CI 67.8-68.7) vs. 66.6 (66.4-66.8) years] than those not on treatment. There was no difference in HbA1c (7%, 55 mmol/mol).There were significant differences between the groups for the Townsend deprivation index, with a greater proportion (30.6% vs. 22.8% of patients with treated neuropathic pain) having a score of ≥1 (Χ(2)=83.9, p<0.0001).Multivariate logistic regression analyses indicated that each unit increment in the Townsend index was associated with an 6% increased odds of requiring neuropathic pain treatment [odds ratio (95%CI) 1.06 (1.05-1.08), p<0.0001] independent of 5 year age band, BMI, gender, systolic BP, eGFR, HbA1C and total cholesterol.
  
  
  CONCLUSIONS
  In this study using pseudonymised clinical records, a higher level of socioeconomic deprivation seemingly may predispose to severe neuropathic pain in diabetes requiring pharmacological intervention. Targeted allocation of healthcare resources to this group may offer clinical benefits.
authors.affiliation: Cardiovascular Sciences Research Group, The University of Manchester, Manchester, United Kingdom.
authors.forename: S G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Department of Obesity and Endocrinology, University of Liverpool.
authors.forename: R P
authors.initials: RP
authors.lastname: Narayanan
authors.affiliation: Vascular Research Group, The University of Manchester.
authors.forename: N S
authors.initials: NS
authors.lastname: Malipatil
authors.affiliation: Department of Medicine, Leighton Hospital, Crewe.
authors.forename: H
authors.initials: H
authors.lastname: Roberts
authors.affiliation: Department of Podiatry, East Cheshire NHS Trust, Macclesfield.
authors.forename: G
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Department of Medicine, Leighton Hospital, Crewe.
authors.forename: A H
authors.initials: AH
authors.lastname: Heald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000209:etiology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology* / Q000209:etiology; D012923:Social Class; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult