Inequalities in access to diabetes care: evidence from a historical cohortstudy

Objective-To establish which factors predict attendance at a hospital diabe tes clinic and for diabetes review in general practice. Design-A historical cohort study of individuals with diabetes identified fr om general practice records. Information on service contacts and other clin ical, 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 prac tice and 332 (54%) attended a hospital diabetes clinic at least once. The m ain predictors of attending a hospital clinic were younger age, longer dura tion 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 a n increased likelihood of attending, although living in a less deprived are a 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 depriv ed 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 no t. Conclusions-Whilst an indicator of area deprivation predicts reduced Likeli hood of review in general practice, individual indicators predict reduced l ikelihood of attending outpatients. This suggests a need for different appr oaches to tackling inequalities in access to care in primary and secondary care settings.