Edwards R, Burns J A, McElduff P, Young R J, New J P
Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The Medical School, The University of Manchester, Oxford Road, Manchester, M13 9PT, United Kingdom.
Diabetologia. 2003 Jun;46(6):750-9. doi: 10.1007/s00125-003-1102-z. Epub 2003 May 23.
AIMS/HYPOTHESIS: Our aim was to investigate trends in provision and outcomes of care by socio-economic status among patients with diabetes in Salford, United Kingdom.
Salford is a deprived urban area in North West England. Data for people with diabetes who were younger than 20 years of age (4034 patients in the year 1993 and 5671 by the year 2000) were extracted from the Diabetes Information System. Age-standardised means, proportions and attainment of targets were calculated for: processes of care indicators, intermediate outcomes and prescribing of preventive drug treatments in 1993 to 1994 and in 2000 to 2001 by quintiles of Townsend deprivation score. We did comparisons of means and proportions using age-adjusted linear regression and of trends using generalised estimating equations. Rate ratios for first microvascular and first macrovascular complication were estimated from proportional hazards models.
Marked improvements occurred in all indicators. For patients managed in primary care, blood pressure and cholesterol measurement increased from 53% to 64% (p<0.001) and 27% to 61% (p<0.001) respectively; whilst mean systolic blood pressure decreased from 147 to 140 mmHg (p<0.001) and cholesterol concentrations from 6.0 to 5.1 mmol/l (p<0.001). Mean HbA(1c) increased from 7.8 to 8.1% (p<0.001). Prescribing of aspirin, anti-hypertensive and lipid-lowering drugs increased greatly. Trends varied little by socio-economic status. Patients from more affluent areas generally received more frequent clinical monitoring and preventive treatments, and had a lower BMI (29.5 vs 30.2 kg/m(2); p=0.009) and HbA(1c) (7.8 vs 8.2% p=0.006), though risks of first microvascular or macrovascular complications were similar.
CONCLUSION/INTERPRETATION: Improvements in process and outcomes of care are possible for patients from all socio-economic groups. Socio-economic deprivation does not preclude high quality diabetes care.
目的/假设：我们的目的是调查英国索尔福德糖尿病患者按社会经济地位划分的护理提供情况和结果趋势。
索尔福德是英格兰西北部一个贫困的市区。从糖尿病信息系统中提取了年龄小于20岁的糖尿病患者的数据（1993年有4034例患者，到2000年有5671例）。按汤森贫困评分五分位数计算了1993年至1994年以及2000年至2001年护理过程指标、中间结果和预防性药物治疗处方的年龄标准化均值、比例和目标达成情况。我们使用年龄调整线性回归比较均值和比例，并使用广义估计方程比较趋势。从比例风险模型估计首次微血管和首次大血管并发症的发生率比。
所有指标均有显著改善。在初级保健机构管理的患者中，血压测量和胆固醇测量分别从53%增至64%（p<0.001）和从27%增至61%（p<0.001）；而平均收缩压从147 mmHg降至140 mmHg（p<0.001），胆固醇浓度从6.0 mmol/l降至5.1 mmol/l（p<0.001）。平均糖化血红蛋白从7.8%增至8.1%（p<0.001）。阿司匹林、抗高血压药和降脂药的处方量大幅增加。按社会经济地位划分，趋势变化不大。来自较富裕地区的患者通常接受更频繁的临床监测和预防性治疗，且体重指数较低（29.5 vs 30.2 kg/m²；p = 0.009），糖化血红蛋白也较低（7.8% vs 8.2%，p = 0.006），不过首次微血管或大血管并发症的风险相似。
结论/解读：所有社会经济群体的患者在护理过程和结果方面都有可能得到改善。社会经济贫困并不妨碍高质量的糖尿病护理。
