Inequalities in access to diabetes care: evidence from a historical cohort study

Abstract

Objective—To establish which factors predict attendance at a hospital diabetes clinic and for diabetes review in general practice. Design—A historical cohort study of individuals with diabetes identified from general practice records. Information on service contacts and other clinical, social, and demographic variables was collected from general practice records and postal questionnaires. Setting—Seven Leicestershire general practices. Subjects—Individuals registered with study practices who had a diagnosis of diabetes made before 1990. Main outcome measurements—Attendance at a hospital diabetes clinic or for a documented diabetes review in general practice at least once between 1990 and 1995. Results—124 (20%) had at least one recorded diabetes review in general practice and 332 (54%) attended a hospital diabetes clinic at least once. The main predictors of attending a hospital clinic were younger age, longer duration of diabetes, and treatment with insulin. Access to a car (OR 1.34, 95% CI 1.06 to 1.71), home ownership (OR 1.48, 95% CI 1.14 to 1.58) and a non-manual occupation (OR 1.56, 95% CI 1.09 to 2.24) were all associated with an increased likelihood of attending, although living in a less deprived area was not. The main predictors of attending for review in general practice were older age, less co-morbidity, and being white. Living in a more deprived area was related to a reduced chance of review in general practice (OR 0.81, 95% CI 0.76 to 0.86) while individual socioeconomic indicators were not. Conclusions—Whilst an indicator of area deprivation predicts reduced likelihood of review in general practice, individual indicators predict reduced likelihood of attending outpatients. This suggests a need for different approaches to tackling inequalities in access to care in primary and secondary care settings. (Quality in Health Care 2000;9:85–89)