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Estimating diabetes prevalence by small area in England
1Department of Geography, Queen Mary University of London, Mile End Road, London E1 4NS, UK. p.congdon@qmul.ac.uk
Journal of Public Health (Oxford, England)
|January 27, 2006
Summary
Diabetes prevalence varies geographically due to deprivation and ethnicity. Current health performance indicators for diabetes may not accurately reflect care quality as they are influenced by prevalence rates.
Area of Science:
- Epidemiology
- Public Health
- Health Services Research
Background:
- Diabetes prevalence is influenced by socioeconomic deprivation and ethnicity, leading to significant geographic variations.
- Geographic disparities in diabetes prevalence may confound the interpretation of health performance indicators, which are often based on age-standardized hospitalization rates.
- A positive correlation between prevalence and health outcomes suggests that performance indicators may not solely reflect the quality of care.
Purpose of the Study:
- To estimate diabetes prevalence at small-area levels across England.
- To investigate the relationship between estimated diabetes prevalence and geographic variations in health performance indicators.
- To assess whether current performance indicators for diabetes adequately account for underlying prevalence differences.
Main Methods:
- Regression analysis of Health Survey for England (HSE) data on age, sex, and ethnicity to estimate prevalence.
- Integration of census data and a Bayesian approach to refine small-area prevalence estimates.
- Adjustment for social factors using a deprivation gradient and incorporation of historical prevalence data.
Main Results:
- Estimated 1.5 million people with diabetes in England (188,000 type 1, 1.341 million type 2).
- Prevalence varied from 2.4% to 4% across Strategic Health Authorities.
- Rates of diabetic ketoacidosis and coma positively correlated with prevalence, but amputation rates did not.
Conclusions:
- The developed methodology can estimate small-area prevalence for chronic diseases using demographic survey data.
- Current diabetes performance indicators may require adjustment to account for variations in disease prevalence.
- This approach is valuable for understanding geographic health inequalities and improving performance measure accuracy.
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