Geographic and social factors ave related to increased morbidity and mortality rates in diabetic patients

Aims To investigate differences in metabolic control, access to healthcare, clinical outcomes and mortality rates in people from different cultural an d ethnic backgrounds living in different geographical areas within central London. Methods Out of a cohort of 610 patients living within the Greater London bo undary and having a first visit to St Thomas' hospital in 1982-1985, 332 pa tients (54%) were reviewed in 1995, 186 patients (30%) died between 1982 an d 1995 and 92 patients (16%) were lost to follow-up. The patients' correspo nding 'electoral wards' were ascertained in relation to postcodes of reside nce (Mapinfo). Each electoral ward has a Jarman 'Underprivileged Area Score ' (UPA) so that patients can be clustered into prosperous, intermediate or deprived areas. Results Patients living in deprived areas tit = 181) were older (61.3 years (95% confidence interval (CI) 59.5-63.1) vs. 58.6 years (95% CI 55.1-62.1) , P = 0.01) and had a higher body mass index (29.2 kg/m(2) (95% CI 28.4-30. 0) vs. 25. 7 kg/m(2) (95% CI 24.1-27.2), P = 0.003) and worse glycaemic con trol (HbA(1) (%), 10.5 (95% CI 10.1-10.9) vs. 9.1 (95% CI 8,2-10.0), P = 0. 003) than patients in prosperous areas (n = 59). Patients in deprived areas were more likely to be Caucasian (P < 0.005), and were less likely to be i nsulin-treated (P = 0.004). Smoking was more prevalent in deprived areas (P = 0.02). The prevalence of microvascular complications was related to geog raphical location and the age-sex adjusted mortality rate was significantly higher in deprived than prosperous areas (2.6 vs. 1.91 per 100 person-year s). Conclusions Environmental factors affect diabetes outcomes: increased morbi dity and mortality rates in diabetic patients are related to socioeconomic and ethnic status.