Outcomes and inequalities in diabetes from 2004/5 to 2011/12: English longitudinal study

Robert Fleetcroft, Miqdad Asaria, Shehzad Ali, Richard Cookson

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Background: Outcomes of diabetes care are unequal and the NHS has a duty to consider reducing inequality in healthcare outcomes.

Aim: To quantify trends in socioeconomic inequality in diabetes outcomes.

Design and Setting: Whole-population longitudinal study of 32,482 neighbourhoods (Lower Layer Super Output Areas) in England between 2004/5 and 2011/12.

Method: Slope indices of inequality between more and less deprived neighbourhoods measured annually for: (i) glycated haemoglobin control in diabetics, (ii) emergency hospitalisation for diabetes and (iii) mortality from diabetes.

Results: Between 2004/5 to 2011/12 glycaemic control improved in all social groups, although inequality was unchanged as measured by the SII (0.04, 95% CI -0.43 to 0.52). Diabetes mortality improved in all social groups, with faster mortality declines in more deprived neighbourhoods. Inequality in diabetes
mortality improved, with the SII falling by 2.68 (95% CI 1.93 to 3.43) resulting in 594 (95% CI 420 to 767) fewer deaths. In contrast emergency hospitalisations for diabetes increased in all social groups, with faster growth in more deprived neighbourhoods. The socioeconomic gradient increased with the SII widening by 19.59 admissions for diabetes per 100,000 (95% CI 16.00 to 23.17) resulting in an increase in excess admissions associated with socioeconomic inequality of 5,991 (95% CI 5,084 to 6,899) compared to 2004/5.

Conclusion: In diabetes mortality declined faster, but emergency hospitalisation grew faster in more deprived neighbourhoods. Unequal growth in hospitalisation for diabetes is partly due to increased diabetes prevalence and patients living longer, but may also be due to over-use of glycaemic control medication.
Original languageEnglish
Pages (from-to)e1-e9
Number of pages9
JournalBritish Journal of General Practice
Issue number654
Early online date6 Dec 2016
Publication statusPublished - 1 Jan 2017


  • Diabetes mellitus
  • socioeconomic factors
  • quality of healthcare
  • mortality
  • emergency medicine
  • patient admission

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