Inequalities in the prevalence recording of 205 chronic conditions recorded in primary and secondary care for 12 million patients in the English National Health Service.

Autor: Wang S; Health Organization, Policy and Economics, University of Manchester, Manchester, UK., Lau YS; Health Organization, Policy and Economics, University of Manchester, Manchester, UK., Sutton M; Health Organization, Policy and Economics, University of Manchester, Manchester, UK., Anderson M; Health Organization, Policy and Economics, University of Manchester, Manchester, UK., Kypridemos C; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK., Head A; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK., Barr B; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK., Cookson R; Centre for Health Economics, University of York, York, UK., Bentley C; Independent Population Health Consultant, Sheffield, UK., Anselmi L; Health Organization, Policy and Economics, University of Manchester, Manchester, UK. laura.anselmi@manchester.ac.uk.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2024 Dec 02; Vol. 22 (1), pp. 570. Date of Electronic Publication: 2024 Dec 02.
DOI: 10.1186/s12916-024-03767-4
Abstrakt: Background: Understanding the prevalence of diseases and where it is detected and recorded in healthcare settings is important for planning effective prevention and care provision. We examined inequalities in the prevalence of 205 chronic conditions and in the care setting where the related diagnoses were recorded in the English National Health Service.
Methods: We used data from the Clinical Practice Research Datalink Aurum linked with Hospital Episode Statistics for 12.8 million patients registered with 1406 general practices in 2018. We mapped diagnoses recorded in primary and secondary care in the previous 12 years. We used linear regressions to assess associations of ethnicity, deprivation, and general practice with a diagnosis being recorded in primary care only, secondary care only, or both settings.
Results: 72.65% of patients had at least one diagnosis recorded in any care setting. Most diagnoses were reported only in primary care (62.56%) and a minority only in secondary care (15.24%) or in both settings (22.18%). Black (- 0.08 percentage points (pp)), Asian (- 0.08 pp), mixed (- 0.13 pp), and other ethnicity patients (- 0.31 pp) were less likely than White patients to have a condition recorded. Patients in most deprived areas were 0.27 pp more likely to have a condition recorded (+ 0.07 pp in secondary care only, + 0.10 pp in both primary and secondary care, and + 0.10 pp in primary care only). Differences in prevalence by ethnicity were driven by diagnostic recording in primary care. Higher recording of diagnoses in more deprived areas was consistent across care settings. There were large differences in prevalence and diagnostic recording between general practices after adjusting for patient characteristics.
Conclusions: Linked primary and secondary care records support the identification of disease prevalence more comprehensively. There are inequalities in the prevalence and setting of diagnostic recording by ethnicity, deprivation, and providers on average across conditions. Further research should examine inequalities for each specific condition and whether they reflect also differences in access or recording as well as disease burden. Improving recording where needed and making national linked records accessible for research are key to understanding and reducing inequalities in disease prevention and management.
Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval and consent to participate were not required. Consent for publication: Consent for publication was not required. Competing interests: Laura Anselmi, Ben Barr and Chris Bentley are members of the Technical Advisory Group, Matt Sutton and Chris Bentley are members of the Advisory Committee on Resource Allocation, Richard Cookson was a member of the Advisory Committee on Resource Allocation. This study was funded by the NIHR Health and Social Care Delivery Research Programme (NIHR130258). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
(© 2024. The Author(s).)
Databáze: MEDLINE
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