Patients from ethnic minorities are not only more likely to suffer from diabetes, but also receive lower quality care from the National Health Service (NHS), claims a paper published in the online open access journal, International Journal for Equity in Health.
Michael Soljak, together with colleagues from Imperial College, London, UK, investigated the treatment received in 2002 by 21,343 diabetic patients in three North West London Primary Care Trusts (PCTs): Ealing, Hammersmith & Fulham, and Hounslow. The researchers also compared the patients' general health, shown by factors such as blood pressure and cholesterol levels, and diabetes control, to the patients' treatment.
General practitioners (GPs) were encouraged to record new patients' ethnicity by providing training and support to the practices. Of the diabetic patients in the three PCTs, 70 percent had a valid ethnicity code, obtained through patient questionnaires and entered by practice staff.
The authors found that although diabetes control was worse among the South Asian population, a smaller proportion of South Asians were prescribed insulin. They also found that although the White population studied was older, blood pressure differences between the groups were small, indicating poorer control in non-White ethnic groups.
The poorer quality of care for Asian diabetic patients could be explained by patient factors- such as poor understanding of the disease- or by the standard of care their GPs offered. Institutional racism is unlikely to be a major cause, as many South Asian patients are registered with GPs from their own ethnic group.
"This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences. But we don't just need to know more about both the practice and patient factors involved," says Soljak, "there should be more intensive management of diabetes and education about the disease in South Asian patients. The best option would be trials comparing different types of such interventions. Our study also shows that in future these trials can be carried out using routinely collected clinical information".
Ethnic inequalities in the management and outcome of diabetes in three English Primary Care Trusts
Michael Soljak, Azeem Majeed, Joseph Eliahoo and Anne Dornhorst
International Journal for Equity in Health (in press)
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