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. 2015 Feb 23;10(2):e0116689.
doi: 10.1371/journal.pone.0116689. eCollection 2015.

Inequality in diabetes-related hospital admissions in England by socioeconomic deprivation and ethnicity: facility-based cross-sectional analysis

Yoshitaka Nishino  1 , Stuart Gilmour  1 , Kenji Shibuya  1
Affiliations

Inequality in diabetes-related hospital admissions in England by socioeconomic deprivation and ethnicity: facility-based cross-sectional analysis

Yoshitaka Nishino et al. PLoS One. .

Abstract

Objective: To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England.

Design: Facility-based cross-sectional analysis.

Setting: National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010-2011 (355 facilities).

Participants: Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions.

Main outcome measures: The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders.

Results: There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0-1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02-2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51-2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80-0.94).

Conclusions: More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better interventions in poorer areas, are needed to reduce these inequalities.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Data exclusion flowchart.
Fig 2
Fig 2. IMD quintile-specific directly standardized admission rate due to diabetes.
Fig 3
Fig 3. Sensitivity of relative risk of admission to IMD quintiles by ethnicity.
Fig 4
Fig 4. Sensitivity of relative risk of readmission to IMD by ethnicity.
See this image and copyright information in PMC

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Grants and funding

This study was in part supported by a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare, Japan (Grant No. H24-25-007) (http://www.mhlw.go.jp/english/policy/other/research-projects/index.html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.
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