Cathie Marsh Institute for Social Research, Department of Social Statistics, School of Social Sciences, The University of Manchester, Manchester, UK
Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
J Epidemiol Community Health. 2023 Sep;77(9):565-570. doi: 10.1136/jech-2022-219654. Epub 2023 Jun 23.
The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing type 2 diabetes mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity or deprivation is not known.
We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (1) prevalence of NDH (using survey data from UK Household Longitudinal Study (n=794) and Health Survey for England (n=1383)); (2) identification in primary care and offer of programme (using administrative data from the National Diabetes Audit (n=1 267 350)) and (3) programme participation (using programme provider records (n=98 024)).
Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) (4% of the population with NDH (95% CI 2.4% to 6.5%)) and older adults (aged 80 and above) (12% (95% CI 9.5% to 14.2%)) were slightly under-represented among programme participants (2% (95% CI 1.8% to 2.2%) and 8% (95% CI 7.8% to 8.2%) of programme participants, respectively). People living in deprived areas were under-represented in eight sessions (14% (95% CI 13.7% to 14.4%) vs 20% (95% CI 16.4% to 23.6%) in the general population). Ethnic minorities were over-represented among offers (35% (95% CI 35.1% to 35.6%) vs 13% (95% CI 9.1% to 16.4%) in general population), though the proportion dropped at the programme completion stage (19% (95% CI 18.5% to 19.5%)).
The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age and limiting illness or disability-related inequalities in T2DM. While ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target under-represented groups to ensure equitable access and narrow inequalities in T2DM.
英国国民保健制度（NHS）的糖尿病预防计划（DPP）是一项针对非糖尿病性高血糖人群（NDH）预防 2 型糖尿病的行为干预措施。该计划如何通过年龄、性别、限制疾病或残疾、种族或贫困程度来影响不平等现象尚不清楚。
我们使用多项和二元逻辑回归模型来比较不同阶段的 NDH 人群是否代表 NDH 人群：阶段包括（1）NDH 的患病率（使用来自英国家庭纵向研究的调查数据（n=794）和英格兰健康调查（n=1383））；（2）在初级保健中确定并提供计划（使用国家糖尿病审计的行政数据（n=1 267 350））和（3）计划参与（使用计划提供商记录（n=98 024））。
从回归中得出的预测概率，以人口统计学作为每个结果，并以数据集标识符作为预测因子，表明年轻成年人（年龄在 40 岁以下）（NDH 人群的 4%（95%CI 2.4%至 6.5%））和老年人（80 岁及以上）（12%（95%CI 9.5%至 14.2%））在计划参与者中略低（分别为 2%（95%CI 1.8%至 2.2%）和 8%（95%CI 7.8%至 8.2%））。生活在贫困地区的人在八节课中代表性不足（14%（95%CI 13.7%至 14.4%）与普通人群中的 20%（95%CI 16.4%至 23.6%））。少数民族在提供方面的代表性过高（35%（95%CI 35.1%至 35.6%）与普通人群中的 13%（95%CI 9.1%至 16.4%）），尽管在计划完成阶段比例下降（19%（95%CI 18.5%至 19.5%））。
DPP 有可能减少种族不平等，但可能会扩大与 2 型糖尿病相关的社会经济、年龄和限制疾病或残疾方面的不平等。虽然少数民族在识别和提供阶段的代表性过高，但仍需要努力支持计划的完成。计划提供者应针对代表性不足的群体，以确保公平获得机会，并缩小 2 型糖尿病方面的不平等。
