title: Outcomes and inequalities in diabetes from 2004/2005 to 2011/2012: English longitudinal study.
abstract: BACKGROUND
  Outcomes of diabetes care are unequal and the NHS has a duty to consider reducing inequality in healthcare outcomes.
  
  
  OBJECTIVE
  To quantify trends in socioeconomic inequality and diabetes outcomes.
  
  
  METHODS
  Whole-population longitudinal study of 32 482 neighbourhoods (Lower Layer Super Output Areas [LSOAs]) in England between 2004/2005 and 2011/2012.
  
  
  METHODS
  Slope indices of inequality (SIIs) between neighbourhoods of great and little deprivation were measured annually for: glycated haemoglobin control in people with diabetes; emergency hospitalisation for diabetes; and amenable mortality from diabetes.
  
  
  RESULTS
  From 2004/2005 to 2011/2012 glycaemic control improved in all social groups, regardless of deprivation level, although inequality was unchanged as measured by the SII (0.04, 95% confidence interval [CI] = -0.43 to 0.52). Diabetes-related amenable mortality improved in all social groups, but decreased at a faster rate in neighbourhoods of greater deprivation. Inequality in diabetes-related amenable mortality improved, with the SII falling by 2.68 (95% CI = 1.93 to 3.43), resulting in 594 (95% CI = 420 to 767) fewer deaths. In contrast, emergency hospitalisations for diabetes increased in all social groups, with faster growth in neighbourhoods of greater deprivation. The socioeconomic gradient increased with the SII widening by 19.59 admissions for diabetes per 100 000 (95% CI = 16.00 to 23.17), resulting in an increase of 5991 (95% CI = 5084 to 6899) excess admissions associated with socioeconomic inequality during the study period.
  
  
  CONCLUSIONS
  In diabetes, mortality declined faster, but emergency hospitalisation grew faster in more deprived neighbourhoods. Unequal growth in emergency hospitalisation for diabetes is likely to be partly due to increased diabetes prevalence and patients living longer, but may also be due to overuse of glycaemic control medication.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich.
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.affiliation: Centre for Health Economics, University of York, York.
authors.forename: Miqdad
authors.initials: M
authors.lastname: Asaria
authors.affiliation: Centre for Health Economics, University of York, York.
authors.forename: Shehzad
authors.initials: S
authors.lastname: Ali
authors.affiliation: Centre for Health Economics, University of York, York.
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D004630:Emergencies; D004739:England / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D017063:Outcome Assessment, Health Care; D011204:Poverty Areas; D015995:Prevalence; D011787:Quality of Health Care; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013222:State Medicine
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes mellitus; emergency medicine; mortality; patient admission; quality of health care; socioeconomic factors