Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database.

ABSTRACT

AIMS: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. METHODS: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. RESULTS: Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine aRR 0.99 (95% CI 0.98-0.99), ACR aRR 0.94 (0.92-0.96), BP aRR 0.98 (0.97-0.99), HbA1c aRR 0.99 (0.98-0.99) and serum cholesterol aRR 0.97 (0.96-0.98) measured; achieve BP aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors aRR 0.92 (0.90-0.94) or statins aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements aRR 0.98 (0.96-0.99); achieve BP aRR 0.91 (0.8-0.95) or HbA1c aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97). CONCLUSIONS: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.